Cialis daily vs on demand

cialis daily vs on demand

Cialis vs Cialis Daily: What’s the Difference?
Wouldn’t it be great if you didn’t have to take your ED med just before sex?
Cialis® Daily (tadalafil) is the only erectile dysfunction (ED) medication that’s intended to be taken once daily, every day, in order to prepare your body for intimacy at any time.
But it can be confusing understanding the differences in Cialis Daily dosage vs Cialis used on-demand. Let’s clear up the confusion.
Quick Facts About Cialis vs Cialis Daily.
Cialis (tadalafil) is a PDE5 inhibitor like Viagra (sildenafil). They work by the same mechanism in the body and are the two most popular ED medications by volume in the U.S. Cialis (tadalafil) comes in 5 mg, 10 mg, and 20 mg doses for on-demand use (just before sexual intimacy). Cialis (tadalafil) also comes in 2.5 mg and 5 mg doses to be taken once daily (Cialis Daily) without worrying about timing sexual activity. All doses of Cialis and generic tadalafil are available affordably and easily from Rex MD.
Which Cialis Dose is Best?
Cialis is the brand name for tadalafil, the third PDE5 inhibitor approved by the FDA after Viagra (sildenafil) and Levitra (vardenafil). All three are now available as generic drugs for cheaper than ever before, and they’re all effective for most men with ED.
Cialis is available in a wide variety of doses – and not all are to be used the same.
Cialis comes in 5 mg, 10 mg, and 20 mg doses for use directly before sexual intimacy. Eli Lilly reports that Cialis 20 mg has been shown to improve the ability of men with ED to have a single successful intercourse attempt for up to 36 hours after dosing. Cialis also comes in 2.5mg and 5mg doses to be taken once every day, essentially priming your system for sexual intimacy at any time. In these lower doses, it’s often called Cialis Daily.
Because of this, daily Cialis has become a popular option for men with ED who may have frequent sex or simply don’t want to worry about taking a medication before intimacy.
The FDA-approved Cialis prescribing label demonstrates these differences:
The History of Cialis.
Cialis was first approved for the treatment of ED in 2003, five years after Viagra’s landmark approval in 1998 as the first medication for ED, and about two months after Levitra (vardenafil).
Five years later, in 2008, the FDA approved Cialis for daily use in new dose forms: 2.5 mg and 5 mg. According to Eli Lilly, the drugmaker behind Cialis, once-daily Cialis may be “most appropriate for men with ED who anticipate more frequent sexual activity (e.g. twice weekly).”
Cialis obtained “blockbuster status” in 2005 when it reached $1 billion USD in worldwide sales, and then went on to generate $2 billion in one year globally a few years later.
How Much Does Daily Cialis Cost?
Cialis, Cialis Daily, and tadalafil in all four doses are available affordably through Rex MD. We carry all major FDA-approved ED meds at industry-beating prices.
With Rex MD, you can get daily Cialis for as low as $3/dose, and our system is set up for simplicity: medications prescribed through our online visit process (if approved), delivered discreetly with 2-day free shipping, and refilled each month with no hassle.
How Does Cialis Daily Work?
Cialis and Cialis Daily are both tadalafil, one of the most effective and popular PDE5 inhibitors. That’s right – all of the medications approved by the FDA for the treatment of ED are PDE5 inhibitors, which stands for phosphodiesterase-5.
PDE5 is an enzyme that breaks down cGMP in the body. What does cGMP do?
CGMP is a substance that’s central to getting a firm erection. It promotes increased blood flow in the penis, leading to more blood (as much as 7x normal!) and swelling. As spongy tissues in the penis fill with blood, the dorsal vein at the top of your penis is compressed, helping to keep blood trapped in the penis. The blood continues to flow in and can’t escape – an erection forms.
PDE5 is the enzyme that breaks down and removes cGMP. It’s a natural enzyme that helps bring erections back to normal after intimacy. It’s a little like the brakes on a car. By stopping PDE5 from doing its usual thing – acting as a brake system – an erection can happen more easily.
That’s how all of the popular and effective ED meds work today.
Cialis and Cialis daily both do this, but Cialis Daily uses a lower dose to keep PDE5 reduced in the body at all times, rather than on-demand as with Cialis or Viagra.
Is Cialis Daily or Cialis Better?
Whether Cialis or Cialis Daily will be better for you is a personal question. Some guys like taking a medication daily so they’re ready for action. Others might prefer taking Cialis when they need it. And, Cialis is already known for how well it works over the course of a day or two compared to Viagra’s effects, which last only a few hours. (That’s why Cialis is often called the weekend pill – its effects can last 36 hours or longer.)
Curious if ED meds are right for you? Rex MD makes getting ED meds easier than ever, with online ordering and discreet, 2-day shipping if approved.

What happens if you take 2 cialis

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Cialis Dosage Guide.
Cialis is a popular and effective treatment for erectile dysfunction that contains tadalafil. When taken at least 30 minutes before sex, it helps you achieve and keep a strong erection so you can have a normal, healthy sex life.
But Cialis comes in a variety of different dosages. Smaller dosages of Cialis oral tablets, 2.5mg and 5mg, are perfect for daily use. If you have sex on a regular basis, then Cialis daily is a good option for you. Larger dosages of Cialis, on the other hand, such as the 10mg and 20mg oral tablets, are better for those who have sex less frequently (fewer than 2 – 3 times per week).
To help you find the right dosage of Cialis for you, we’ve compiled this useful guide. It looks at the recommended dosage per person, how often you should take Cialis for best results, what happens if you take more than one tablet of Cialis, and more.
General dose information.
Cialis comes in four different dosages:
The smaller dosages of 2.5mg and 5mg are known as the Cialis Once Daily Tablet. These are prescribed to men who are looking to have spontaneous sex and do not wish to plan their intercourse. These tablets are taken once a day, every day.
The 10mg and 20mg dosages of Cialis, on the other hand, are known as “the weekend pill”. They last for 36 hours and are prescribed to men who have sex less regularly. Regular Cialis is not taken every day. Instead, it is taken as required allowing you to participate in sexual activity at any point during a 36-hour period, hence its nickname “the weekend pill”.
Each dosage of Cialis should be taken at least 30 minutes before sex, but it may take longer to take effect depending on the person.
If you need more information on this treatment and how it works, then read our ‘what is Cialis?’ guide.
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How to use Cialis and how often should it be taken?
The correct usage of Cialis depends on the type of Cialis you’re taking and the frequency with which you have sex.
The 2.5mg and 5mg dosage tablets of Cialis should be taken once daily at the same time each day, one tablet per day. Avoid skipping doses of Cialis, and never take more than one tablet per day, even if you have missed a day.
The 10mg and 20mg dosage tablets of Cialis should be taken as required, at least 30 minutes before sex. They can help to get a better erection for up to 36 hours, so you should not take more than one Cialis tablet in 36 hours. While Cialis can be taken with food, it should not be taken with excessive alcohol as this can make it less effective.
Your doctor may change your prescription depending on the severity of your erectile dysfunction.
Using Cialis with food.
Unlike Viagra or sildenafil, Cialis can be taken with or without food. It can be taken after a meal, or on an empty stomach.
Some studies suggest that you should not eat grapefruit or drink grapefruit juice while taking Cialis unless approved by your doctor. This is because this may increase the risk of Cialis’ side effects occurring. If you are unsure, always speak with your doctor first.
The recommended dosage of Cialis.
The recommended dosage of Cialis depends on how often you have sex, how serious your ED is, and the type of Cialis your doctor has prescribed you.
If you have sex regularly (at least twice a week), most doctors will start you on the 2.5mg dosage for Cialis Daily. If you have sex more often than this, or you find it is not as effective as you hoped, your doctor might increase your dosage to Cialis 5mg.
If you have sex less frequently than twice a week, your doctor will likely start you on 10mg for Cialis on demand. If the 10mg dosage of Cialis does not work as expected, your doctor might increase your dosage to 20mg instead.
It also depends on your lifestyle and the spontaneity at which you want to enjoy sexual activity. For instance, the Once Daily tablet will allow you to participate in sexual activity any time any day.
Rather than trying to gauge the dosage for yourself the best course of action is to speak to a qualified physician. The Independent Pharmacy provides a free consultation with a qualified UK GP before you buy Cialis from us.
Storing and handling Cialis.
Cialis should be stored at room temperature out of direct sunlight. This ensures that your Cialis stays effective at treating your erectile dysfunction. Always keep Cialis out of reach of children.
Cialis and Viagra dosages compared.
Cialis and Viagra are both effective treatments for impotence. However, each comes in different dosages and work in different ways.
Whereas Cialis comes in 4 doses, Viagra comes in the following 3 dosages:
The recommended dosage of Viagra is 50mg, at least one hour before sex. However, you can generally take Viagra anywhere between 30 minutes and four hours before sex. The effects of Viagra’s dosages last for around four hours, although this may vary depending on the user.
For more information on the difference between Viagra and Cialis, read our Cialis vs Viagra comparison guide here.
Viagra Tablets – Buy Online Viagra is available to buy online as 25mg, 50mg, or 100mg tablets. To get your prescription online today all you need to do is complete a free health consultation and your erectile dysfunction treatment can be delivered straight to you.
Cialis and alcohol.
While you can drink while taking any dosage of Cialis, it is not recommended. Drinking excessive amounts of alcohol can increase your heart rate and reduce your blood pressure. This can increase the risk of experiencing Cialis’ side effects, such as dizziness or headaches.
Drinking alcohol with any dosage of Cialis can also decrease its effectiveness, making it harder to achieve an erection.
What happens if you take more than one Cialis tablet?
You should never take more than one Cialis tablet at a time. The maximum recommended dose for 2.5mg and 5mg Cialis tablets is once per 24 hours, and once per 36 hours for 10mg and 20mg Cialis tablets.
If you exceed the maximum recommended dose of Cialis, you put yourself at serious risk. It is more likely you will experience the more severe side effects of Cialis. As a result, you will require immediate medical attention.
Visit this page for more information on Cialis side effects.
How to take Cialis for best results.
To get the best results from your Cialis dosage of 10mg and 20mg tablets, it is recommended that you give it enough time to take effect. As results of Cialis are not instant, you should take it no less than 30 minutes before sex, or even longer if possible.
That said, you should also expect to take it slow. Don’t rush yourself into sex — let yourself become naturally aroused and take time getting into the mood.
Another way to get the best results from your dosage of Cialis is by avoiding alcohol. Alcohol makes it more difficult to get an erection and increases the risk of side effects occurring.
Avoiding mixing any dosage of Cialis with nitrates, such as isosorbide mononitrate or GTN spray. These can cause a significant drop in blood pressure, which at best decreases the effectiveness of Cialis and at worst can cause serious health issues.
For more general advice on erectile dysfunction, read our ED advice guides here.
Summary.
Cialis comes in a range of four dosages, each of which is prescribed according to your unique situation and requirements.
If you need to get an erection at least twice a week, Cialis daily tablets of 2.5mg and 5mg are for you. If you have sex less regularly, then the higher dosages of 10mg and 20mg Cialis on demand are a better option.
The advice above should give you a good idea of what Cialis dosage is right for you. If you feel like Cialis is the right option for your ED treatment, The Independent Pharmacy sells both Cialis Once Daily tablets and Cialis 10mg and 20mg tablets.
Simply complete our free online consultation for our in-house UK doctors to approve. Once you’ve approved, we’ll dispatch your Cialis to you within the next few working days in plain packaging for your discretion.
Sources.

