Posted on: Saturday, June 11, 2005
PRESCRIPTIONS
Maca won't put the macho in a drooping sex life
By Landis Lum
Q. Do maca and tongkat ali work for erection problems, or do drug companies make better products?
A. First, see your doctor to see if you have a treatable cause of impotence, such a side effect of certain drugs or various endocrine, metabolic or physical conditions.
Maca is a root found in the Andes of Peru and belonging to the brassica (mustard) family with supposed aphrodisiac and fertility qualities. However, there is little scientific evidence it improves erections.
Tongkat ali grows wild in the rainforests of Southeast Asia and has purported energy and sexual-enhancing properties. But a 2003 study found lead contamination in samples from this area, and like maca, this plant's effectiveness is suspect.
Of the natural products, yohimbine shows the greatest promise for improving erection. It's an alkaloid derived from an African tree. The excellent reference source Clinical Evidence found yohimbine more effective than fake pills (placebos), though this conclusion was based on only seven studies, some measuring outcomes of questionable validity. The dose is 5 to 10 mg, three times a day. It may take two to three weeks to work.
Side effects were mild, and included agitation, anxiety, headache, mild blood pressure increases, and stomach upset.
As with other supplements, purity and potency are not guaranteed.
The drugs Cialis, Levitra, and Viagra work better than herbs or supplements for impotence. All increase the flow of blood into the penis so that when a man is sexually stimulated, he can get an erection.
I'm not overly concerned about recent reports of blindness — not only were these events rare, but they may not have even been caused by these drugs. Such blindness, caused by blockage of blood flow to the optic nerve, occurs most often in the elderly and in those with high cholesterol, high blood pressure, diabetes and a history of smoking — namely, the same people who get erectile dysfunction.
These drugs sometimes cause headache, stomach upset, and flushing. Temporary blue-green vision occasionally occurs — probably less so with Cialis.
Family physician Dr. Jason Lam favors Cialis because it still works 36 hours or even longer after it's taken, while Viagra and Levitra usually must be taken within four to five hours of sex.
"But the main problem is that many men are embarrassed to even bring up the topic to their physicians," says Lam. "And doctors should likewise be asking, but don't."
For premature ejaculation, impotence, or other problems, I'd also buy books like "Sexual Solutions" by Michael Castleman for their great advice.
Drugs like Paxil 20 mg taken several hours before sex may be effective for premature ejaculation.
Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate professor at the University of Hawai'i's school of medicine. Send your questions to islandlife@honoluluadvertiser.com.
