If Viagra or Cialis Don't Work, Here's Another Option to Solve Erection Problems for Older Men

An overview of the PDE5 enzyme, cGMP, and nitric oxide for increasing the blood flow in male production organs to allow desired erection

This story reflects my scientific research and personal experiences in solving men's health. This post does not include health advice. It is for information and awareness purposes.

A happy elderly couple showing affection to each otherPhoto byPhoto by Vlada Karpovich:

There is absolutely no need to feel embarrassed when it comes to learning about men’s health and well-being. It is the same for women. As I have grown older, I have realized that it’s quite common for my readers, friends, and family members to have questions they might feel a bit shy about asking openly as they fear judgment.

Several readers of more mature ages have sent me private messages, looking for information beyond what they discuss with their doctors. This interest was sparked by a previous article I wrote in 2021 titled "Three Tips to Boost Nitric Oxide and Lower Heart Disease/Stroke Risks," which explored the vital role of nitric oxide in heart health and briefly mentioned its connection to intimacy function. Nitric oxide is one of the most powerful ideas from Nobel Laureates.

Many mature readers expressed a strong desire to explore this topic further because their doctors commonly prescribed Viagra or Cialis. However, their effectiveness varied greatly, working for some while falling short for others. It is this intriguing puzzle that motivated the creation of this informative article to create awareness.

Based on my scientific research and personal experiences as a man over 55, my goal is to offer a scientific and independent overview of the complex mechanisms that underlie male production function.

While studying human cognition, I observed a significant connection between the brain, heart, and the penis.

Central to this narrative lies the enigmatic enzyme, Phosphodiesterase type 5 (PDE5), a linchpin in the orchestration of various signaling pathways within the human body, most notably those governing cyclic guanosine monophosphate (cGMP) levels.

For example, PDE5 exists in smooth muscle cells in blood vessels, regulating blood flow, the corpus cavernosum in the penis, where it is involved in erectile function, lungs (involved in the relaxation of smooth muscle cells in blood vessels), heart (involved in various cardiovascular processes), and various other tissues where it regulates cGMP levels.

In this post, I aim to unfold the multifaceted role of PDE5, abundant in the smooth muscle cells of diverse tissues, from vascular walls to the hollow chambers of the male reproductive organ. Its primary mission, being cyclic, is metabolizing cGMP into its inert counterpart, guanosine monophosphate.

I hope that this short story will help you understand the pivotal role of PDE5, cGMP, and nitric oxide in the intricate male production health process. Armed with this knowledge, you may demystify why some men find success with Viagra or Cialis while others turn to nitric oxide supplementation as an alternative solution. But there is more to this story in the conclusion section.

A Serendipitous Encounter from Clinical Trials

Viagra (sildenafil) was not initially developed for the treatment of erectile dysfunction. It was initially created as a medication for treating different medical conditions, specifically heart-related issues.

Sildenafil, the active ingredient in Viagra, was initially studied as a potential treatment for angina, a heart condition characterized by chest pain due to reduced blood flow to the heart.

During clinical trials, researchers observed an interesting side effect of the medication. It increased blood flow to the penis, resulting in improved and sustained erections in male participants. This serendipitous discovery led to the development of Viagra as a treatment for erectile dysfunction.

In 1998, the U.S. Food and Drug Administration (FDA) approved Viagra as the first oral medication for the treatment of erectile dysfunction.

Since then, Viagra and other similar medications have become widely used for this purpose. While Viagra didn’t become the heart medication it was initially intended for, its accidental discovery revolutionized the treatment of erectile dysfunction, offering a new solution for millions of men worldwide.

An anatotical overview of male productive organPhoto byCourtesy of Wiki Commons

PDE5 is an enzyme found in our tissues, including the smooth muscle cells of blood vessels and the corpus cavernosum in the penis. Its primary role is to break down cyclic guanosine monophosphate (cGMP) into its inactive form, guanosine monophosphate (GMP). I’d like to briefly explain how it works.