Can you take cialis 20 mg every day?

can you take cialis 20 mg every day?

Can You Take Cialis 20 mg Every Day? Exploring Daily Cialis Use

Introduction

Cialis (generic name: tadalafil) is a widely known medication prescribed for the treatment of erectile dysfunction (ED). It belongs to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors, which work by increasing blood flow to the penis during sexual stimulation, thus helping men achieve and sustain an erection. While Cialis is commonly used on an as-needed basis before sexual activity, some individuals may wonder if it’s safe and effective to take Cialis 20 mg every day for continuous ED management. In this comprehensive guide, we’ll explore the concept of daily Cialis use, its benefits, potential risks, and important considerations.

Understanding Cialis 20 mg

Cialis is available in various dosages, including 2.5 mg, 5 mg, 10 mg, and 20 mg tablets. The 20 mg dose is the highest strength available and is typically used for on-demand treatment of ED. When taken as needed, it can provide effective results for up to 36 hours, earning it the nickname “the weekend pill.”

Daily Cialis Use

While Cialis is commonly used as an as-needed medication, there is an alternative dosing regimen known as daily Cialis. Daily Cialis involves taking a lower dose of tadalafil (usually 2.5 mg or 5 mg) every day, regardless of sexual activity. This regimen is primarily intended for men with frequent or persistent ED who want a more spontaneous and continuous approach to managing their condition.

Benefits of Daily Cialis

  1. Continuous Efficacy: Daily Cialis ensures that a low level of tadalafil is consistently present in the bloodstream. This allows for more spontaneous and reliable responses to sexual stimulation, as there is no need to plan ahead for medication intake.
  2. Improved Sexual Confidence: Knowing that you have a consistent treatment plan in place can boost sexual confidence, reducing anxiety related to ED.
  3. Lower Dose: Daily Cialis uses a lower dose compared to the higher doses often required for as-needed use. This may result in fewer side effects for some individuals.
  4. Treatment for Benign Prostatic Hyperplasia (BPH): Daily Cialis is also approved for the treatment of benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate gland. The continuous presence of tadalafil may help alleviate BPH symptoms.
  5. Reduced Planning: Unlike the as-needed approach, where you have to time your medication before sexual activity, daily Cialis eliminates the need for planning.

Important Considerations

While daily Cialis has its advantages, there are important considerations to keep in mind:

  1. Consultation with a Healthcare Provider: Before starting daily Cialis, it’s crucial to consult with a qualified healthcare provider. They will assess your medical history, overall health, and specific ED symptoms to determine if daily use is appropriate for you.
  2. Dosage: Daily Cialis typically uses lower doses (2.5 mg or 5 mg) compared to the higher doses (10 mg or 20 mg) used for as-needed use. The appropriate dosage will be determined by your healthcare provider.
  3. Adherence: Daily Cialis must be taken consistently, even on days when you don’t anticipate sexual activity. Missing doses or inconsistent use may reduce its effectiveness.
  4. Side Effects: While lower doses may reduce the risk of side effects, it’s essential to be aware of potential side effects, such as headaches, indigestion, back pain, muscle aches, and facial flushing. These side effects are usually mild and temporary.
  5. Interactions: Inform your healthcare provider about all other medications you are taking, as Cialis can interact with certain drugs, especially those containing nitrates or alpha-blockers.
  6. Cost: Daily Cialis may be more expensive than the as-needed version, as it requires a daily supply of medication.

Is Daily Cialis Right for You?

Determining whether daily Cialis is suitable for you depends on your individual circumstances, including the severity of your ED, your overall health, and your lifestyle preferences. It’s essential to have an open and honest discussion with your healthcare provider, who can provide personalized guidance based on your specific needs.

Conclusion

Daily Cialis, when prescribed by a qualified healthcare provider, can be a viable and effective treatment option for men with persistent or frequent ED. It offers continuous efficacy, improved sexual confidence, and a more spontaneous approach to managing ED. However, it’s crucial to consult with a healthcare provider, adhere to the recommended dosage, and be aware of potential side effects and drug interactions. Whether you choose daily Cialis or the as-needed version, the goal is the same: to enhance your overall quality of life by addressing and managing erectile dysfunction effectively.

