Erectile Dysfunction (ED)

If you’re suffering with erectile dysfunction, you might feel like the only man in the world with this anxiety inducing problem. But that’s far from the truth: statistics state that about 5% of men over 40 years old have total erectile dysfunction, and when it comes to men over 70 the figure rises to 15% . This is an all too common with many causes, and as an anabolic steroid user you could be at higher risk of experiencing ED at a much younger age.

Out of all the possible side effects we can experience when using anabolic steroids, there’s one that strikes fear into the heart’s of all men: erectile dysfunction. And while anabolic steroids might not always kill your sex drive or libido, they can greatly affect your physical performance in the bedroom.

This is partly due to the suppression of natural testosterone and other sex hormones in the body that anabolic steroids cause, bringing about a reduction or complete halt to the functioning of the testicles, including sperm production. This condition is known as hypogonadism.

As we will see though, the underlying causes of ED can vary and this condition is often an indication of more serious health issues that may or may not relate to steroid use at all.

Experiencing erectile dysfunction is not only physically frustrating, but can quickly lead to anxiety, depression and relationship problems. Thankfully, it’s now easier than ever to treat ED and you have a range of options at your disposal which can be decided on with your doctor.

My ED treatment guide has been broken down into the following sections:

What is Impotence (Erectile Dysfunction)?

Erectile dysfunction is diagnosed as a disorder when a man experiences difficulty or complete inability to obtain or keep an erection, with a three month period being the general medical basis for diagnosing the condition. It is most common in men over 40 years old, but can affect men of any age, especially those with certain risk factors relating to health and lifestyle.

Causes of ED

ED can be caused by either physical or psychological factors – or sometimes both. Erectile function is a complex process that involves many parts of the body including the brain, so when something becomes unbalanced it can lead to partial or complete impotence.

Sometimes, an unknown underlying health problem can be the cause of ED, but there are many reasons why you might start experiencing this very distressing problem. These include:

Mental stress

When you’re dealing with excessive life stress, whether it be work related, relationships, financial or anything else this will have a negative effect on the brain. The brain is a critical part of erectile function, therefore ongoing stress is a common cause of erectile dysfunction.

Cardiovascular

Heart disease, atherosclerosis, high blood pressure and high cholesterol are all risk factors for a man to get erectile dysfunction. Vascular related diseases or disorders can affect how much blood can get to the penis and how long it can stay there, which has a direct impact on erection quality. Some anabolic steroids pose a risk to increasing blood pressure, cholesterol or both. In these cases it is critical to monitor your levels regularly not only to help avoid ED, but for your general health.

Diabetes

Men with diabetes often have decreased levels of testosterone, but that is not the main driver of ED in diabetic men. People with this disease can have abnormal blood supply to the penis, resulting in an inability to gain or keep an erection. When blood sugar levels are not managed correctly by a male diabetic it results in less production of nitric oxide, contributing further to erectile dysfunction.

Obesity

Being very overweight brings with it a host of health problems, so ED can be either a direct or indirect consequence of obesity. Obese men are more likely to have diabetes, high blood pressure and other conditions which are known to cause erectile dysfunction. Being obese can cause blood vessels to become damaged, testosterone to lower, and the body to succumb to increased inflammation – all things which are linked to impotence.

Depression and anxiety

Normal functioning of the penis is as much psychological as it is physical, and men who are suffering from even mild to moderate depression, anxiety or stress can find themselves experiencing erectile dysfunction. Counselling and other psychological therapy can often assist with relieving ED that’s caused solely by anxiety and other mental health related conditions.

Drugs and medications

Many over the counter, prescription and recreational or illicit drugs are known to potentially cause ED. Many medications have side effects that can affect blood circulation, hormone function, the nervous system or mental health; all potentially leading to erectile difficulties. The list of drugs that could contribute to ED is extensive, but includes many blood pressure medications, diuretics, anti-anxiety and anti-depression medications, antihistamines, NSAID’s, and cancer treatment drugs.

