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Sexual Health

Sildenafil (Viagra)

Sildenafil is approved by the Food and Drug Administration (FDA) for the treatment of erectile dysfunction. It helps stimulate the body's normal response to increase blood flow to the penis. Sildenafil is also FDA approved for the treatment of pulmonary arterial hypertension, where it relaxes the blood vessels that are located in the chest near the lungs and heart. This ultimately reduces the workload of the heart by increasing the supply of blood to the lungs.
Sildenafil belongs to a group of medications called phosphodiesterase 5 (PDE5) inhibitors. This class of medication ultimately increases blood flow to the penis by preventing an enzyme called phosphodiesterase type-5 from working too quickly. By controlling the enzyme, Sildenafil helps men who have difficulty getting or staying erect, making it the go to drug for erectile dysfunction.
Typically, the amount of Sildenafil in the bloodstream correlates to how long the effects can last. With that being said, Sildenafil’s effect is strongest 2-4 hours after it’s taken, and could last up to 8-12 hours. Please seek medical attention if you feel like you are experiencing a longer than expected erection that lasts more than 4 hours (priapism).
Sildenafil usually begins to work for erectile dysfunction within 30 minutes of taking it on an empty stomach. Taking the medication on an empty stomach is recommended due to the effect food can have on the absorption of Sildenafil. It then continues to work for up to 4 hours, with its peak effect being 1 hour after it’s taken. How long the medication lasts may differ depending on the individual. Keep in mind that Sildenafil makes it easier to get and maintain an erection, but will only work when an individual is sexually aroused.
Sildenafil comes in 3 doses – 25mg, 50mg, and 100mg. A starting dose of 25mg is usually prescribed if you have not previously used this medication or if you are taking other medications, which may cause potential side effects. Our clinical team will decide what’s best based on your medical questionnaire. Dosing is increased as needed to achieve the desired effects.
Taking more Sildenafil than prescribed is considered to be too much. Even If you are planning to have sex more than once per day, you should not take more than your prescribed dose in one day. Considering there are a few options in terms of prescription dosage (50mg or 100mg), please reach out to our providers if you feel that your prescribed dose is not working effectively.
Absolutely. According to many clinical trials, Sildenafil was seen to improve erections in approximately 2/3 of men. If it does not work for you the first time you take it, don’t be discouraged. Some men stated that they needed to give their body time to get used to the medication, making them try it a few times before they were able to establish whether or not it works for them. Still not satisfied with the effects of Sildenafil after you try it? Please reach out to our providers so that we can work with you to help you get there.
The most common reported side effects of Sildenafil include, but are not limited to, lowered blood pressure, dizziness, back pain, headache, muscle aches, stomach discomfort following meals, blurred vision, flushing, stuffy or running nose, trouble sleeping and diarrhea. If these side effects become persistent and/or bothersome, please contact your provider to discuss whether or not the medication should be stopped. If you start to experience rare, but serious, side effects such as a prolonged painful erection for longer than 4 hours (priapism), sudden loss of vision, double vision, hearing problems, convulsions, trouble breathing or hives- please seek medical attention immediately.
Although Sildenafil has been shown to be safe for most men, it may not be suitable with certain medical conditions, and sometimes it may be used but only if extra care is taken. For these reasons, men with pre-existing medical conditions such as heart conditions or blood vessel disease, any injury or deformity of the penis, low blood pressure or angina, history of stroke or heart attack, liver or kidney problems, bleeding conditions that cause ulcers, and any eye condition causing loss of vision, may be subject to adverse reactions. Please inform our providers if you suffer from any of these conditions or if you are taking any medications (prescribed or over the counter) that may interact with Sildenafil.
Sildenafil include alpha-blockers, other PDE5 inhibitors (tadalafil, vardenafil), oral antifungal medicines (ketoconazole, itraconazole), antibiotics (clarithromycin, erythromycin), nitrates (nitroglycerin), guanylate cyclase stimulators (riociguat) and HIV protease inhibitors (ritonavir, atazanavir sulfate, saquinavir).