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Daily ed medication

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ED Medication: Which Pills Are the Most Effective?
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Erectile dysfunction (ED) is a treatable condition, and various medications can help, such as sildenafil and tadalafil. The pills that people find most effective will depend on their individual needs and lifestyles.
All ED pills are available via prescription only, so a person must first speak with a doctor or healthcare professional to discuss symptoms. Some companies offer telehealth consultations. The healthcare professional will then decide whether ED medication is appropriate.
Research from 2019 shows that phosphodiesterase type 5 (PDE5) inhibitors can effectively improve erectile function and the prognosis of people with cardiovascular disease.
These drugs impede the functioning of PDE5, an enzyme within the blood vessel walls that helps control blood flow.
Following arousal, the body releases enzymes that cause blood vessels in the smooth muscles to relax, allowing for more blood flow. PDE5 inhibitors block the degradation of these enzymes, increasing blood flow and resulting in an erection.
It is important to note that a person needs to be aroused for a PDE5 inhibitor to help with ED.
This article focuses on PDE5 inhibitors. It discusses what erectile dysfunction is and what may cause it and looks at the common PDE5 medications for ED in detail.
Below is a comparison table of these oral ED treatments.
Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra or Staxyn) Avanafil (Stendra or Spedra) Dosage options 25 mg, 50 mg, 100 mg 2.5 mg, 5 mg, 10 mg, 20 mg 2.5 mg, 5 mg, 10 mg, 20 mg 50 mg, 100 mg, 200 mg Typical dosage 50 mg 10 mg as needed or 2.5 mg per day 10 mg (5 mg for people 65 years or older) 100 mg When to take (onset) 30–60 minutes before sex 30 minutes before sex 60 minutes before sex 15 minutes before sex for 100 mg and 200 mg, 30 minutes before sex for 50 mg How long it lasts (duration) 4 hours up to 36 hours 4–5 hours 6 hours How to store around room temperature, from 68–77°F (20–25°C) at 77°F (25°C) at 77°F (25°C) around room temperature, from 68–77°F (20–25°C)
Erectile dysfunction occurs when a person cannot develop or maintain an erection firm enough for sexual intercourse.
According to a 2023 overview of the condition, ED is common in individuals over age 40.
ED can differ from one person to another. While some people can get an erection, they may not be able to maintain it, and they may not be able to get one every time they want to have sex. Others may not be able to get an erection at all.
According to a 2021 study , ED can be a short- or long-term complication of COVID-19.
ED may occur due to factors such as stress, anxiety, or alcohol consumption. However, someone who experiences ED regularly should talk with a doctor.
depression performance anxiety other sexual disorders aging heart problems high blood pressure diabetes metabolic syndrome neurological disorders, such as multiple sclerosis hormone changes traumatic injuries stroke sleep apnea chronic obstructive pulmonary disease glaucoma priapism prostatic hyperplasia medication side effects.
Below is detailed information about the PDE5 inhibitor drugs available.
Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.
Medical News Today follows a strict product selection and vetting process. Learn more.
Sildenafil (Viagra)
Sildenafil (Viagra) is common in the treatment of ED. It can also treat conditions such as pulmonary hypertension, a type of lung high blood pressure.
The pills come in 25 mg, 50 mg, or 100 mg.
Some healthcare professionals may prescribe Revatio (sildenafil), which comes in 20 mg. However, this drug is for the treatment of pulmonary hypertension, and healthcare professionals are more likely to prescribe Viagra or generic sildenafil.
Some advantages of taking sildenafil for ED include:
Fast-acting: It starts working around 30 minutes after taking the pill. Research: Clinical trials and studies confirm its effectiveness. Lasting effects: Up to 4 hours. Side effects: Serious side effects are rare, though they can include allergic reactions and heart problems.
Short-term use: According to clinical trials, sildenafil is effective for 12-16 weeks . Unsuitable for some health conditions: Sexual activity can present a risk for people with cardiovascular disease. Viagra’s prescribing information states that people with cardiovascular disease should take Viagra with caution. This also applies to people with aortic stenosis, idiopathic hypertrophic subaortic stenosis, or those with severely impaired autonomic blood pressure control. MedlinePlus states people with serious liver conditions, low blood pressure, multiple myeloma, or sickle cell anemia should speak with a doctor before taking Viagra. Drug interactions: It can interact with other drugs, including some heart disease and blood pressure medications. Preference: People seem to prefer an alternative drug called tadalafil, especially those with sustained morning erections, according to a 2022 study. However, both have similar effectiveness.
There are also some possible side effects of sildenafil, including:
a stuffy or runny nose hot flashes headaches a fever nausea chest pains painful erections lasting several hours dizziness vision problems indigestion.
Where to buy sildenafil (Viagra)
The following companies offer sildenafil:
Roman Lemonaid Blink Health Optum Perks BlueChew Hims REX MD Cost starting from $4 per dose starting at $2 per pill initial cost of $10 , then around $9.95 per month, excluding refills dependent on pharmacy starting from $20 per month starting from $4 per dose starting from $10 per dose Available dosage 20–100 mg, according to a doctor’s recommendation 20 mg; doctors may recommend taking multiple pills to create a 40 mg, 60 mg, 80 mg, or 100 mg dose 20 mg, 25 mg, 50 mg, 100 mg 20–100 mg, according to a doctor’s recommendation 30 and 45 mg 20–100 mg 25–100 mg.
Tadalafil (Cialis)
Tadalafil (Cialis) works by increasing blood flow to the penis. Doctors also use the drug to treat high blood pressure in the lungs and enlargement of the prostate. For ED, people take it as an oral tablet.
Some advantages of tadalafil include the following:
Longest lasting: It is the longest lasting PDE5 drug for ED, typically lasting up to 36 hours, though some reports suggest it can last up to 72 hours. Longer-term use: It is possible to take a low dose of 2.5–5 mg once per day for a longer-term solution. Daily use: People who regularly engage in sexual activities may prefer taking a daily pill. Increased confidence: Research suggests that people who take tadalafil experience more sexual confidence than those who do take sildenafil. Multipurpose use: Tadalafil has FDA approval to treat the symptoms of benign prostatic hyperplasia.
However, the disadvantages include the factors below:
Cost: Taking it every day can have a higher cost. Hidden underlying ED causes: Taking it long term may prevent or delay treatment for the underlying cause of ED, which may be psychological. Drug interactions: Tadalafil can interact with several types of medication, including common blood pressure drugs.
There are also possible side effects from tadalafil, including:
Where to buy tadalafil (Cialis)
Tadalafil is available to purchase from the following companies:
Roman Lemonaid Blink Health Optum Perks BlueChew Hims REX MD Cost starting from $8 per dose $65 per pill initial cost of $10 , then starting from $9.95 per month, excluding refills dependent on pharmacy starting from $20 per month starting from $40 per month starting from $10 per dose Available dosage 2.5, 5 mg, 10 mg, 20 mg 5 mg, 10 mg, 20 mg 2.5 mg, 5 mg, 10 mg, 20 mg 2.5, 5 mg, 10 mg, 20 mg 6 and 9 mg 2.5-20 mg 10-20 mg.
Avanafil (Stendra)
Avanafil (Stendra) is another PDE5 drug. It works similarly to other drugs in its class by increasing blood flow to the penis.
Fast-acting: Avanafil can start working 15 minutes after taking the drug. Safe: Research has found that avanafil is a safe and effective ED treatment. Longer lasting: Its effects can last up to 6 hours, according to research from 2014 . More effective: Recent research has found that avanafil is more effective than sildenafil at improving erectile function over a 12-week period.
However, a disadvantage of the drug is that it is currently unavailable in generic form, making it more expensive than other PDE5 drugs.
There are also some possible side effects of taking avanafil, including:
Where to buy avanafil (Stendra)
The following companies offer avanafil (Stendra).
Blink Health Optum Perks Hims Cost $414.33 for 6 200-mg tablets dependent on pharmacy starting from $53 per dose Available dosage 200 mg 50 mg, 100 mg, 200 mg 50 mg, 100 mg, 200 mg.
Vardenafil (Levitra)
Similar to other PDE5 medications for ED, vardenafil (Levitra) works by increasing blood flow to the penis.
Some advantages of vardenafil include clinical trials finding it to be effective. In addition, unlike avanafil, vardenafil is available in a more affordable, generic form.
Its disadvantages are that the drug can take comparatively longer to start working, and a person needs to take it 1 hour before sexual activity. In addition, compared with tadalafil and sildenafil, vardenafil has no unique advantages.
Some possible side effects of vardenafil include:
Vardenafil is unsuitable for people taking type 1A or type I3 anti-arrhythmic drugs, as they can cause minor QT prolongation.
Where to purchase vardenafil (Levitra)
Levitra and its generic version, vardenafil, are only available to purchase once a doctor has prescribed them.
Four 2.5-mg tablets cost between $29 and $178 at the time of publication, while thirty 20-mg tablets can cost up to $442 .
The following companies offer vardenafil (Levitra).
People can purchase ED medications with a valid doctor or healthcare professional prescription at a pharmacy.
Alternatively, they can purchase them online, usually after completing an online questionnaire reviewed by a doctor or healthcare team.
Individuals should check reviews of the health company before purchasing a product and consult a doctor or pharmacist if they have any concerns.
ED pills are only available with a prescription, and each dispensing pharmacy or telehealth service may charge different amounts.
However, purchasing ED pills can save money in several ways.
Using telehealth websites.
Telehealth websites, such as Hims, Roman, and Lemonaid, offer ED pill subscriptions for a lower price. These websites often offer medication starting at around $2 per pill.
Many of these websites offer free initial consultations with healthcare professionals or offer consultations at a lower price than many in-person health clinics.
While ED pills may be cheaper to purchase through telehealth websites, it is important to note that many do not accept insurance.
Pill splitting.
People can also ask a healthcare professional about pill splitting. This means that a doctor prescribes double the usual dose and a person then splits the pill in half, receiving twice the amount for a lower price.
Research from 2022 suggests that immediate-release medications, such as PDE5 inhibitors, are typically safe to split. However, it is important only to split pills if a healthcare professional has advised it is safe. While the FDA has approved pill splitting for some medications, other drugs may not always have the same weight or dose in each half.
Pill splitting also involves some storage considerations. Split tablets may be more affected by temperature, humidity, and moisture changes. It is important that a person only splits another pill once they have finished their current one.
Using manufacturer discount programs.
Some manufacturers may offer discounts and saving programs. This may benefit people who cannot take generic versions of the medication.
For example, Viagra offers a Viagra Saving Card. The company states that eligible customers can save up to 50% on up to 12 prescriptions of name-brand Viagra per year.
Manufacturer discount programs have terms and conditions. A person should carefully read through these to ensure the program suits their situation. For example, the Viagra Saving Card is not suitable for people who receive part or whole reimbursement from any federal or state healthcare program.
ED pills are safe and effective when someone takes them under a doctor’s supervision.
Results may vary between individuals, but a 2021 review of 23 studies found that 50 mg and 100 mg sildenafil pills were more effective than a placebo. However, there is insufficient data to compare the different PDE5 inhibitor pills.
ED pills are typically taken around 1 hour before sex. However, instructions may vary between medications.
Some pills require people to take them with food, and other pills on an empty stomach.
A person should always follow the instructions before taking any prescription medication.
While ED medications are often effective, some individuals may prefer to try other methods of ED treatment, including :
Diet, exercise, and healthy habits involve staying active, following a nutritious diet, and avoiding smoking. Psychotherapy: Dealing with underlying emotional or psychological issues may help ease ED. Vacuum devices: These devices use suction to bring blood into the penis to achieve an erection. Surgery: When all other treatments are ineffective, a doctor may recommend a surgical implant to help a person achieve or maintain their erections.
Some people may consider using ED rings. These devices use constriction to maintain an erection. A person puts this device around the base of their penis. An example of this is Eddie by Giddy. The product comes in different sizes, and the website provides full instructions. Learn more about the Eddie product.
Researchers are investigating alternative ED therapies like gene therapy and stem cell transplantation. However, these therapies are in the early stages of animal research, and studies on humans are necessary to determine the effectiveness of these remedies.
Individuals should keep regular contact with their doctor if they experience prolonged ED, as an underlying health condition may need exploration.
After taking ED pills, a person may experience side effects such as headaches, indigestion, dizziness, or a stuffy nose. These are common and usually subside over time.
However, a person should consult their doctor if these side effects become severe or persistent.
Although rare, ED medications can also cause more serious side effects, including:
chest pain vision problems hearing loss seizures skin reactions, including itchy, red, or swollen skin priapism, a painful erection lasting more than 4 hours.
If someone experiences any of these side effects, they should discontinue using the drug immediately and seek medical advice.
Symptoms, such as wheezing, tightness in the chest or throat, difficulty breathing, and swelling of the mouth, throat, lips, or tongue, may have links with anaphylaxis, a life threatening allergic reaction.
If a person notices any symptoms of anaphylaxis, they should call 911 or go to the nearest emergency room.
Some people should not take ED medications or should take them with caution. Some examples include:
Those avoiding sexual activity: Individuals with recommendations from a healthcare professional to avoid sexual activity due to health concerns should not take any ED drugs. Those consuming grapefruit or grapefruit juice: A person should not take PDE5 inhibitors with grapefruit or grapefruit juice because it may affect how the drugs work. Those with a history of adverse reactions: People who previously experienced sudden hearing loss or vision problems should not use the drugs. If someone new to ED drugs experiences these symptoms, they should discontinue use and seek immediate medical attention.
ED medications may also interact with other drugs, including:
nitrates certain blood pressure medications alpha-blockers guanylate cyclase stimulators certain antifungal medications and antibiotics.
Additionally, individuals taking HIV protease inhibitors, such as ritonavir (Norvir), should not take avanafil. The FDA advises that people with liver or kidney problems do not take avanafil.
Those who experience an erection lasting more than 4 hours should also consult their doctor.
Herbal supplements.
A person should be cautious when considering herbal supplements that claim to help with ED. This is because very little research proves their effectiveness, and the FDA has not approved these products.
Specifically, the FDA advises against buying “herbal Viagra” because it contains undeclared ingredients that may negatively interact with some prescription drugs.
Here are some common questions about ED and medications for the condition.
What causes ED?
ED can develop due to some emotional factors, like relationship issues, or mental health conditions, including stress, anxiety, or depression.
ED has many physical causes, such as heart disease, diabetes, reduced physical activity, and high blood pressure. Smoking tobacco, consuming high amounts of alcohol, and taking certain medications may also contribute to the condition.
How do you know whether ED is due to a physical or mental factor?
A doctor or healthcare professional can determine whether a person’s ED is due to physical or mental health factors by collecting information about their medical and sexual history. They may also conduct a physical exam.
Healthcare professionals may also recommend an overnight erection test, which involves placing a device around the penis to measure the number of nocturnal erections. If a person can achieve a set number of erections at night, it may indicate that their ED is due to psychological problems rather than physical conditions.
A person may also undergo an intracavernosal test. During this test, doctors inject a small amount of medication into the base of the penis to cause an erection. Imaging techniques, such as an ultrasound, can also help determine whether there are any problems with blood flow.
How much do pills for ED cost?
To get a pill for ED, a person needs a prescription from a doctor or an online telehealth service. Once the prescription is ready, the cost will depend on whether an individual’s insurance plan covers all or some of the costs.
Typically, generic versions of ED pills, such as sildenafil, cost significantly less than brand-name versions, such as Viagra.
How effective are ED medications?
Each medication mentioned in this article is effective at treating ED. However, according to research from 2022 , avanafil may be the fastest-working medication with the least visual side effects.
It is important to note that for any of these medications to work, a person requires sexual stimulation.
Which ED medication is best?
The type of ED medication a person should take depends on individual needs. Each medication type may have different side effects, dosage requirements, and times to work properly.
Individuals should consider these factors before trying these medications.
Which ED drug is safest?
All four of the main ED pills — sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) — are safe for most people to use. These drugs are FDA approved for use in ED. A person must ensure their medication is doctor prescribed and comes from a legitimate source.
Is it safe to combine ED treatments?
Health experts advise against combining ED medications unless a doctor advises otherwise.
If one medication for ED is not working, a person should consult their doctor to determine whether alternative treatment options may work better or if other underlying factors may contribute to ED.
What is the most popular ED pill?
The most commonly prescribed erectile dysfunction medications are sildenafil (Viagra) and tadalafil (Cialis).
Can you get ED medications over the counter?
Most ED medications require a prescription from a doctor. However, people can buy ED devices such as vacuums and rings online.
Several medications can treat ED, and many drugs — including those in this article — work by blocking the PDE5 enzyme, increasing blood flow to the penis.
The best choice of ED medication will depend on various factors. For example, people who regularly engage in sexual activities may prefer taking tadalafil, which is available as a daily pill. Meanwhile, others may prefer medications they can take just before having sex, such as sildenafil, avanafil , or vardenafil.
However, it is important for a person to consult a doctor before taking ED medication and only use it as directed to help prevent adverse side effects.
Last medically reviewed on August 3, 2023.

