How to treat erectile dysfunction in elderly?

Question

Hello doctor,

I am an 80-year-old male, and I have erectile dysfunction issues. I am also a non-smoker, non-drinker, and non-drug user, and I exercise four to five times a week playing pickleball.

At this point, neither Cialis nor Sildenafil generics has worked. My nurse practitioner urologist wants me to take 20 mg of generic Sildenafil every day at the same time and to stop taking L-Citrulline. If intercourse is a possibility, she wants me to go up to 80 mg. When an opportunity arose, that did not work. I do not understand what she is trying to accomplish.

Currently, I am taking 10 mg of Rosuvastatin and 50 mg of Losartan; baby Aspirin every three nights.

Please enlighten me, especially why she would recommend L-Citrulline since it produces nitric oxide, which is supposed to improve blood flow.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for writing, and I understand your concern.

Thank you for providing a detailed history of your issue. Let me first address your question about L-Citrulline. While there is some evidence that it helps (only in mild to moderate cases of erectile dysfunction), the evidence is not strong enough.

The reason she has asked you to stop it is to prevent it from reducing the effects of Sildenafil due to drug interactions. Coming to a daily low dose of Sildenafil with an add-on dose on the day of intended intercourse is a reasonable way to keep the blood flow in the penis even after one day of no sexual activity. The thinking behind this approach is to improve blood flow daily.

In my practice, I follow the same approach; however, I use Cialis 5 mg (daily) instead of Sildenafil. If you are not experiencing benefits with Sildenafil, a switch to Cialis can be attempted. If even Cialis (Tadalafil) is not effective, you may have to consider the use of penile pumps or intra-cavernous injections to achieve optimal erections.

I hope I have answered your questions to your satisfaction.

Please let me know if there is anything else I can help you with.

Take care.

Thank you.