Sleeping disorders

Problems with sleep quality can impact all parts of your life, including sexual function. Besides chronic tiredness from lack of sleep, sleep disorders like sleep apnea can negatively impact your testosterone levels and even your oxygen levels. Studies have shown that men with obstructive sleep apnea have a high tendency to report suffering from ED and males with this sleep condition are more likely to suffer from ED than men without sleep apnea.

Anabolic steroids

These can work in several ways to hamper erectile function. We know that some anabolic steroids can cause high blood pressure and high cholesterol, and those two factors can bring about ED, especially in men who might have already had cholesterol or hypertension but wasn’t aware of it.

Depending on the cause of your ED, there are steps every man can take to at least reduce the risk or severity of erectile dysfunction provided there’s not a serious health issue as the cause. Quitting smoking, getting regular exercise and living a healthy lifestyle all reduce the risk of ED, as does limiting alcohol intake and reducing stress. Keeping your blood pressure, blood sugar and cholesterol levels at a healthy level is perhaps the most critical part of avoiding ED for bodybuilders, as these are aspects which can be negatively affected by a number of the most popular steroids used.

Symptoms of ED

The most obvious symptom of ED is of course the inability to get an erection. This can include not being able to get an erection at all, or not being able to sustain an erection for long enough.

A decrease in sexual desire is another recognized symptom of impotence. While any of these symptoms are not a cause of concern if they only happen every now and then, it’s when you are experiencing a persistent inability to get or keep an erection that ED becomes a medical concern. Medical professionals consider three months of erectile difficulty as a suitable time period to consider this to be diagnosed as a medical condition.

Some men with ED find that it happened literally overnight, while for others it can be a much more gradual process, with increased erection difficulty being noticed over time until it finally gets to a point where can no longer get an erection at all. When ED is being cause mostly for psychological reasons, such as stress or performance anxiety, you might find it comes and goes and may get better on its own.

It’s important to be aware that ED symptoms can be different depending on what’s causing the problem. Chronic impotence – when it usually begins to happen gradually and gets worse over time without ever getting better – is almost always a sign that there’s a physical underlying cause such as diabetes or cardiovascular conditions. Psychological related ED tends to be more sporadic, with periods of normal functioning combined with other times where you struggle to get an erection. In some men, it’s a combination of both and only your doctor can give you a proper diagnosis of the real cause of your erectile dysfunction.

When should you speak to your doctor about your ED concerns? This is a potentially embarrassing situation for men, but keep in mind that millions of men have spoken to a doctor about this very issue, and doctors will professionally evaluate your unique situation and medical history. If your ED is causing anxiety and bringing stress to your relationship, a visit to the doctor and discussion of treatment options is the best way to get on top of the problem as soon as possible.

Erectile Dysfunction Treatments

Phosphodiesterase Type 5 (PDE5) Inhibitors

These drugs are a standard medical treatment for erectile dysfunction and include the famous drug Viagra, amongst others. PDE5 drugs causes dilatation of the blood vessels in the penis. They work by blocking the phosphodiesterase type 5 enzyme.

These drugs increase nitric oxide which brings about relaxation to the penis muscles so that blood is able to flow through the penis better and increase the chances of an erection being achieved.

Sexual stimulation is still needed when you use one of these medications. This is when the release of nitric oxide occurs. In healthy men, this results in an erection, but those needing a PDE5 inhibitor for ED will then rely on the drug to stimulate the release of nitric oxide after stimulation, so that blood can then flow to the penis and an erection can occur.

While they are now very well established, widely used and considered safe for the vast majority of men who are prescribed them, like most medications PDE5 inhibitors come with their potential side effects which you can find out more about below.

Androgens

Natural androgens produced in the body are responsible for all the characteristics that make a male a man. These are male sex hormones, including testosterone, that develop male traits as well as in reproduction. Androgen therapy for ED is essentially hormone replacement therapy with the focus on testosterone.