What increases free testosterone?

what increases free testosterone?, improving low testosterone naturally

Whole Health Library

The following information is a summary of materials featured in the Mens Health Whole Health overview. It is meant to be a quick reference for use at the point of care. For additional details and a list of helpful references, refer to the overview.

Hormones change as we go through the life cycle. What is normal for a 20-year-old is not the same normal as for a 60-year-old. Although low testosterone (“low T”) is a diagnosis being promoted by the makers of testosterone medications, it is not as simple as just prescribing hormone replacement. A low testosterone level can be due to many factors. A clinician must also take care not to add testosterone too quickly without exploring other therapies first, because once external testosterone is given, it inhibits the body’s natural production of testosterone. Testosterone supplementation is also not without risks, and in terms of long-term use, there is much about safety that we do not yet know.

Key Factors in Optimizing Male Hormones

Maintain Ideal Body Weight

This is probably the most important thing a man can do. As belly fat increases, there is an increase in activity of the enzyme “aromatase” which converts testosterone in the fat cells to estrogen. This reduces testosterone and increases estrogen, which can increase fat deposition in typical female areas (breast, hips, thighs) and increase the risk of enlargement of the prostate and even prostate cancer. With every one-point drop in your body mass index (BMI) your testosterone level will increase by approximately 1 point. In fact, management of obesity may prevent declining total testosterone in the aging male.

Avoid Developing Diabetes

Developing diabetes increases the risk of having a total testosterone level of less than what is considered normal. Over a 10-year period, the risk for developing abnormally low testosterone levels more than doubles in diabetic individuals.

Exercise

A combination of aerobic (increase in heart rate) and resistance (weightlifting) training has been found to increase the production of testosterone. This also helps prevent the most common diseases that men are most likely to die from, heart disease and cancer. Overtraining in endurance sports such as American football and weight-class wrestling and excessive exercise with calorie restriction can cause testosterone deficiency as well.

Sleep Well

Most of the bodys testosterone is made during deep sleep when a person is in Rapid Eye Movement (REM). A disrupted sleep cycle with less time spent in REM has been associated with low testosterone levels.

Avoid Tobacco Products

Avoid Excessive Alcohol

Alcohol (more than two drinks a day), increases the conversion of testosterone to estrogen.

Avoid Opioid Pain Medications

Morphine and other opiates decrease testosterone. This can go on for months to years while a person is being treated with opioid medications. Levels can drop as quickly as a few hours after starting opioids. It appears that the higher the dose of opioids, the greater the risk of low testosterone. Fortunately, this side effect should be reversible after stopping the pain medication. Of course, do not stop or change pain medication suddenly without consulting with the prescribing provider.

