FrankTalk.org

Today, I stumbled upon this study:
https://pubmed.ncbi.nlm.nih.gov/24859322/
which shows that for young rats (and therefore potentially also young men), the usage of PDE5 medication (sildenadil, tadalafil & vardenadil) leads to increased collagen levels (and therefore increased fibrosis). For those unaware, it is widely believed that fibrosis hinders proper relaxation of smooth muscle content, leading to “venous leak” ED.

I’m quite shocked and kind of depressed finding this information, given that we are always told that using PDE5 medication should not cause any physical harm that could worsen ED. In fact, there are many studies showing that they are even beneficial for penile health (promoting nocturnal erections etc.) and indeed often proposed for penile rehabilitation (especially after certain surgeries). However, these studies are always done for older populations, suggesting that the pills work differently for them?

I’m 27, and have sporadically used quite a bit of tadalafil 5mg over the last 5 years (around 200 pills in total). Recently, reading about its potential benefits to penile health (I am worried because I hardly ever get morning wood), I even started taking 5mg daily. Now of course I’m panicking, fearing that in fact I have been worsening my ED all this time!

Any thoughts? If true, shouldn’t this be more common knowledge here? Shouldn’t we be warned about any potential long-term/permanent damage they can cause?!
I was hoping that maybe someone (preferably someone young) could share their experience after having taken ED pills regularly (daily?) for multiple months/years.

I've been taking 100mg Sildenafil every night for about a year now. Without it, I wouldn't get nocturnal erections. Tried lower doses with no results.
If the study is true, it wouldn't change my approach. Lack of nocturnal erections = atrophy and worsens ED through a lack of oxygen. I've not noticed my ED getting worse in the last year.

I would say if you get natural nocturnal erections then there is no need to take any medication. For many others like myself, we have little choice.

Interesting study, but I haven’t noticed any change in erectile function in the 10 years I’ve been using pde5 inhibitors. I only use them on-demand, maybe twice a week on average.

I don't believe the study applies to humans because there are studies in humans showing that daily PDE inhibitor use can reduce fibrosis and thereby improve Peyronies. There are also studies indicating that over a period of daily use PDE inhibitors can "cure" ED in a proportion of men, in the sense that you don't need them anymore.

In both cases, you have to use them every day. On demand use doesn't show these benefits.

Benjohn wrote:I've been taking 100mg Sildenafil every night for about a year now. Without it, I wouldn't get nocturnal erections. Tried lower doses with no results.
If the study is true, it wouldn't change my approach. Lack of nocturnal erections = atrophy and worsens ED through a lack of oxygen. I've not noticed my ED getting worse in the last year.

Indeed, I've been thinking about taking 5mg of tadalafil daily before bedtime for the same reasons.
I notice that I almost consistently wake up with morning wood when doing so, whereas that just doesn't happen (or only very rarely, and not at full rigidity) when I don't.

If I may ask, how would you know that your natural function / ED has not gotten any worse? Do you take breaks from the sildenafil?

seekonk wrote:I don't believe the study applies to humans because there are studies in humans showing that daily PDE inhibitor use can reduce fibrosis and thereby improve Peyronies. There are also studies indicating that over a period of daily use PDE inhibitors can "cure" ED in a proportion of men, in the sense that you don't need them anymore.

In both cases, you have to use them every day. On demand use doesn't show these benefits.

Indeed, I'm not sure how much we can generalise these findings for humans. Actually, the experiment was done on 4-month old rats, which apparently would be equivalent to a 10-year old human. I can image that giving a PDE5i at that age might not be a good idea for healthy development
It's also slightly confusing, because other studies (including the ones I assume you are referring to) are also often done on "relatively young" rats, and show improvements from chronic PDE5i usage, which seem to directly contradict this one.

TwoStep wrote:Interesting study, but I haven’t noticed any change in erectile function in the 10 years I’ve been using pde5 inhibitors. I only use them on-demand, maybe twice a week on average.

That's reassuring! I've basically been doing something similar over the last 5 years (taking them mostly on special occasions, holidays, weekends, ...) and they've been working great. At this point I'm considering whether it would be a good idea switching to a chronic daily/nightly regimen. I am currently not sexually active on a regular basis (recently single after a LTR), so I'm purely considering this from a "penile health" perspective.

So basically, right now, I would consider using 5mg tadalafil daily/nightly because

- I experience no adverse side effects from them
- cost is not an issue (thanks to the availability of generic tadalafil)
- they seem to improve ED / penile health on chronic usage, as seekonk mentions.
- it practically stays active 24/7 when on daily usage, so that ED is never a problem when opportunity presents itself

Hence, my only remaining worry comes from potential long-term (permanent?) effects from taking the drug daily from a young age on. I'm only 27, so I don't want to risk killing whatever natural ability I have left (unreliable, but definitely not completely useless right now) when I get in my 30s (and later).
Most studies showing that daily tadalafil doesn't lose efficacy are unfortunately pretty much always done for older populations, and I don't find many testimonials from younger guys taking daily PDE5i for years without any loss of efficacy of the drug or natural function without the drug. Therefore, thank you very much for sharing your (mostly positive it seems) experiences here!

Another study that might be interesting in this investigation: https://pubmed.ncbi.nlm.nih.gov/16698365/
Apparently, chronic PDE5i therapy also helps people who have the opposite problem of ED, recurrent priapism (= frequently getting long-lasting, sometimes painful erections without sexual/physical stimulation). The idea is that chronic PDE5i treatment can lead to an upregulation of PDE5 produced by your body (to compensate the effect of the PDE5i), therefore inhibiting these unwanted erections. Of course, that again raises questions whether this mechanism potentially makes things worse for those already suffering from ED ... It's frustrating because science doesn't seem to have a clear answer to this question, and anecdotal evidence is not always in agreement either.