This treatment option is mostly considered for men who are suffering with low libido, depressed mood and other factors that are caused by low testosterone. However there is no hard evidence that this therapy alone can effectively cure erectile dysfunction in men that isn’t being caused specifically by low testosterone.

When androgens are used to treat erectile dysfunction caused by low testosterone, these drugs can come in different forms including oral medication, gels, injectable and even transdermal application.

Some men take a combination of testosterone and PDE5 inhibitors as it is possible that this combo gives some men better results, although studies are still going on to determine if this is in fact the case and whether there is a higher risk of side effects when combining the two.

Penile Injections (Prostaglandins)

This is a treatment option that most men are likely to be very hesitant to consider, for good reason. Penile injections are a daunting thought, but it’s worth looking into what this particular treatment is beneficial for. By injecting a vasodilator like a prostaglandin directly into the penis, a doctor is able to very quickly determine whether the blood vessels are functional and able to dilate. This in fact makes this method a very good diagnostic tool as well as a treatment.

Within just five minutes of the injection being given, a doctor can determine whether the blood vessels are functioning correctly because an erection will occur if they are. The injection is given straight into the corpora cavernosa.

Some studies have found that prostaglandin E1 (PGE1) injections are the most effective non-surgical treatment for ED in men aged 65 and over.

Men who undertake this type of therapy for ED can be taught by their doctor how to self-inject the formula into the penis. Because the erection develops so quickly after injecting PGE1, this is the only option for men who want to make practical use of the treatment in their sex lives – for some men though the prospect of regularly injecting into the penis is not something they wish to consider, and if you’re one of those men then you’re likely to look into other treatment options such as oral medications.

PDE5 Inhibitors

There are four commonly prescribed PDE5 inhibitor drugs, with Viagra no doubt being the most familiar. Here is the full list:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
  • Avanafil (Stendra)

All work in a similar core way to enhance nitric oxide so that blood flow to the penis is increased. Nitric oxide is critical in the process of causing the penile muscle to relax so that blood can flow and an erection can be both gained and maintained. Various health conditions (diabetes, high blood pressure) can cause natural nitric oxide function in the body to become impaired, which is then known to result in potential erectile dysfunction.

Nitric oxide, which is normally released from the penis’ nerve endings, allows the blood vessels to dilate so there is increased blood flow in the penis which then of course results in an erection. PDE5 inhibitors have been developed to simulate this natural action in men who struggle to gain or maintain an erection because of inadequate nitric oxide functionality.

The main differences to look for with these drugs is their active life or half life (how long they provide the desired effects for), and the different side effects for each one. All four are established medicines, but as you will see we have one relatively newer option that comes with some benefits over the older drugs.

It is important to point out that, contrary to what is often thought by the general public about these drugs, they are not aphrodisiacs. They don’t cause arousal in men but instead stimulate only the physical aspects of gaining an erection, not the psychological.

Let’s look at the four PDE5 inhibitors below. All of these medications are long proven to effectively treat erectile dysfunction and are considered safe for men who are not taking nitrate drugs, do not have heart disease and do not have hypotension (very low blood pressure).

Different ED drugs should never be combined, alcohol should be kept to a minimum, and your doctor should know of any other medications you’re taking because PDE5 inhibitors interact with a wide range of other drugs.

Sildenafil (active ingredient in Viagra)

Sildenafil Structure
Sildenafil Structure

The most famous of all ED drugs is Viagra. It is absorbed very quickly into the bloodstream and takes just one hour to reach its maximum level of concentration in the blood; meaning that Viagra starts working rapidly.

The duration of the effects of Viagra will depend on your dosage, but it’s possible that the drug’s effects are active for over five hours in some people. This allows a relatively wide period of time when you can take the drug and have it be effective; in other words, it can be taken anywhere from one to several hours before you plan to have sex with noticeable effects beginning between half an hour and one hour after taking a dose.

The majority of Viagra users experience no to only mild side effects and due to the drug’s short half life, side effects also disappear within three to five hours as the drug exits the body.