Avoid Xenobiotics

Xenobiotics are compounds from the environment that mimic the bodys hormones. Research has shown that the average testosterone level in men has gradually dropped over the years. This may be in part due to all the environmental toxins that have accumulated over the years. The main toxins that we know about thus far include the following:

  • Bisphenol A (BPA). BPA is found in plastics. To avoid it, don’t microwave food in plastic containers. Avoid plastic containers with the numbers 3, 6, or 7 engraved in the triangle on the product. Buy BPA-free water containers. Drinking water out of containers with the numbers 2, 4, 5, or 7 is OK. Do not drink out of Styrofoam containers.
  • Phthalates. These chemicals are used in plastics, coatings, lubricants, and binders. Many are found in hygiene products such as shampoos and colognes. A useful website on phthalate-free products is the Guide to Less Toxic Products.
  • Organophosphates. These are mainly found in pesticides and herbicides. Eat organic when possible to avoid exposure to them.

Avoid Excessive Stress

Cortisol levels in the blood are indicators of stress level. This steroid hormone can increase fat deposition, resulting in more conversion of testosterone to estrogen.

Eat Well

Poor nutrition is at the root of many diseases and can also create an imbalance of male hormones.

  • Foods to avoid:
    • Excessive sugar
    • Excessive caffeine
    • Red meat and other sources of animal fat
    • Excessive dairy products
    • Food dyes
    • Processed foods
    • Foods to include:
      • Green tea
      • Multicolored fruits and vegetables
      • Nuts (particularly Brazil nuts which are rich in selenium – two a day is plenty)
      • Fiber (covered by eating fruits and vegetables)
      • Ground flax seed (1 tablespoon a day)
      • Soy products (soy milk instead of cow’s milk)

      Consider dietary supplements

      Note: Please refer to the Passport to Whole Health, Chapter 15 on Dietary Supplements for more information about how to determine whether or not a specific supplement is appropriate for a given individual. Supplements are not regulated with the same degree of oversight as medications, and it is important that clinicians keep this in mind. Products vary greatly in terms of accuracy of labeling, presence of adulterants, and the legitimacy of claims made by the manufacturer.

      To maintain healthy testosterone levels, the changes discussed above will trump any supplement, but the nutrients below have been found to inhibit aromatase and may be additive benefits.

      • Zinc (if levels are low): 25-50 micrograms daily.
      • Quercetin: 400 micrograms daily.
      • Grape seed extract: 100-300 micrograms daily. You can get all these nutrients by eating nuts, fruits (grapes and citrus) and vegetables.
      • DHEA: 25-50 micrograms daily. It is an OTC supplement that is a precursor to testosterone found in the adrenal gland. It goes down when stress (cortisol) goes up. The best way to raise DHEA is to learn to see life in a less stressful way.

      Author(s)

      Low Testosterone was written by Robert Z. Edwards, MD (2014, updated 2020).

Causes of low testosterone

causes of low testosterone

What is the Main Cause of Low Testosterone?

Home » FAQs » What is the Main Cause of Low Testosterone?

Aging is o ne of the main causes of low testosterone in men . As men reach their 40s, their testosterone levels gradually drop by one or two percent each year, though some men may begin losing testosterone earlier in life.

Testosterone loss can also be a side effect of another underlying condition, such as obesity or chronic kidney disease, so you may want to get a physical exam to determine the root cause of your low testosterone (T) levels. Our facility offers multiple treatments to help men increase their T levels, which we can discuss in your first appointment.

Low Testosterone can Occur Because of Aging or an Underlying Condition

While getting older is generally the main cause of low testosterone in many men, low T levels can also be a symptom of other underlying conditions or comorbidities. According to the Asian Journal of Andrology , these conditions may include:

  • Obesity
  • Chronic kidney disease
  • Erectile dysfunction (ED) or other sexual dysfunctions
  • Alcoholism or other substance addictions
  • High blood pressure (hypertension)
  • High cholesterol (hyperlipidemia)
  • Chronic stress or other mental conditions, such as depression
  • Chronic obstructive pulmonary disease
  • Type 2 diabetes
  • Rheumatoid arthritis

Men who are experiencing low testosterone in their 20s or 30s may experience comorbidity, meaning they may have to address those health conditions in order to rebalance their hormone levels. However, in some cases, patients may only require testosterone treatment to address one negative symptom, such as erectile dysfunction.

Our facility makes sure to examine each patient fully. We perform a physical exam and conduct blood tests to gauge the extent of your physical health. That way, when we provide treatment, it addresses what your whole body needs, not just your symptoms.

Symptoms of Low Testosterone in Men

The following symptoms may indicate that you have low T levels:

  • Hair loss
  • Loss of libido or experiencing other sexual dysfunctions
  • Erectile dysfunction, or difficulty getting or maintaining an erection
  • Bone density loss
  • Muscle mass loss
  • Chronic fatigue
  • Mood changes, such as depression
  • Weight gain, including increased fat in the breast tissue

Low Testosterone in Women

Can women also experience low testosterone levels? Yes. Both men and women carry testosterone and estrogen in varying amounts, but both hormones play a crucial role in bodily functions in people.

Women have lower testosterone levels than men. However, if a woman’s T levels are too low, she may experience symptoms like:

  • Hair loss
  • Irregular menstruation (testosterone is produced in the ovaries)
  • Loss of bone density
  • Loss of sexual libido
  • Infertility

Women can undergo hormone replacement therapy (HRT) to help balance their hormone levels.

Our Facility Offers Treatments to Help Raise Testosterone Levels in Men

To treat low T levels, our facility offers testosterone replacement therapy (TRT), which transfers the hormone into the body to encourage natural testosterone production. This type of treatment is non-invasive, as it requires no surgeries. Instead, patients can receive testosterone via:

Before we begin any treatment, we will measure your testosterone levels to confirm whether you have low T levels or another condition.

Other Treatments We Offer

In some cases, a patient with low T levels might benefit from other treatments besides TRT. Our facility offers various anti-aging and regenerative therapies to help people suffering from erectile dysfunction, muscle and joint pain, hair loss, and other negative symptoms.

If you are interested in learning about our other treatment services, you can get a consultation at our office.

We Strive to Offer Our Patients the Medical Treatment They Need

At our facility, we strive to give our patients the medical care they need to improve their health. Our priority is to view each patient’s health as a whole rather than just treating their symptoms, and we hope to continue helping patients with their personal health tracts.

Read some of our Google reviews from our patients below to get an idea of how our facility operates:

  • Chris Squires wrote, “I had a great experience here. The staff is very accommodating and more than helpful. I am thoroughly impressed with the professionalism by Dr. Jason and the staff. They have earned a repeat client!”
  • Jonathan Peres wrote, “Excellent and thorough doctors. I feel I’m in great hands here!”

Call Now to Get an Appointment with Anti-Aging & Regenerative Associates

If you are suffering negative symptoms and suspect it may be because of low testosterone, come to Anti-Aging & Regenerative Associates for a physical exam and assessment. We can check how we may be able to help you and suggest treatments we offer to address your health needs.

Call today to schedule your appointment with one of our physicians.

Low testosterone in teenage male

low testosterone in teenage male

Male hypogonadism

Male hypogonadism is the result of deficiency of the male sex hormone testosterone. It can lead to loss of sex drive and function, delayed puberty, osteoporosis, and there can also be associated failure of the testes to produce sperm.

Alternative names for male hypogonadism

Testosterone deficiency syndrome; testosterone deficiency; primary hypogonadism; secondary hypogonadism; hypergonadotrophic hypogonadism; hypogonadotrophic hypogonadism

What is male hypogonadism?

Male hypogonadism describes a state of low levels of the male hormone testosterone in men. Testosterone is produced in the testes and it is important for the development of male characteristics such as deepening of the voice, growth of facial and pubic hair, and growth of the penis and testes during puberty. In the hypothalamus, kisspeptin causes the release of Gonadotrophin-releasing hormone, which in turn stimulates the pituitary gland to produce luteinising hormone and follicle stimulating hormone (gonadotrophins). The gonadotrophins then act on the testes causing them to produce testosterone. Low levels of testosterone can occur due to disease of the testes or from conditions affecting the hypothalamus or pituitary gland. Men can be affected at any age and present with different symptoms depending on the timing of the disease in relation to the start of puberty. In some cases, it can be difficult to tell if there is a true deficiency of testosterone, particularly when the levels are in the borderline range.

What causes male hypogonadism?

Male hypogonadism can be divided into two groups. Classical hypogonadism is where the low levels of testosterone are caused by an underlying specific medical condition, for example Klinefelter’s syndrome, Kallmann’s syndrome or a pituitary tumour. Late-onset hypogonadism is where the decline in testosterone levels is linked to general ageing and/or age-related diseases. Additionally, obesity and type 2 diabetes can be associated with hypogonadism in men.

