The Unexpected Link Between Erectile Dysfunction, Viagra & the Heart (ft Medlife Crisis)

Erectile dysfunction isn’t exactly the best party conversation. In fact men rarely talk about reproductive health so there are loads of misconceptions out there, and one of the biggest is that the inability to maintain an erection, or erectile dysfunction, is associated with our favorite marker of manliness: testosterone. So when I was researching for the last episode in the hormone series I found that a lot of men buy sildenafil citrate, more commonly known as Viagra, under that exact premise. So while I was in London for VidCon I met up with cardiologist and YouTuber doctor Rohin Francis of the channel MedLife Crisis who for a heart doctor sees a surprising amount of ED in his patients. But why? These body parts seem about as disconnected as can be so how does heart health impact male fertility and is there any truth to this testosterone myth and how can we prevent it? For an organ that we spend a lot of time thinking and making jokes about, men know very little about how their member works and even more about the times that it doesn’t work. Erectile dysfunction affects a lot of people and as you’d expect the incidence of ED goes up with age. We don’t have a lot of data globally for how many men it affects but the ranges go from 50% of men over age 40 to 20% of all German men. But you’d never know the numbers are so high because men don’t talk about it, either with their friends or their physicians. Men classically don’t go to the doctors as much as women do and that’s especially true when it comes to issues of fertility. In fact, less than10% of men who experience reproductive difficulties will ever seek medical attention. Now, in contrast, huge numbers of men will buy a product without talking to anyone and we are talking about some big numbers here. There were about 1million prescriptions of Viagra in 2006 in the UK but by 2017 that number jumped up to 3 million prescriptions. Why such an increase? Well, part of it has cost. The pill went from $7 a pop down to $1. But the other part was demand. Advertisements sprang up out of nowhere making it seem like if you weren’t ready to go at all times then you should be. So not only were men surrounded by perky penises, they weren’t talking to their doctors to see if they even should be taking anything for it. Now one of the common misconceptions about erectile dysfunction is that it’s caused by low testosterone production which seems like it makes sense. We know that old men are likely to produce less testosterone than when they were younger and that they’re more likely to experience erectile dysfunction. And there /are/ some heart health drawbacks that come from having low testosterone like an increase in total and LDL cholesterol and some of those markers of inflammation but that just one piece of the puzzle. Age is associated with a lot of health issues, not just heart disease and you know what most men don’t find particularly arousing? Being reminded that they’re old and need medicine for their heart. So in the 1990s this pharmaceutical company called Pfizer was testing sildenafil as possible angina or chest pain medication in a group of working-age men.And the drug was terribly unsuccessful at what it was supposed to do and the research was almost discontinued. But remember, men never talk about sexual health so during those final interviews when the researchers were asking their routine questions like “how did you feel/did you have any side effects” they were surprised when a lot of the participants sheepishly responded that they had had unexplained erections after taking the pill. Pfizer instantly reworked their trial format and instead of investigating sildenafil’s effect on chest pain, they went in with the intention of getting it up. But how did this happy accident happen? I mean other than both being involved in dating, the heart and the genitals don’t seem to have a lot of overlap. Except you are not your body parts. You are in fact an entire body, and your systems like your cardiovascular and you’re reproductive are all intimately connected and sexual arousal is a really good example of their intercourse…I mean their interconnectedness! Also, fair warning you’re about to see a penis diagram in three… two…. one…. In healthy men, sexual arousal triggers the release of nitric oxide from a structure in the penis called the corpus cavernosum – the structures that fill with blood and make up the bulk of an erection. The clitoris actually has a corpus cavernosum as well which is what allows it to swell. All that nitric oxide affects the activation of an enzyme between the cells called guanylate cyclase which regulates some other proteins which ultimately leads to a reduction in intracellular calcium. Since calcium is needed for muscular contraction, less calcium means muscular relaxation. Now blood vessels are wrapped in thin smooth muscle that isn’t exactly like the skeletal muscle in your arms and legs but they can contract and relax around the vessels. When that chain of events is kicked off by nitric oxide, the relaxation of smooth muscle loosens the grip around the vessels in the penis, expanding the diameter of the vessel and allows more blood to pass through which results in an erection. And that’s where sildenafil comes in. The pill doesn’t do anything inherently manly it’s just a fancy vasodilator.And that’s what I knew I needed the help of a cardiologist When Patrick decided he wanted to make a video about erectile dysfunction he told me that he immediately thought of me. Now either he’s been checking my browsing history or he’s aware that there’s a huge overlap between what I treat, heart disease, and erectile dysfunction. When I see men with heart disease in the clinic they rarely mentioned ED but if I asked it about it it’s surprisingly common.Now a strong association between heart disease and ED has been noted for many years and the traditional view was that atherosclerosis or the narrowing of arteries that we see in the arteries in the heart was causing narrowing of arteries to the penis and this is certainly implicated but it’s probably not the main reason. In fact, the key factor is probably the nitric oxide that Patrick was just talking about. The risk factors for erectile dysfunction and heart disease are pretty much the same: namely smoking, increasing age, diabetes, high blood pressure, high cholesterol, and obesity. Nitric oxide causes your blood vessels to open up or vasodilate as you’ve already heard it’s the increased blood flow that causes an erection. A reduction in your ability to produce nitric oxide or a narrowing of the arteries will both contribute to impaired vasodilation. Viagra (sildenafil) or Cialis (tadalafil) and similar drugs all belong to a class of medication called phosphodiesterase five inhibitors and they work by potentiating or increasing the effects of nitric oxide. I should say at this point that if you’re already taking any medication please consult with your doctor before taking a phosphodiesterase 5 inhibitor because they can interact with quite a few different drugs. If I’ve got one key message today it’s that if you develop erectile dysfunction don’t ignore it.64% of men presenting to hospital with a first heart attack experienced some erectile dysfunction in the preceding 12 months before their heart attack.Some even say that erectile dysfunction should be treated as a risk factor for heart disease in the same way that smoking or obesity are for example and that after diagnosing erectile dysfunction there exists a window of opportunity of perhaps two to three years where heart disease could be recognized and potentially treated. The reason that manifests itself earlier is because the arteries supplying the penis are smaller than the arteries supplying the heart or your legs for example and so they get affected earlier. So what can you do about it?Unsurprisingly it’s the same lifestyle modifications that we recommend for someone with heart disease, namely stopping smoking, achieving a healthy weight, and regular exercise. Exercise, in particular, has been found to have powerful effects on reducing ED now this might be as part of a cardiac rehabilitation program for people with established heart disease or just regular aerobic and anaerobic exercise at least three times a week.But remember even if you’re very young prevention is always better than cure and you can reduce your likelihood of developing any of these problems in the first place by getting in the habit of taking regular exercise from any age. Now you’re probably staring at your lap and planning your diet and exercise regiment as we speak but keep an eye peeled for future video collaboration between us about the sweet spot of exercise and how doing too much might actually be bad for you.

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