Tadalafil (active ingredient in Cialis)

Tadalafil Structure
Tadalafil Structure

Cialis has the longest acting effects of all four PDE5 inhibitors at up to 36 hours from a single dose. It also starts working faster than Viagra in most men with effects beginning in as little as 15 minutes after a dose, and before 45 minutes for most people.

Side effects of Cialis are very similar to the other drugs in this category, although one unique downside is the risk of pain in the limbs and this side effect is not known to occur with the other three medications.

Selecting Cialis over Viagra usually comes down to preference for the length of time you wish to enjoy the effects without resorting to multiple doses as would be required with Viagra. Besides ED, Cialis is also used to treat benign prostatic hyperplasia and pulmonary arterial hypertension.

Vardenafil (active ingredient in Levitra)

Vardenafil Structure
Vardenafil Structure

Levitra has an active life slightly longer than Viagra but still much shorter than Cialis, at anywhere from four to eight hours for most men and noticeable effects should begin within an hour of taking your dose.

Levitra is considered to be much stronger than Viagra and as such is normally taken at lower doses with tablets as low as 2.5mg available for men who might be struggling with side effects.

Avanafil (active ingredient in Stendra)

Avanafil Structure
Avanafil Structure

Stendra is the newest PDE5 inhibitor. This drug is preferred by many men mostly because of its more selective targeting action which minimizes side effects compared to the three other medications. Studies show less than 14% of users experience mild side effects from Stendra.

While similar side effects are possible, like headaches and facial redness, the risk is lower and chances of more serious side effects like visual disturbance are significantly lower in this newer drug. Avanafil can start working as quickly as fifteen minutes after taking a dose with the concentration reaching its peak within 30 to 45 minutes, and the drug’s effects can last for longer than 6 hours.

Viagra vs Cialis vs Levitra vs Stendra

We know what Viagra, Cialis, Levitra, and Stendra have in common. They are all:

  • Oral medications used to treat erectile dysfunction
  • PDE5 Inhibitors
  • Enhancers of nitric oxide so the penis muscles relax and allow more blood flow

Despite the fact they are all PDE5 inhibitors, there are still some subtle differences between these four widely prescribed ED medications. Each drug comes with its own pros and cons, and aspects that differentiate it slightly from the others. For example:

  • Cialis is available as a small 2.5mg dose so can be safely taken daily if desired
  • Cialis is also effective for treating enlarged prostate
  • While both Levitra and Viagra last about 4 hours, Viagra usually starts working a little faster than Levitra
  • Levitra users report less of the most common side effects compared to Viagra and muscle aches are not reported with Levitra. Visual changes are only a very rare side effect of Levitra compared with Viagra.
  • Stendra has the benefit that you can use it at very short notice and have it start working fast: as little as 15 minutes.
  • Stendra has much less risk of common side effects compared with Viagra with only the potential for a sore through being the only adverse effect that some Stendra users might feel which is not the case with Viagra.
  • The three older PDE5 inhibitors are now available as generic versions, bringing their costs down. These alternative options will ensure that the three older drugs remain cheaper than Avanafil for some time to come.

Your doctor is best prepared to help you choose the right one for your personal needs, but it’s wise to have a good idea of what separates each of these four drugs from each other. Even though they are similar in their actions, some men find that one drug or another causes side effects while another one might not – therefore it’s positive that we have four different options to try.

PDE5 Inhibitors Side Effects

Not everyone will experience side effects when using a phosphodiesterase type 5 (PDE5) inhibitor medication, but it’s wise to be aware of the potential negative effects that you could notice after you start taking one of these drugs to treat ED.

As I’ve covered above, out of these four drugs Stendra comes with the least risk of side effects of any kind, and less risk of some of the more serious side effects. While that is not a sole reason to select that drug over the others, many men will take this into consideration as will your doctor.

The main reported side effects of any of these medications can include:

Facial flushing

Facial redness or hot flushes is another of the most common side effects. This should subside quickly in most men. This reaction is a result of these drugs encouraging blood vessel dilation in the penis, which might also occur in other parts of the body like face and neck.