There are two types of classical male hypogonadism – primary and secondary. Primary hypogonadism occurs when the low level of testosterone is due to conditions affecting the testes. Primary hypogonadism is also referred to as hypergonadotrophic hypogonadism, whereby the pituitary produces too much luteinising hormone (LH) and follicle stimulating hormone (FSH) (gonadotrophins) to try and stimulate the testes to produce more testosterone. However, as the testes are impaired or missing, they are not able to respond to the increased levels of gonadotrophins and little or no testosterone is produced. In some patients with primary hypogonadism, testosterone levels may be within the normal range, but the increased LH and FSH indicate that the pituitary gland is trying to compensate for a deficiency and treatment may still be needed.

Examples of conditions affecting the testes, which lead to primary gonadal failure, include:

  • inflammation due to infections such as mumps
  • chemotherapy or radiotherapy to the testes
  • failure of the testes to descend into the scrotum

Secondary hypogonadism occurs when signalling to the testis is unable to stimulate sufficient testosterone production and is caused by conditions affecting the function of the hypothalamus and/or pituitary gland. It is also known as hypogonadotrophic hypogonadism due to low levels of LH and FSH resulting in decreased testosterone production. Secondary hypogonadism often occurs as part of a wider syndrome of hypopituitarism. Examples of causes can include:

  • pituitary tumours and their treatment
  • isolated hypogonadotrophic hypogonadism (low levels of gonadotrophin-releasing hormone from birth)
  • Kallmann’s syndrome – a rare genetic condition, which causes loss of the development of nerve cells in the hypothalamus that produce gonadotrophin-releasing hormone. This results in failure to go through puberty, loss of sexual maturation and failure of the testes to develop. It is typically associated with loss of sense of smell.
  • use of anabolic steroids
  • Prader-Willi syndrome
  • head injury.

What are the signs and symptoms of male hypogonadism?

The signs and symptoms depend on the stage at which the patient presents with hypogonadism in relation to sexual maturity. If testosterone deficiency occurs before or during puberty, signs and symptoms are likely to include:

  • Delayed puberty:
    • lack of development of the testes and lack of growth of the penis
    • lack of pubic and facial hair
    • failure of the voice to break
    • reduction or absent sperm production in the testes, resulting in infertility.

    Around the time of puberty, boys with too little testosterone may also have less than normal strength and endurance, and their arms and legs may continue to grow out of proportion with the rest of their body.

    In men who have already reached sexual maturity, symptoms are likely to include:

    • inadequate erections, loss of libidoand poor sexual performance
    • tiredness
    • loss of motivation and concentration
    • loss of pubic and facial hair
    • decreased sperm count
    • soft, small testes
    • mood changes
    • increased body fat
    • growth of breast tissue (gynaecomastia)
    • thinning of the bones (osteoporosis)
    • reduced muscle bulk and physical strength
    • a wrinkled ‘parchment-like’ appearance of the skin

    As some of these symptoms (e.g. tiredness, mood changes) can have multiple causes, diagnosis of male hypogonadism may sometimes get missed initially.

    How common is male hypogonadism?

    Male hypogonadism is more common in ageing men. The levels of testosterone in men start to fall after the age of 40. It has been estimated that 8.4% of men aged 50–79 years have testosterone deficiency. Male hypogonadism is also linked with type 2 diabetes: approximately 17% of men with type 2 diabetes are estimated to have low testosterone levels.

    Is male hypogonadism inherited?

    Male hypogonadism does not run in families. There are genetic causes of hypogonadism, which include Klinefelter’s syndrome and Kallmann’s syndrome; however, these conditions occur sporadically, they are not inherited from the parents.

    How is male hypogonadism diagnosed?

    A detailed medical history should be taken. In particular, it is important to find out if virilisation (development of normal male characteristics) was complete at birth, whether the testes descended and to see if the patient went through puberty at the same time as his peers. The patient should be thoroughly examined and the presence and size of the testes recorded, and whether they are correctly positioned in the scrotum.

    Many of the symptoms of male hypogonadism are non-specific and can be caused by a range of conditions. Therefore, when diagnosing hypogonadism, it is important that biochemical tests are performed to assess the levels of testosterone in the blood to confirm diagnosis. Blood tests will be carried out to measure testosterone levels. The blood sample should be collected in the morning between 08:00 and 10:00 when testosterone levels are highest (as levels of testosterone change throughout the day) and in the fasting state (because eating can lower testosterone levels). The blood test can be carried out as an outpatient appointment. If the result of the first test shows a low level of testosterone, the test should be repeated after two or three weeks to confirm the result. Other hormones are also tested along with the second blood sample. These hormones include luteinising hormone, follicle stimulating hormone and prolactin (produced by the pituitary gland). The results of these blood tests will help distinguish between primary (low testosterone and high gonadotrophins) and secondary (low testosterone and normal or low gonadotrophins) hypogonadism. Testosterone is carried around the blood stream by a protein called Sex Hormone Binding Globulin (SHBG). SHBG is often checked at the same time as testosterone as it makes it easier to interpret whether there is a true deficiency. In patients with obesity and type 2 diabetes, SHBG is often low which can make the testosterone level appear lower than it really is.

    Depending on the findings of the above tests, other investigations may be carried out. These include: a bone density scan to assess the impact of testosterone deficiency on bone; semen analysis; genetic studies; an ultrasound of the testes to check for nodules or growths; and an MRI scan of the pituitary gland.

    How is male hypogonadism treated?

    Treatment of classical hypogonadism involves replacement of testosterone with the aim of raising the level of testosterone in the blood to normal levels. Exact treatment will vary between patients and be tailored to their individual needs. Different preparations of testosterone are available:

    1. Injectable forms – these are preparations that can be given into the muscles, either every three to four weeks or every three months.
    2. Daily (morning) application of testosterone gel on the skin.
    3. Testosterone implants – small pellets placed under the skin. These are increasingly being replaced by the three-monthly testosterone injections.

    All of these options should be discussed with a medical professional and the most appropriate treatment option chosen. During treatment with testosterone replacement, regular blood tests should be carried out to monitor testosterone levels and if necessary, the dose adjusted to ensure levels return to the normal range. Tablet forms of testosterone taken by mouth are not recommended due to a link with liver damage, and because it is more difficult to monitor replacement.

    Testosterone should not be given if the patient has prostate cancer, because it might make the tumour grow more quickly. Before starting treatment with testosterone, a blood test to measure a hormone produced by the prostate called PSA (prostate-specific antigen) is carried out (PSA levels are elevated in prostate cancer). The prostate may also be examined (via the back passage) to rule out prostate cancer.

    For patients who have been diagnosed with late-onset hypogonadism, there is currently not enough evidence for us to know whether treatment with testosterone is safe and effective over the long term. While there are some short-term studies that indicate it may benefit these patients over a short period of time, there is a need for longer-term clinical trials in this area, following a large number of patients, to assess the long-term impact of testosterone treatment on patients with late-onset hypogonadism. Areas that particularly require focus are assessing the effects of treatment on the likelihood of developing cardiovascular disease, prostate cancer and secondary polycythaemia (a condition in which there are increased numbers of red blood cells in the blood, which may predispose to increased blood clots).

    If patients have any concerns about their health, they should contact their GP in the first instance.

    Are there any side-effects to the treatment?

    There can be mild side-effects of testosterone replacement depending on the form used: injectable forms can cause pain and bruising at site of injection; the gel form can cause skin irritation.

    Treatment with testosterone can cause an increase in red blood cells (known as polycythaemia), which increases the risk of thrombosis. Regular blood tests should be carried out during treatment to check for an increase in red blood cells. Enlargement of the prostate is another serious side-effect that should be monitored. Prostate examination and a blood test for PSA should be performed every three months for the first year and then annually in men over the age of 40 years after starting treatment. If patients have any concerns about these possible side-effects, they should discuss them with their doctor.

    What are the longer-term implications of male hypogonadism?

    Symptoms of male hypogonadism, such as lack of sex drive, inadequate erections (erectile dysfunction) and infertility, can lead to low self-esteem and cause depression. Professional counselling is available to help deal with these side-effects; patients should talk to their doctor for more information. Patients generally see an improvement in their sex drive and self-esteem following testosterone replacement therapy. Erectile dysfunction is a common symptom in patients without hypogonadism and may need treatment in addition to testosterone.

    Male hypogonadism has been linked with an increased risk of developing heart disease (low testosterone can cause an increase in cholesterol levels). Studies have shown that testosterone levels can be lower in men with type 2 diabetes and in men with excess body weight. However, it is not clear whether this is an association or a direct cause and effect. Lifestyle changes to reduce weight and increase exercise can raise testosterone levels in men with diabetes.

    Testosterone levels in men decline naturally as they age. In the media, this is sometimes referred to as the male menopause (andropause) although this is not a generally accepted medical term. Low testosterone levels can also cause difficulty with concentration, memory loss and sleep difficulties. Current research suggests that this effect occurs in only a small group of ageing men. However, there is a lot of research in progress to find out more about the effects of testosterone in older men and also whether the use of testosterone replacement therapy would have any benefits.