When a man becomes intimately aroused, nitric oxide is released. This unique gas triggers the production of cGMP in the corpus cavernosum of the penis.

Elevated cGMP levels relax the smooth muscle cells in the blood vessel walls of the penis, leading to vasodilation and increased blood flow into the erectile tissue. This increased blood flow results in an erection.

PDE5 acts as a regulatory enzyme. It naturally degrades cGMP, maintaining a balance in the levels of cGMP in the penis. After an erection, PDE5 breaks down cGMP, allowing the smooth muscles to contract, the blood vessels to constrict, and the penis to return to its flaccid state.

In the context of erectile dysfunction, there may be insufficient cGMP production or excessive PDE5 activity, preventing the proper relaxation of smooth muscle cells in the penile blood vessels. This can result in difficulty achieving or maintaining an erection.

Medications like Viagra (sildenafil), Cialis (Tadalafil), or other PDE5 inhibitors work by selectively inhibiting the action of PDE5. By doing so, they prevent the rapid degradation of cGMP, allowing cGMP levels to remain elevated in the corpus cavernosum.

This enhanced cGMP level promotes prolonged vasodilation and improved blood flow to the penis, helping men with erectile dysfunction achieve and sustain an erection when stimulated.

Therefore, instead of increasing PDE5, Viagra and similar medications inhibit its activity, thereby increasing cGMP levels and facilitating the physiological process of achieving and maintaining an erection.

Unfolding 3 Key Concepts for Erection

1- Vasodilation

Vasodilation, the widening of blood vessels, is a critical process, particularly within penile blood vessels, where cyclic guanosine monophosphate (cGMP) takes center stage.

cGMP plays a pivotal role in relaxing the smooth muscle cells lining the walls of these vessels. This relaxation, known as vasodilation, facilitates the expansion of blood vessels, allowing for increased blood flow to the targeted tissue.

However, in this delicate equilibrium, PDE5 acts as a counterbalance by breaking down cGMP, triggering the contraction of smooth muscle cells and the subsequent constriction of blood vessels.

2 — Erection Control in Penis

In the context of erectile function, the pivotal role of PDE5 in orchestrating blood flow to the penis comes to the forefront. When a man experiences arousal, the release of nitric oxide sets in motion the production of cGMP.

Elevated cGMP levels induce the relaxation of smooth muscle cells within the penile blood vessels, paving the way for augmented blood flow into the penis, ultimately resulting in an erection.

Subsequently, PDE5 within the penile structure steps in, diligently degrading cGMP, thereby facilitating the return of the penis to its flaccid state following an erection.

PDE5 is an integral guardian of equilibrium in cGMP levels across a spectrum of tissues. It diligently prevents the excesses of vasodilation under normal circumstances and shoulders the crucial role of regulating blood pressure while upholding the smooth functioning of cellular processes

3 — PDE5 Inhibition for Enhanced Blood Flow

The inhibition of PDE5, as accomplished with medications like Viagra or Cialis, results in the elevation of cGMP levels through the deceleration of cGMP degradation.

This, in turn, promotes vasodilation and amplifies blood flow. In the case of Viagra, PDE5 inhibition is harnessed with precision to facilitate blood flow to the penis, extending a helping hand to men grappling with erectile dysfunction in their quest to attain and sustain an erection.

PDE5 inhibitors, exemplified by Viagra, have proven efficacy in the treatment of ED, as well-documented in the literature. Nonetheless, their usage should be conducted under medical supervision, owing to potential interactions with specific medications and considerations relating to people with underlying medical conditions.

An Alternative Approach to Viagra or Cialis

For some men, Viagra or Cialis may not yield the desired results, but an alternative option lies in nutritional supplementation with L-citrulline, L-arginine, or a combination of both using the same pathway.