Nasal congestion

Extra dilation of the sinus blood vessels can also bring about nasal congestion or stuffiness soon after taking your dosage. This is another effect which usually passes by very quickly.

Headaches

This is considered the most common side effect of most PDE5 inhibitors like Viagra. Studies have shown that up to 25% of men who take Viagra will experience headaches, which are mostly mild and short lived. However a smaller percentage of men might experience more painful headaches or migraines. These cluster headaches have not shown to be an issue with other PDE5 inhibitors like vardenafil and tadalafil.

Men who use Viagra and suffer with cluster headaches have seen improvements when either changing the drug to anther PDE5 inhibitor or lowering the dosage of Viagra and combining it with the non-steroidal anti-inflammatory medication Naproxen for pain relief.

Visual changes

A long known side effect, with more recent research indicating this problem could be much worse than originally thought. A urology physician notes that far more serious effects on the eyes are a risk factor for some people taking this drug, most notably the potential to develop a rare disease of the eyes called non-arteritic anterior ischemic optic neuropathy (NAION), with the FDA even changing labelling to list this as a potential side effect of PDE5 inhibitors. Out of the four PDE5 inhibitors, Avanafil has shown to produce much lower risk of this worrying adverse effect compared with the other three.

Back pain

Those taking Cialis might report back pain and other muscular aches within 12 to 24 hours of taking a dose. For most men these symptoms will disappear on their own. Back pain is a known side effect particularly with Tadalafil. Studies have shown an almost 100% success rate in preventing back pain with this drug when it’s combined with two other medications.

Dizziness

Another effect of a sudden drop in blood pressure after taking one of these drugs is dizziness or light headedness. Therefore you should never drive after taking one of these medications.

Sleep problems

Insomnia is a potential side effect of Viagra. Additionally, a study from 2006 suggested that even a single dose of Viagra can make obstructive sleep apnea worse for men who are already suffering with the condition.

Another study found that men with both severe obstructive sleep apnea and cardiovascular disease are high risk users of Viagra because the drug showed both a worsening of sleep apnea and an immediate negative effect on heart rate. As Viagra is the most studied of all PDE5 inhibitors, this side effect may or may not be restricted only to this drug.

Sore throat

This is a side effect mainly seen with Stendra. While this newer PDE5 inhibitor has less side effects overall compared with the others, this effect is unique to this drug; however it is considered a mild side effect that subsides quickly.

Stomach upset

Diarrhea and other gastrointestinal conditions are possible with any of these medications, however it should be kept in mind that this is a potential side effect of almost any medication and is mostly dependent on your individual reaction to the drug. If one PDE5 inhibitor has a bad effect on your digestive system, your doctor can prescribe a different one or lower the dosage.

Decreased blood pressure

A drop in blood pressure occurs usually within a short time of taking the medication. For example, with Viagra the blood pressure decrease happens within only the first couple of hours of taking the drug. This makes it important to factor in any existing low blood pressure issues and discuss it with your doctor before starting to use one of these drugs.

Sudden hearing loss

Another rare side effect that required a a change of labelling directed by the FDA in 2007 relating to a small number of PDE5 inhibitors experiencing sudden but temporary deafness. The results of an in depth scientific study on this issue led researchers to conclude that one person in every 5000 new users of a PDE5 inhibitor develops sudden hearing loss.

Another study on one man found that he developed sudden hearing loss and tinnitus. It’s still not certain whether PDE5 inhibitors are the direct cause of this effect, or whether it’s also due to an underlying health condition or use of other medications.

Abnormally long erections

Men who experience an erection lasting for more than four hours should consider going to the emergency department as this is not only a painful problem, but one that can cause permanent damage to the penis.

Anabolic Steroids and ED

Studies show that the longer and more frequently that anabolic steroids are used, the higher the chance of a man experiencing ED. But importantly, the study also found that men who make use of anti-estrogen drugs were able to more successful maintain normal erectile function after using anabolic steroids, indicating the critical important of post cycle therapy.