Tadalafil (Cialis)

Tadalafil is approved by the Food and Drug Administration (FDA) for the treatment of male sexual function problems, symptoms of benign prostatic hyperplasia, and pulmonary arterial hypertension. For erectile dysfunction, it helps stimulate the body's normal response to increase blood flow to the penis.
Tadalafil can be prescribed as needed, or once daily for ED. If taken as needed before sexual activity, with a typical starting dose of 10mg or 20 mg, a higher dose is needed than in the once daily regimen (5mg). Taking Tadalafil once daily will allow the medication to build up in your system, making it up to 1.6-times the daily dose. This means 5mg daily can have the same effect as taking 8mg. Both the as needed and the once daily regimens should be specific to the patients age, medical history and health conditions.
Tadalafil belongs to a group of medications called phosphodiesterase 5 (PDE5) inhibitors. This class of medication ultimately increases blood flow to the penis by preventing an enzyme called phosphodiesterase type-5 from working too quickly. By controlling the enzyme, Tadalafil helps men who have difficulty getting or staying erect, making it the go to “weekend” drug for erectile dysfunction.
The most common reported side effects of Tadalafil include, but are not limited to, fast or irregular heartbeat, dizziness, headache, muscle aches, confusion, blurred vision, faintness, spontaneous penile erection and chills. If these side effects become persistent and/or bothersome, please contact your provider to discuss whether or not the medication should be stopped.If you start to experience rare, but serious, side effects such as prolonged painful erection of penis (priapism), sudden vision loss, ringing in your ears, chest pain, trouble breathing or hives- please seek medical attention immediately.
Tadalafil’s effectiveness has been seen to last for up to 36 hours, with its peak effect being 30 minutes to 2 hours after it is taken. Its long effectiveness allows you to take it well in advance making it easier to plan for sexual activity over a longer period of time.
Although Tadalafil has been shown to be safe for most men, it may not be suitable with certain medical conditions, and sometimes it may be used only if extra care is taken. For these reasons, men with pre-existing medical conditions such as heart conditions or blood vessel disease, sickle cell anemia, leukemia, multiple myeloma, any injury or deformity of the penis, low blood pressure or angina, history of stroke or heart attack, liver or kidney problems, bleeding conditions that cause ulcers, and any eye condition causing loss of vision, may be subject to adverse reactions. Please inform our providers if you suffer from any of these conditions or if you are taking any medications (prescribed or over the counter) that may interact with Tadalafil.
When Tadalafil is used for erectile dysfunction, it begins to work within 60 minutes. It then continues to work for up to 24-36 hours, with its peak effect being 2 hours after it’s taken. Tadalafil also must be taken before you plan on being sexually active. When taken at a lower prescribed dose (5mg) at the same time every day, Tadalafil increases the ability to achieve and maintain an erection under sexual stimulation (effects are seen after 4 to 5 days).
Before taking Tadalafil, please inform your provider if you are taking any medications that are known to interact with Tadalafil. Some prescription medications that interact with Tadalafil include alpha-blockers, other PDE5 inhibitors (sildenafil, vardenafil), oral antifungal medicines (ketoconazole, itraconazole), antibiotics (clarithromycin, erythromycin), nitrates (nitroglycerin), guanylate cyclase stimulators (riociguat) and HIV protease inhibitors (ritonavir, atazanavir sulfate, saquinavir).

Hair Loss

Finasteride (Propecia)

Finasteride is a medication used to treat male pattern baldness (androgenetic alopecia) in men. It works by reducing the hormone DHT that contributes to hair loss.
Taking a daily dose of 1mg of Finasteride for a minimum of three months has proven to be 85% effective in increasing hair regrowth. But your hair will reach its full potential at the one-year mark. It’s important to note that Finasteride will not create hair follicles; it treats existing follicles, so start early and continue the therapy for as long as recommended to see results. Continued use of finasteride is needed to maintain desired effects beyond one year.
Finasteride is well-tolerated, but, like all medications, it can cause side-effects. Sexual dysfunction from taking Finasteride is rare (occurring in less than 2% of patients) but talk to your doctor if you experience any changes. This can include loss of libido, erectile dysfunction or decreased ejaculate volume. Side effects tend to subside after discontinuation. When it comes to Finasteride and prostate cancer, the link is far from known. Studies have shown a possible increased risk but the clinical significance of these findings are inconclusive. As with any medication, Finasteride can cause a severe allergic reaction. Although very rare, if you experience symptoms such as trouble breathing, swelling of your throat or tongue or hive please call 911 or go to the nearest emergency room immediately.
Yes, they actually work in harmony to promote hair regrowth. Finasteride focuses on preventing the breakdown of testosterone into DHT and Minoxidil stimulates blood flow to the scalp.
No, Finasteride is available by prescription only.

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