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Patients who express a loss of libido, depression, or any signs of diminished secondary sexual characteristics should have an endocrine evaluation that consists of at least measuring morning serum testosterone levels. The relative merits of measuring total, free, and bioavailable testosterone levels and serum hormone–binding globulin are controversial. At this time, measuring total and free testosterone levels is recommended and should be performed when screening for hypogonadism. These hormone levels are generally higher in the morning than later in the day; therefore, a morning level should be checked whenever possible. Free or bioavailable testosterone is an important component because this is the testosterone that is usable. That portion attached to other proteins, the serum hormone–binding globulins, store testosterone. Viagra® is absorbed and processed rapidly by the body and is usually taken 30 minutes to 1 hour before intercourse. Results vary depending on the cause of erectile dysfunction, but studies have shown that Viagra is effective in 75% of cases. It helps men with erectile dysfunction associated with diabetes mellitus (57%), spinal cord injuries (83%), and radical prostatectomy (43%). Vasodilators (nitroglycerine) Safe Long-term results not available Penile biothesiometry–This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glands and shaft of the penis. A decreased perception of vibration may indicate nerve damage in the pelvic area, which can lead to impotence. Condoms offer the most protection against STIs of all the barrier method options. Using a spermicide with condoms can offer better protection against pregnancy, but it does not increase your protection against STIs . Spermicides containing nonoxynol-9 can cause genital irritation and can actually increase your risk of catching an STI. Optimal combination of drugs not known For the study, Barst's team randomly assigned 405 pulmonary hypertension patients to Cialis or placebo once a day, or to Cialis and bosentan (Tracleer) a common treatment for pulmonary hypertension. * Happy and comfortable atmosphere at home is very essential to stimulate sexual desire and keep sexually healthy.  Medical diagnosis fSocieta Italiana di Medicina Generale, Varese, Italia; What Doctors Treat ED? viagra canada online Qaseem and colleagues analyzed the findings of 130 studies that evaluated PDE-5 inhibitors alone or combined. They found that treatment with the drugs led to statistically significant and clinically relevant improvements in sexual intercourse and erectile function in men with ED, regardless of the cause (e.g., diabetes, depression, prostate cancer) or ED severity at the start of the study. Examples of medicines that may cause ED are listed below. The list of possible offenders is long, however, so check with your doctor about all medications you are taking to rule out any as a cause of, or contributor to, your ED. Oral phosphodiesterase type 5 (PDE5) inhibitors (sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) Cavernosography: Used in conjunction with the dynamic infusion cavernosometry, this test involves injecting a dye into the penis. The penis is then X-rayed so that the venous leak can be seen. Varied surveys have made known that at one or different time in their lives more than fifty% of the Americans have turned to alternative drugs and treatments. And while many such erectile dysfunction treatments are utilized in some Asian countries for centuries, the Western World is only currently starting to catch up.