With aging there is a normal decline in male sexual function. Testosterone, the male sex hormone, decreases—and with it goes some of a man’s muscle mass, bone strength, and, of course, libido. As a man grows older, it may take longer to become aroused. Erections are usually less firm and ejaculations less forceful, and the time between erections lasts longer. Conservative estimates suggest that at least 30 million men experience difficulty maintaining an erection. Yet these difficulties do not need to interfere with healthy and enjoyable sex.

The success of Viagra and newer drugs in helping men maintain erections has led to numerous alternative therapies that also claim to improve libido and erectile function. Since Viagra costs more than $8 per dose, many men consider responding to the ubiquitous e-mail advertisements for potency herbals and aphrodisiacs. Some turn to physicians who offer testosterone injections. In this chapter, I’ll describe these alternative therapies and answer the important questions: Do they work as well as Viagra? And do they have fewer side effects?

More Solutions Than Just Viagra In 1998, Viagra was introduced, and men discovered that diminished sexual function was no longer something they just had to live with. Although Viagra doesn’t rev up sexual desire, it does help the body to maintain erections when taken anytime between 30 minutes and four hours before it’s needed. Now, as you undoubtedly know from the barrage of television and print advertising, there are newer prescription medications that have challenged Viagra. These drugs, Levitra and Cialis, last longer than Viagra. Cialis can be effective for up to three days.

The side effects of Viagra, Levitra, and Cialis are similar and include headache, flushing, and runny nose. There may also be a subtle change of vision, causing objects to appear blue. This is the source of many jokes about these drugs, but in a small percentage of the population this effect can develop into a serious eye problem. Occasionally, these drugs can also cause priapism, a condition in which an erection lasts for four or more hours. Again, this is a side effect that many people laugh about, but it’s a painful, even dangerous condition that must be treated immediately.

Viagra, Levitra, and Cialis also interact with prescription drugs, including nitrates (nitroglycerin), taken for heart disease, and alpha-blockers (Cardura, Minipress, and Hytrin), which are used to lower blood pressure. And of course, with a cost of several dollars per dose, another of these drugs’ side effects is damage to your bank account. With so many perils surrounding conventional drugs, many men would prefer a safer, lower-cost alternative.

To Crank Up Your Libido, Bring Down Your Weight It was once thought that erectile and arousal problems were purely psychological in origin. These days, we tend to assume that libido woes are a matter of biochemical imbalance, to be cured with a pill. But did you know that you can improve sexual performance without drugs or psychotherapy?

Recent studies strongly suggest that exercise and appropriate weight loss are effective bedroom boosters. According to the Health Professionals Follow-Up Study, regular physical activity appears to reduce impotence risk by nearly a third. So does weight maintenance. In the same study, men who were substantially overweight were 30 percent more likely to experience impotence than their fit-and-trim counterparts. When obese men lose weight, many of them regain their sexual functioning.