Best combination with viagra

best combination with viagra

Viagra and nitrates don’t mix, so how are some men still taking both?
Some men get overlapping prescriptions for the ill-advised pair and yet somehow seem to navigate taking them safely, new research finds.
As any sports fan knows, thanks to the incessant drumbeat of game-time Viagra and Cialis commercials, mixing erectile dysfunction drugs with nitrates for chest pain can cause an unsafe drop in blood pressure. Most medical guidelines strongly warn men not to take both types of medications.
Researchers in Denmark and the U.S., however, have recently found that a substantial number of men are nevertheless obtaining overlapping prescriptions for both classes of drugs. But evidence suggests that they don’t appear to suffer negative health outcomes, such as heart attacks, as a result.
“We were a little surprised that we didn’t find an increased risk,” said Dr. Anders Holt, a researcher at Copenhagen University Hospital Herlev-Gentofte. He is the lead author of a study published Monday in the Annals of Internal Medicine that identified a steep escalation in the co-prescribing of erectile dysfunction drugs and nitrates among Danish men. The researchers reported no conflicting ties to the pharmaceutical industry.
So how are men managing to navigate taking the drugs safely?
While the new study couldn’t tease out how men timed taking each medication, Holt speculated that one possible explanation for the lack of apparent health consequences is that people with coronary artery disease typically take longer-acting nitrate medications in the morning and tend to take erectile dysfunction drugs in the evenings. The span of time might be sufficient to prevent harmful drug interactions.
But medical groups such as the American Heart Association advise men to avoid taking nitrates within at least 24 hours of shorter-acting erectile dysfunction drugs, including Viagra (sildenafil) and Levitra (vardenafil), and within at least 48 hours of a longer-acting drug, such as Cialis (tadalafil).
Widely used medications.
In 2019, more than 4 million men and women in the U.S. received prescriptions for the top three nitrates — nitroglycerine, nitrofurantoin and isosorbide — according to the drug statistics website ClinCalc.com’s list of the top 300 medications. About 1.4 million men were prescribed Viagra and Cialis.
A 2008 study estimated that 3 percent of men in the U.S. experience severe erectile dysfunction, 6 percent experience moderate dysfunction and 26 percent experience mild dysfunction. And a 2020 paper estimated that 2.4 million men ages 40 and older have physician-diagnosed chest pain.
Both erectile dysfunction medications and nitrates cause blood vessels to dilate, which can dramatically escalate if the drugs are taken close together, potentially causing a sharp drop in blood pressure. That raises the risk of major cardiovascular health events, such as heart attacks or strokes.
Experts also strongly advise against consuming amyl nitrate, known as “poppers” and used as a recreational drug, with erectile dysfunction medications.
Spacing out doses of erectile dysfunction and nitrate medications “will decrease the chances that there will be a drug interaction,” said Dr. Robert A. Kloner, a professor of medicine at the University of Southern California , who led some of the key studies that established the American Heart Association’s safety protocol. (Kloner is a paid consultant for Sanofi, which has an agreement with Eli Lilly to sell Cialis in several countries if it were to become an over-the-counter medication.)
Results from Denmark.
In the new Danish study, Holt and his colleagues analyzed medical records from nearly 250,000 Danish men ages 30 to 85 with ischemic heart disease. About 42,000 of them had stretches during which they received ongoing nitrates prescriptions.
From 2000 to 2018, the researchers found, the rate at which men received erectile dysfunction drug prescriptions increased tenfold among the entire group while soaring twentyfold among those on nitrates. By the last five years of the study period, 9 percent of those in the latter group filled at least one prescription for a drug such as Viagra within three years of having started nitrates.
The authors looked at health outcomes during periods when the men received prescriptions for both drug types and compared them to outcomes during stretches when they received just one such medication. The data suggested that receiving concurrent prescriptions for the two drug classes wasn’t associated with any increase in heart health problems, such as cardiac arrest, heart attack or stroke.
Kloner, who wasn’t involved with the research, said the findings suggest “that health care providers are likely becoming more comfortable co-prescribing these two classes of drugs despite the guidelines and are at least educating their patients about not taking them right at same time.”
The study is limited by the fact that the study authors couldn’t know for sure when men were actually taking each of the medications. But when they adjusted their analysis to focus on periods from one to four weeks after the men received new erectile dysfunction drug prescriptions, the findings held.
The authors suggest that it’s also possible that some men may, indeed, experience drops in blood pressure from taking both drugs but that that doesn’t lead to health problems substantial enough for them to visit an emergency room. The researchers had access only to hospital data, not to medical records from general practitioners.
The study also couldn’t account for drugs men obtained on the black market — a common practice among those seeking medications like Viagra.
Similar findings in the U.S.
A U.S. study from the drugmaker Sanofi, published in The Journal of Sexual Medicine in August, reached similar findings. The pharma researchers analyzed electronic medical records covering 2012 to 2016 from more than 168,000 U.S. men who had at least one erectile dysfunction drug prescription. Out of 480,000 men who had one or more nitrate prescriptions, 3,167 received medications from both drug classes during overlapping periods — without any apparent increased risk of cardiovascular health problems.
The study also had access to health care providers’ appointment notes. Those records indicated that in perhaps half of the co-prescription cases, the physicians did caution their patients about the dangers of taking the medications together or instructed them about mitigating the risk of drug interactions.
Holt stressed that men’s sexual health and well-being are as important as the rest of their physical health.
“You can definitely possess both drugs,” Holt advised men who are candidates for both nitrates and erectile dysfunction medications. “But certainly don’t take them at the same time. We don’t have evidence that that’s safe.”
Raymond Rosen, an adjunct full professor of psychiatry and behavioral services at the University of California, San Francisco School of Medicine, said, “Erectile dysfunction drugs like Viagra have been a boon to many men and their partners who suffer from this common but potentially disruptive male disorder.”
“New evidence,” said Rosen, who wasn’t involved in either of the recent studies, “has challenged this long-held belief” that men can’t take both nitrates and erectile dysfunction drugs.
Still, he said, “men should always consult with their physician or health provider before making changes in either of these medications.”
Benjamin Ryan is independent journalist specializing in science and LGBTQ coverage. He contributes to NBC News, The New York Times, The Guardian and Thomson Reuters Foundation and has also written for The Washington Post, The Nation, The Atlantic and New York.

What is considered to be a low testosterone level?

what is considered to be a low testosterone level?

Low Testosterone

Men produce testosterone primarily in their testicles. The Leydig cells in the testicles produce testosterone. There is also a very small amount of testosterone produced from the adrenal glands.

Typically, this testosterone exists within a range in our body between roughly 8.5 units to 29.5 units in Canadian laboratories. When total testosterone levels drop below this, we’re considered to have low testosterone. We are also considered to have low-normal or borderline testosterone between the 8.5- and 12-unit mark in Canadian labs.

The clinical diagnosis of low testosterone is when somebody with borderline or low testosterone (so less than 8.5 units) and they’re symptomatic.

Causes

There are a lot of different potential causes for low testosterone. Oftentimes, we can’t explain why testosterone is low, and this is referred to as idiopathic.

There does not appear to be any conclusive evidence that low testosterone is hereditary. However, this is not greatly understood, and more research is needed.

  • Trauma or injuries to the testicles
  • Infection to the testicles called orchitis
  • Chemotherapy can damage some of the cells in the testicles
  • Alcohol abuse
  • Obesity
  • Ageing
  • Obstructive sleep apnea
  • Some medications
  • Poor sleep or shift work

Can testicular cancer cause low testosterone?

Men with testicular cancer will also have low testosterone. This could be due to dysgenesis of some of the testicular cells, meaning that some of the testicular cells didn’t form normally, which led to testicular cancer. This can present as either low testosterone or infertility.

If you have had one testicle removed due to cancer, you are at an increased risk of low testosterone in the future. Many men will have normal testosterone with one testicle, but it does put them at increased risk as they age.

When testicular cancer patients undergo radiation therapy, this increases the risk of low testosterone, particularly if there’s not adequate shielding of the remaining testicle. If patients undergo chemotherapy, this puts them at increased risk of low testosterone, depending on which chemotherapeutic agent is used.

Some patients have more or less risk, but all testicular cancer patients should have testosterone drawn or monitored at some point in time.

Can a vasectomy cause low testosterone?

No. In a vasectomy, the vas deferens tube transporting sperm is cut and blocked. This is completely independent of how testosterone is made. Testosterone is made inside of the testicle by the Leydig cells, which then distribute testosterone into the blood.

Are there foods that cause low testosterone?

Some studies have suggested that a high intake of bread, pastries, dairy products, desserts and processed foods, and low intake of homemade foods (good sources of vegetables or healthy sources of cholesterol and Omega-3) can be associated with lower levels of testosterone production.

Prevention

There are lifestyle changes you can make to improve testosterone production. These include maintaining a healthy weight, exercising, eating healthy foods, and getting proper sleep.

