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Apr 23, 2020
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I am an 80-year-old man who still has psychological drive, but who has lost the physical ability for an erection. Is there any safe way to restore this? I have had multiple bypass surgeries, so I am fearful of medicines like Viagra or Cialis, but I wonder about the safety of testosterone. F.E.D.
ANSWER: Although older men often have decreasing ability for an erection, finding out the underlying cause is important before trying medications. In men with a known history of blockages in the artery whether in the heart (leading to a stent or bypass), brain (leading to stroke or TIA) or elsewhere in the body (claudication, painful calf muscles with walking is a common symptom) it is worth considering whether the arteries that supply the penis with blood flow might also be blocked. This might require specific treatment. In men without known blockages, erectile dysfunction is a clue that there might be arterial disease and should always be considered.
Treatment with sildenafil (Viagra) or similar drugs is usually safe in people with heart disease; however, these drugs may not be used by men who take nitroglycerine or related drugs. Further, they can drop the blood pressure. Its usually not enough to cause problems, but your heart doctor can tell you whether it is safe for you.
Testosterone is used only in men with signs and symptoms of low testosterone and at least two documented low blood levels, ideally with tests taken at 8 a.m.
DEAR DR. ROACH: Whats the difference between smoking tobacco, marijuana or clove to our body? They all are from plants. Why are some OK or legal and the others are not? I.F.
ANSWER: Just because a substance is a plant or plant-derived does not mean it is safe.
Tobacco contains nicotine, a habit-forming and moderately toxic chemical. Cigarette smoke is dangerous. It causes dramatic increase in the risk of heart disease and cancer, and smoking kills approximately 500,000 people per year in the U.S. alone, 7 million worldwide. It is legal.
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