Why are steroids and Viagra taken together?

There are two reasons that men will choose to take Viagra while using anabolic steroids: one is to take advantage of the way this drug dilates the arteries for improved blood flow which is not only beneficial for performance enhancement, but can also get the steroids moving through the body more efficiently.

The second reason for Viagra being used with steroids is to treat potential erectile dysfunction as a side effects of the steroids, which is of course the main purpose of Viagra.

Is it safe to take steroids and Viagra together?

So far there is no evidence that shows it is unsafe to take Viagra and steroids together at sensible doses, including those prescribed by your doctor. The possible health risks come about when very high doses of either are used. There are however two areas where the combination of steroids and Viagra can cause problems: with sleep quality (insomnia) and blood pressure.

Common Q&A Related to ED

Do anabolic steroids cause erectile dysfunction?

Yes and no. Using some anabolic steroids can give you a higher risk of ED, but many steroid users will make use of a testosterone source during a steroid cycle as well and this has shown in studies to reduce the occurrence of erectile dysfunction, however if testosterone is stopped then ED and other problems like decreased libido are more likely.

Does taking testosterone help with erectile dysfunction?

When using anabolic steroids, taking an exogenous testosterone ester can help to prevent ED. But for men who do not use steroids and are suffering from erectile dysfunction for any other reason, testosterone is very unlikely to help with the problem when the man has normal testosterone levels, or even those who have low T but have no other symptoms like low libido and fatigue.

Can you take Viagra with testosterone?

There is no known benefit for combining these two for men with low testosterone levels, when it comes to treating ED. But when it comes to steroid users who might be using testosterone in a cycle, there is no known danger in using Viagra as well and this is sometimes done to reverse the ED side effects of some steroids.

Does Viagra raise testosterone?

Viagra and other PDE-5 inhibitor drugs have not been formulated to affect testosterone, but instead to encourage blood supply and muscle relaxation in the penis. However studies have shown that an unexpected effect of Viagra when taken by men with both ED and low testosterone is that it resulted in an increase in serum total and free testosterone, with researchers being confident that Viagra has a direct effect on the testicles which can benefit men with existing low testosterone.

Can Viagra kill you?

Most of the side effects from Viagra are mild, like headaches and facial flushing. But we know for a small percentage of men, the adverse effects can be much more serious. In the first nine years of Viagra’s existence starting in 1998, a study found that over 1800 men who were using the drug died, with most of them being heart attacks. The main culprit is believed to be when men with existing heart problems combined Viagra with angina medications called nitroglycerin, their blood pressure dropped to dangerous levels. Now doctors never prescribe Viagra to men who are taking nitrate medications for angina.

Does Winstrol cause erectile dysfunction?

A possible side effect of Winstrol (Stanozolol) is actually the opposite to ED: some men can experience prolonged or frequent erections.

What can I take over the counter for erectile dysfunction?

If you’re embarrassed about seeing a doctor about your ED you might have thought about trying any available over the counter (OTC) treatment options. Potential options include the natural hormone Dehydroepiandrosterone (DHEA), the amino acid L-arginine, and herbs like yohimbine and ginseng. There is no scientific proof that any of these natural ED treatments are effective, especially in men who have serious underlying causes of ED like diabetes and high blood pressure.

What’s better: Viagra or Cialis?

The better drug is the one that works for you. Both are PDE5 inhibitors but one of the major differences is the length of time each one is effective: Viagra lasts for up to 5 hours while the effects of Cialis last much longer: up to 36 hours. Another consideration is that Viagra works best when taken on an empty stomach, while Cialis is not affected by food. When it comes to treating ED, both drugs have shown to have a very similar rate of successful results. Many men prefer neither of these two drugs and instead choose to use Stendra which comes with a lower chance of side effects.

Does aging cause erectile dysfunction?

Even though men will see their levels of serum testosterone decrease as they age, this is rarely low enough to cause ED. The cause of impotence is usually related to other problems.

Updated on by Juice

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