I’d like to explain the rationale behind this alternative as I use these amino acids, and in fact, I supplement with citrulline malate for many other reasons, as I documented in a story titled L-Citrulline Malate: Six Health Benefits Based on Science and Two Decades of Experience.

L-citrulline and L-arginine are amino acids that intricately contribute to the production of nitric oxide, an essential player in erectile function. Through their influence on cGMP levels, they indirectly support the enhancement of erectile function.

As a precursor to nitric oxide, L-arginine sets the stage for a cascade of effects in the body. Nitric oxide, a signaling molecule, plays a vital role in relaxing the smooth muscle cells within the blood vessel walls of the penis.

This relaxation fosters increased blood flow to the erectile tissue, culminating in an erection. L-arginine propels the production of nitric oxide, subsequently elevating cGMP levels, which translates into improved vasodilation and enhanced blood flow to the penis.

Another crucial amino acid, L-citrulline, which I use in malate format, takes center stage in the urea cycle and eliminates ammonia from the body. Notably, L-citrulline can be converted into L-arginine in abundance within the tissues.

Upon ingestion, L-citrulline undergoes this conversion, leading to increased levels of L-arginine, which, in turn, fuels nitric oxide production. From my experience, it is even better than L-arginine, with fewer side effects.

Scientists believe this conversion is more efficient than direct L-arginine supplementation, as it sustains higher L-arginine levels within the body over an extended period. The outcome is amplified nitric oxide production and protracted vasodilation, potentially promoting enhanced erectile function.

The effects of L-arginine and L-citrulline can vary from one person to another. Individual responses may hinge on overall health, dietary choices, and underlying medical conditions. Additionally, L-arginine supplementation alone may not always yield the desired results, as the enzyme arginase can swiftly metabolize it.

People sometimes combine L-citrulline and L-arginine supplements to maximize potential benefits. However, it is paramount to consult with a healthcare professional before supplementation, as these amino acids in large amounts may interact with medications or present contraindications for specific medical conditions.

Conclusions

Due to the effectiveness in clinical trials, healthcare professionals have placed significant emphasis on the use of PDE5 inhibitors, as their findings have demonstrated the effectiveness of medications like Viagra and Cialis for many men. Millions of men with erectile dysfunction benefit from them.

Nevertheless, it is important to recognize that not all men may require PDE5 inhibition, as individual responses may vary.

From my personal experience, I have found that my body’s needs align more with the enhancement of nitric oxide rather than PDE5 inhibitors. Consequently, I do not rely on medications like Viagra and Cialis after my 50s.

Instead, I have discovered significant benefits from the use of Citrulline Malate. This nutrient not only serves a similar purpose but also contributes to my heart health, a vital aspect of my overall well-being.

To underscore its appeal further, I have not experienced any side effects using 3 grams of Citrulline Malate after my evening meal. This supplementation supports heart health and has the added advantage of promoting growth hormone release and preserving lean muscle mass.

While the inhibition of PDE5 and the enhancement of nitric oxide are undeniably pivotal, it’s crucial to underscore the indispensable role of testosterone in nurturing a healthy and vibrant coupling life. I have witnessed mature men who, despite using Viagra or Arginine, struggled with achieving an erection.

However, through the guidance of healthcare professionals like endocrinologists or urologists and the prescription of testosterone replacement therapy, a remarkable transformation ensued. Their intimacy health was significantly revitalized, and the challenge of erectile dysfunction was effectively surmounted.

What’s even more remarkable is that some experienced a noteworthy alleviation of depression, underscoring the intricate interplay between hormonal balance and mental well-being. I personally boost my testosterone and growth hormone naturally.

These practices serve as a testament to the multifaceted nature of men’s intimacy health, where a comprehensive and proactive approach with support from qualified healthcare professionals can yield profound results.

For optimal health, it is essential to acknowledge the diverse paths one may tread, each tailored to individual needs and preferences. I hope this independently presented information can empower you to make informed choices that align with your unique health goals.

Thank you for reading my perspectives. I wish you a healthy and happy life.