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Last February, Doe mustered the nerve to push his doctor. That won a referral to a urologist. Once the specialist learned of Doe's history of heart disease, he didn't bother with a physical examination. Nor did he think Doe needed specialized tests. "I am 99 percent certain that you've got a circulation problem," he informed Doe. The doctor said Doe could try mechanical contrivances like a vacuum cuff or pump. Or he could have bendable rods surgically implanted. Or, using a small, fine needle, he could inject alprostadil, a drug that mimics a natural substance produced during sexual arousal, into the penis, to encourage blood flow. Doe did not care for any of these options. Priapism warnings. His reaction was slightly less negative to the urologist's final proposal: a tiny alprostadil suppository placed about an inch into the opening of the penis with the aid of a special insertion device. Made by Vivus and called the MUSE system, it produces an erection 60 to 70 percent of the time, and Doe thought it seemed somewhat less onerous than the other methods. Yet many men who try Muse abandon it because of insertion discomfort; nearly one third did so in one large study. The urologist also warned of a small but real danger of priapism--a painful, ongoing erection that threatens permanent damage and must be treated at an emergency room. Too, the timing discourages spontaneity. The drug works five to 10 minutes after it is administered, during which time sitting, standing, or walking around is recommended to stimulate blood flow. And languid dallying is out; the effect wears off after 30 to 60 minutes."There's a new pill coming out" the urologist told Doe. "Take the MUSE brochure. Look it over. See what you think. Maybe the thing to do is to wait for the pill. It's called Viagra." The $209 visit did warm up the atmosphere at home. Armed with the Muse brochure, Doe was inspired to reveal to his wife that he had been seeking help. "She was touched," he says. "She thought I had stopped caring at all." While put off by the fussy Muse procedure, she was willing to go along. But Doe was due for a follow-up talk with his internist. The couple put off the Muse decision until then. The internist, his interest now piqued, disagreed with the urologist. Doe's circulation was fine, he said. As Doe lay on the examining table, the internist pressed Doe's fingers to the femoral arteries in his groin. "A strong pulse, right?" The blood vessels to the penis branch off the femoral arteries, and good femoral circulation argues against poor blood flow to the penis. The internist ordered up a testosterone blood test, and the results made him smile with satisfaction; the number was extremely low. A depressed level of the male sex hormone, pumped out by the testes under the control of the pituitary gland in the brain, does not automatically produce erectile dysfunction--men with low testosterone can have normal sexual function--but it might explain Doe's problem. Doe met with an endocrinologist in early April, and left, for the first time, with hope. The hormone specialist took a detailed history, including a list of all of the medications Doe was taking. He examined Doe thoroughly, including a rectal check of the prostate gland. He was nonjudgmental, empathetic, and eager to answer Doe's questions. Moreover, he was flexible. Doe's testosterone, he said, could be boosted either by injecting the hormone once every week or two or with testosterone gel. But the shots would require frequent visits, or Doe or his wife would have to learn to give them. Doe was aware that Viagra prescription drug had come on the market the week before. Would it make sense to try the new drug before turning to supplementary testosterone? Sure, replied the endocrinologist, writing a prescription for 10 pills and asking Doe to report back. The most excruciating moment of his four-year ordeal, says Doe, was when he approached the pharmacy counter to pick up his prescription. The clerks at the pharmacy have a habit of repeating the name of the medication aloud to prevent mistakes. This time it didn't happen. Doe was grateful. The night Doe and his wife put Viagra to the test taught them that the drug is not an herbal aphrodisiac. It aids an erection but does not cause one. As is true in the absence of Viagra, stress, performance anxiety or nerves play havoc with sexual response, the couple found. A more relaxed attitude allowed Viagra to do its work. The phone call to the endocrinologist would be with gushing emotional delight. Continue with Viagra facts
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