Viagra + Cialis + NEW options for female libido (and does Viagra lower the risk of Alzheimer’s?)

0:00This show is sponsored by Primadine, a clean, natural and science-based spermidine supplement that's been a long-time staple in my own longevity stack. Because studies suggest that through autophagy, spermidine increases healthspan and upregulates a range of health markers, from memory and cognitive function to heart health, hormone balance, fertility and even hair growth. Plus, you can be assured that all ingredients undergo rigorous third-party testing. Buy Primadine now at OxfordHealthSpam.com and use the discount code DrSophie, that's D-R-Sophie for 20 % off. This episode is sponsored by Nuance Paris, the French specialists in next generation anti-aging and one of the best kept secrets over in France, now available here in the UK.

0:47I've recently discovered it's award-winning beauty tech with the Nuance LED masks designed to restart cellular function, perfect for this time of year. and I'm now trialling its stunning skincare range, blending premium natural ingredients with highly concentrated, scientifically proven actives. The result is an award-winning range that's suitable for all skin types, even the most sensitive. Head to Nuance, spelt N-O-O-A-N-C-E hyphen Paris dot com and get 15 % off with the code DRSOPHIE. Hi, I'm Sophie and this is Age Well with Dr. Sophie Schotter, a space devoted to all things health, wellness and longevity.

1:27Because for me, aging well is about looking and feeling like the best possible version of ourselves inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women and men, finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

2:03Dr Sophie Shotter:So, Sophie, can you first give us the lowdown on Viagra and Cialis and the key differences between both? Yes, and although Viagra is well known for treating erectile dysfunction, there are several alternatives now available. And as you said, one of them is called Cialis. They're both designed to help men achieve not only erections, but stronger erections. But they have different active ingredients which will suit different men in different ways. The thing they have in common is that they're both what's called PDE5 inhibitors. This means they relax the smooth muscles in the blood vessels that supply the penis.

2:38And as counterintuitive as it may sound, it's this relaxation that increases blood flow to the penis and creates the erection. It basically means blood can keep flowing to the penis more easily. But, and this is important, both drugs do need some kind of sexual stimulus to take effect. Neither of them will cause an erection on their own. In Viagra, the PDE5 inhibitor itself is a drug called sildenafil, while in Cialis it's called tadalafil. So as with our episode on weight loss drugs, I'll refer to these by their brand name rather than the drug name, as it'll be easier for people to keep up. Interestingly, Viagra was initially developed to treat angina and was meant to relax the blood vessels that supply the heart.

3:20This didn't really work, but in testing, many participants reported developing erections after taking it, and that's where it all began. In terms of the differences, Cialis is slightly faster acting than Viagra. Viagra must be taken at least an hour before sex, whereas you can take Cialis as little as 30 minutes before you plan to have sex. There is another daily dose version of Cialis, and I'll get into that. But, and again this is important, both help achieve and sustain the same kind of erection. In that regard neither is more powerful than the other so for example while Cialis acts faster it doesn't create a harder erection.

3:55Another difference is that Viagra remains effective for four to six hours whereas Cialis typically allows you to achieve erections for up to 36 hours after taking a tablet. But this doesn't mean you'll have an erection throughout that time. Again it should only happen when a man is actually sexually stimulated. The dose of Cialis refers to how much of the active ingredient Tadalafil is in them. The lower doses, 2.5 and 5 milligrams, are usually prescribed for daily use, while the higher two doses, 10 and 20 milligrams, can be taken as required or on demand, should I say. So you can take Cialis daily, which is an option for men who, for example, have regular sex three or more times a week.

4:37Or you can take the higher dose of Cialis or Viagra on demand just before sex. So the best option often depends on how often you're having sex.

4:45Dr Sophie Shotter:So this is all about men understanding their own sex lives? Exactly. If someone has sex infrequently or has trouble remembering to take a daily medication, then Viagra or the higher dose of Cialis might be the better option. You should see results after just a single dose and it won't drop in effectiveness from missing daily doses. For fast spontaneous sex they may find the higher dose of Cialis is the better option And for someone having more frequent sex Cialis daily may be a good idea As it's given in a low dose which makes it safe to take every day on its own The low dose also makes side effects less likely And how do men take these?

5:22Dr Sophie Shotter:Does that differ? A little bit, both are pills but you should take Viagra on an empty stomach If you have a large meal shortly before taking a pill it'll slow down the rate at which it takes effect but you can take Cialis after or before eating. With both treatments you should limit your alcohol intake for the most effective results and one other thing to say is that you might not respond to the treatment the first time you take it so don't be worried if that happens it can take a few goes. If you then don't see any results speak to your doctor as you may need a different dose or even a different treatment.

