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Warnings from Impotence
Extensive data from animal and human studies show that male impotence is associated with just about every risk factor that damages blood vessels or causes high blood sugar levels  (Metabolism, April 14, 2018).  Men who have difficulty achieving and maintaining an erection are at significantly increased risk for suffering heart attacks because both conditions are associated with exactly the same risk factors (International Journal of Impotence Research, 2016;28:14–19; J Amer Coll Cardiology, 2004;43:1405–11).  Most impotent men have no idea they are at high risk for a heart attack and cannot even name any of the six factors that put them at high risk for both impotence and heart attacks (Int J Clin Pract, 2010;64:848–857): 
• smoking 
• overweight 
• diabetes
• high cholesterol 
• high blood pressure 
• lack of exercise 
 
Of men who show up in a doctor's office for the treatment for impotence, more than 25 percent have already been diagnosed with heart disease, 23 percent are diabetic, 34 percent are on drugs to treat high blood pressure, and almost 20 percent are on statins to lower high cholesterol (International Journal of Impotence Research, 2008;20:S15–S20). The same lifestyle changes that help to prevent a heart attack also help to prevent and treat impotence (J Sex Med, Jan 2009;6(1):243-50).
 
How Arterial Plaques Cause Both Impotence and Heart Attacks
The arteries that carry blood to the penis are normally closed and allow only a slight trickle of blood to flow. When a man becomes excited, the muscles that surround the penile arteries relax to allow more than six times as much blood to fill through the penis. The pressure from this increased amount of blood closes off the veins that carry blood from the penis, so that more blood comes into the penis and less blood comes out, which causes the erection.  Arteriosclerosis means that plaques are laid down on the inner linings of arteries to obstruct the flow of blood. Anything that obstructs the flow of blood into the penis can make a man impotent (Int J of Impot Res, 2007;19:446–47).  The same plaque formation that can obstruct the arteries leading to the heart can obstruct the flow of blood to the penis.
 
You Need A Medical Evaluation before Taking Viagra or Testosterone
If you suffer from impotence, get a medical evaluation to find the cause. Impotent men suffer a very high rate of heart disease, even if they have not had that diagnosis (J Am Coll Cardiol, 2005; 46: 1503–1506). The rate of impotence in diabetic men is very high primarily because of the disease's very high rate of arteriosclerosis (The Journal of Sexual Medicine, 2013;9(8):2093–2103).  Men who take nitroglycerin or other nitrates for chest pain (angina) should not take drugs for impotence such as sildenafil, tadalafil, or vardenafil because the combination can drop blood pressure to very low levels.  Men taking drugs for high blood pressure, such as alpha blockers doxazosin (Cardura), terazosin (Hytrin), or tamsulosin (Flomax)} also should be wary of taking drugs to treat impotence.  Taking Viagra may help you achieve an erection, but it has not been shown to prevent heart attacks. 
 
The Difference between Low Testosterone and Blocked Arteries
Both having low testosterone and/or blocked arteries can cause impotence.  However, when low testosterone causes impotence, it almost always also causes lack of desire, so if you are a man who has a strong sexual desire and inability to perform, you are at high risk for a future heart attack.  Furthermore, a man requires a certain amount of testosterone to have desire and erections, but once a man has enough testosterone, more does not make him more sexual or give him the ability to achieve stiffer erections (Fertil Steril, 1993;59:1118–1123). Since arteriosclerosis damages the testicles to cause low testosterone, just taking testosterone pills or injections rarely cures impotence. Men with low testosterone levels are at increased risk for suffering from arthritis, cardiovascular disease, clinical depression, high blood pressure, high cholesterol, high triglycerides, pulmonary disease, stroke, and type 2 diabetes (Scientific Reports, April 12, 2018).
 
My Recommendations
Every man who is impotent needs a medical evaluation that includes:
• tests for diabetes and arteriosclerosis with their normal values: (Fasting blood sugar <100, One-hour-after-eating blood sugar <140), HBA1c < 5.7, Triglycerides <150, HDL >40, LDL <100, small size cholesterol particle size and Lp(a) < 100, systolic blood pressure at bed-time <120.) 
• hormone tests including testosterone and free testosterone
• a check for use of medications that can cause impotence
• a check for sleep disorders
• tests for other conditions that cause impotence
Regardless of the diagnosis, every impotent man should avoid smoke, alcohol and substance abuse, avoid being overweight, exercise regularly and follow a heart-healthful diet.  
April 6th, 2018
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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