Get Active

Exercise can help prevent low testosterone by helping to maintain and optimize the natural production of testosterone. Resistance exercises or combinations with some aerobic exercise can be helpful, as well as maintaining lean body mass. Low levels of fat and high levels of muscles can also encourage the maintenance of higher natural levels of testosterone.

However, excess aerobic exercise can suppress the hypothalamus and the pituitary gland. This means less LH is sent to the testicle, the hormone that tells the Leydig cells in the testicle to make testosterone. The absolute amount of aerobic exercise varies from person to person; this is similar to when females are exercising too much and lose their menstrual cycle.

Overall, exercise is very helpful, though extreme high volumes of aerobic exercise can lead to lower testosterone levels.

Eat Healthier

Healthy eating is an important factor in maintaining a healthy body weight. The literature around whether a specific diet can help prevent low testosterone is fairly weak. Most studies are association studies or animal studies. We do know that maintaining lean muscle mass, having low-fat stores within reason, regular exercise, and healthy eating are important for producing testosterone.

A healthy diet includes a good balance of carbohydrates, proteins, healthy fat sources such as Omega-3s, and healthy sources of cholesterol.

Sleep Better

Good sleep hygiene can help prevent low testosterone. Getting healthy and regular sleep has been associated with better testosterone production levels.

Shift work and disrupted sleep in the middle of the night have been associated with lower testosterone levels.

Drink Less

Moderate alcohol consumption or cutting out drinking entirely likely can’t prevent low testosterone. However, drinking smaller amounts or no alcohol compared to excessive drinking habits will help maintain normal testosterone levels.

Drinking excessive amounts of alcohol has been associated with lower testosterone production.

Signs & symptoms

The signs and symptoms of low testosterone can be broad and non-specific, meaning they can overlap with many other situations or medical conditions.

Common Symptoms

Low Testosterone:

  • Decreased energy
  • Decreased exercise tolerance
  • Decreased ability to develop muscle
  • Decreased ability to lose fat tissue
  • Decreased mood
  • Decreased concentration or increased fogginess of mental clarity
  • Decrease sex drive or libido
  • Decreased strength
  • Increasing body weight or fat
  • Absence of morning or nighttime erections

Very Low Testosterone:

Diagnosis & Treatment

Diagnosis

The best way to test for low testosterone is through your primary care doctor and having your morning total testosterone level checked. This means that your blood will be drawn within the first two to three hours upon waking up in the morning. This should be repeated for a second time if it is abnormal the first time.

If the blood testosterone levels are low and a person is symptomatic, then these individuals might be a candidate for consideration of testosterone therapy. Candidates for this therapy should recognize that it is typically a chronic lifelong therapy and should not be implemented in patients that are considering fertility as it will likely stop sperm production.

There are other ways to test for low testosterone beyond total testosterone levels. There are free testosterone levels, measurements of sex hormone-binding globulin or SHBG, and measurement of albumin levels. With this information, bioavailable testosterone can be calculated. Literature is controversial concerning which test is the best to predict symptoms and status of low testosterone. Therefore, total testosterone is often most reliably used and easiest to acquire.

Treatment

If you have low testosterone, a healthy lifestyle that includes regular exercise, good sleep, and a healthy diet is recommended to promote the natural optimization of testosterone production and to maintain healthy body weight. If testosterone levels are still low even with healthy lifestyle changes, then medications can be considered.

There are typically two patient populations:

Men who desire potential fertility in the future:

For this group, exogenous forms of testosterone therapy cannot be used. This is because they will shut down sperm production by suppressing the hypothalamus and pituitary glands, which then suppress the testicle from testosterone production. In these individuals, medications such as clomiphene citrate or aromatase inhibitors (such as Anastrozole) are sometimes recommended. In very specific situations where people have an abnormality of their pituitary or hypothalamus glands, HCG injections may be used.

Men who do not desire future fertility:

Where fertility is not a consideration, testosterone formulations are generally either injections or transdermal:

  • Transdermal might include testosterone gels that can be applied to the armpits or the shoulders and upper arms each day, or testosterone patches can sometimes be used.
  • Different formulations of testosterone injections are typically injected every one to three weeks.
  • Testosterone pellets can be placed under the skin with a small procedure and can produce a slow release of testosterone over many months.

A newer drug to the market likely to come to Canada soon is an intranasal testosterone gel that is absorbed rapidly. So far in a clinical trial, it has shown less suppression on the pituitary and hypothalamus glands, and therefore less disruption to sperm production. It may be a good option for individuals that haven’t ruled fertility options out. However, more research is likely required.

What are the side effects of treatments?

  • With gels (the transdermal treatments), side effects include potential rash and potential transference of the testosterone through the clothes or touch to family members or children; therefore, individuals have to be very careful with washing their hands after treatments.
  • With injections, patients can have discomfort or bruising.
  • Overall, there can be mood changes if testosterone levels fluctuate wildly or are too high. High testosterone levels can lead to the production of red blood cells in the body, leading to something called Polycythemia, where there are too many red blood cells in the bloodstream, and the blood gets thicker and puts patients at risk of further complications. This needs to be monitored.
  • Testosterone therapy typically will result in the suppression of sperm production.
  • Some patients can experience acne or oily skin, or male pattern hair loss.

Are there alternative treatments?

Alternatives to medical therapy include lifestyle measures. The use of supplements is not recommended as they are not well controlled. The effectiveness is less predictable due to the lack of regulation of their active ingredients.

Are there over-the-counter low testosterone treatments?

None that are medical grade and have appropriate regulation over their production to give confidence in the type of response and potential side effects or damage they may cause. These are not recommended.

Coping

If you or someone you care about is suffering because of low testosterone, the best thing to do is connect with a professional in the medical community, such as your primary care physician and have a discussion about navigating your symptoms and checking and managing low testosterone appropriately.

For couples, connect with a primary care doctor to ensure that low testosterone is being properly investigated and managed, to help overcome some of the symptoms, and to have an open dialogue so that each partner understands the symptoms present and what needs to be overcome.

Frequently asked Questions

Are there foods that boost testosterone?

This topic is difficult to study, and most of the literature has significant limitations. We know that to generate testosterone, it needs cholesterol, which is the precursor. Therefore, there has to be some degree of healthy sources of cholesterol intake, which often coincide with Omega-3s. But this likely does not boost testosterone; rather, it helps support normal, natural testosterone production, along with the previously mentioned strategies.

Are there different variations of low testosterone?

In essence, yes. There are different ways of measuring serum testosterone depending on the location in the body. Testosterone can be freely circulated in the blood, it can be bound to the sex hormone-binding globulin (SHBG) protein (which is not active or cannot access the cells), or it can be bound to the albumin protein (which is a looser binding and therefore can also be biologically active).

Can low testosterone cause erectile dysfunction?

Low testosterone is usually associated with a lower libido or sex drive, more so than erectile dysfunction. Just the finding of low testosterone does not make it impossible for men to have erections; a very little amount of testosterone is thought to be needed to obtain an erection.

That being said, testosterone levels may have somewhat of a modulatory effect on erections. Men with erectile dysfunction that are failing treatment and also have low testosterone could be trialled on testosterone therapy to see if their erectile function improves.

Can a woman get pregnant if her partner has low testosterone?

Yes. Even though testosterone is incredibly important for sperm production, low testosterone levels in the blood may be the tip of the iceberg. Testicular testosterone levels are typically around 100 times higher and could be within normal limits within the testicle and support the fullest sperm production. Low testosterone does not cause low sperm counts as a general rule of thumb.

However, in some specific scenarios, enhancing testosterone through promoting the body’s production can sometimes be helpful; this area is quite controversial, and the literature is not conclusive.

Taking testosterone therapy will shut down sperm production; it is never used when fertility is being considered.

Does low testosterone cause premature ejaculation?

There is conflicting data in the literature. Some studies would suggest that men with lifelong rapid ejaculation might have higher free testosterone levels. It’s not clear if there is an association between blood testosterone levels and premature or rapid ejaculation. Low testosterone has, however, been associated with delayed orgasm, delayed ejaculation, or inability to achieve orgasm.

Does low testosterone cause weight gain?

Low testosterone can make it difficult to maintain lean muscle mass and achieve weight loss. Low levels can be associated with increased fat or adipose tissue.

Can low testosterone cause emotional problems?

Low testosterone has been associated with low mood or depressive-like symptoms, decreased energy and difficulties concentrating.

Are there vitamins for low testosterone?

There is minimal data that suggests vitamin D, zinc and magnesium supplementation may result in increased testosterone levels. However, these are very small studies, and the research needs to be performed to substantiate these results. At present, the evidence is not clear.

Further contributing to the diet and testosterone, there’s also evidence that high-fat diets or energy restrictions (as in low calorie or fasting diets) can reduce testosterone production.

Does marijuana lower testosterone levels?

The results in the literature are variable. Some studies have shown lower testosterone levels in individuals that use marijuana, some show no difference, and some show increased levels with recent use. The evidence is inconclusive.

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