5:55You should never take the two drugs together nor should you take more than one Viagra or Cialis pill at any one time. Again, if it doesn't work, then try again next time. And if after around eight goes, you're still not getting the results you want, then speak to your pharmacist or your GP. Another thing to add is that Viagra, the branded version of Sildenafil, is generally not available on the NHS, but the generic version called Sildenafil can be prescribed. Cialis, on the other hand, is rarely prescribed on the NHS, except in certain in unique circumstances. A lot of men go private to a high street or even online chemist and Cialis is slightly more expensive than Viagra.

6:33Dr Sophie Shotter:Okay and how much are they roughly? So the cost of Viagra in the UK can vary but generally you can expect to pay between£1 and£10 per tablet depending on the dosage and how much you buy. The cost of Cialis again varies depending on the dosage, quantity and whether it's the branded version or the generic Tadalafil. A 28 tablet pack of Cialis can cost around£70. For the generic non-branded versions, prices can start from£40p per tablet or around£20 for a pack of four. Okay, and you mentioned side effects. What are the side effects? Side effects are rare but not unheard of. As they're both PDE5 inhibitors, they have similar side effects, although men may find that because Cialis is effective for longer, any side effects also last for longer.

7:19The most common side effects are like headedness, headaches and flushing to the face. Nasal congestion, indigestion and some visual changes are sometimes experienced as well. It's important to say that if you experience chest pain or a prolonged erection for more than four hours, you should seek urgent medical help. And do stay off alcohol while you're on Viagra as it makes the erection more difficult to maintain and there can be more intense side effects.

7:44Dr Sophie Shotter:And so what's all this I've heard about both pills helping with broader health and longevity? because this is really interesting. Yeah, there is some really interesting research happening and to name just one, a study at UCL has found that Viagra might help to lower the risk of Alzheimer's disease. The researchers found that on average men who were prescribed Viagra and similar medications were 18 % less likely to develop Alzheimer's, which is not insignificant. The effect was strongest in men with the most prescriptions, with scientists finding a 44 % lower risk of Alzheimer's in those who receive 21 to 50 prescriptions over the course of their study.

8:21But before we get too excited, they've also said that we can't say whether Viagra and similar pills protect against Alzheimer's or whether these men were simply already less prone. So as always, more research is needed. More generally, I've also heard a lot about so-called biohackers taking Viagra for longevity. Brian Johnson is probably the most well-known and he recently revealed he takes a small dose of Cialis every day for longevity. He quoted nearly 10 individual studies that talk about its effects on longevity, saying it has the potential to improve heart health, metabolism, and brain function.

8:56Personally, I haven't looked at these studies in depth, but I do know it's all to do with nitric oxide. So how Cialis can help improve blood circulation by increasing the levels of nitric oxide in the body. My viewpoint is to look to the work of probably the world's leading expert on nitric oxide, someone who we had on the show last summer, Dr. Nathan Bryant. And I'll link into our conversation with him. And people can think about his advice and his nitric oxide supplement. My feeling is that this could be a better route. But on the show notes, I'll link into the studies themselves because there's certainly interesting data on everything from cardioprotective effects to improvements in overactive bladder.

9:34One large observational investigation also suggested that these meds offered a 25 % lower chance of dying prematurely. But these are very early days in terms of research.

9:44Dr Sophie Shotter:And what are the alternatives to erectile dysfunction? If PDE5 inhibitors aren't working, then your doctor might recommend a range of different things. There are other meds such as Spedra, which works in 15 minutes for most men. And for severe cases, there are other options from urethral depositories to PRP. Talking therapies also help a lot of men. And of course, if you recall our brilliant episode last summer with Dr. Tracy Gappin, he has a lot to say about erectile dysfunction and testosterone, among other things. So we'll link into that episode because he's a real expert on men's health and he does do online consultations for British men.

10:21I'd also once again point all our men to our episode with Dr. Nathan Bryan. He talks a lot about the role of nitric oxide in erectile dysfunction. I think it's also important to think about lifestyle. Stress creates a huge difference and Dr. Tracy reinforced this. Drinking less alcohol can also improve blood flow. Exercise and a healthy diet will keep your weight down and improve your blood flow and talking therapy also helps. So personally for any men I'd start with these.

10:49Dr Sophie Shotter:And where are we at with female Viagra? We do have a female libido drug with the brand name Adye. The drug itself is called flibanserin but this isn't available in the UK. I will say the drug has had a controversial history with concerns about not only its effectiveness but also its side effects which is a big reason why it's not available here in the UK at least not yet. I know though that I have a lot of listeners in the US so for their benefit and in case Ady makes its way over to the UK and other countries let's talk about it. Ady works in a different way from Viagra given the obvious physical differences between male and female bodies, but it's still designed to boost sexual function.

11:30Unlike Viagra, which works by increasing blood flow, Adi targets serotonin and dopamine in the brain, with the idea that this then boosts sexual desire in women. It's not approved for menopausal women because of the way it works on hormones. Basically, Adi tries to short circuit the overthinking that many women do and clears out that prefrontal cortex so women are, in theory, more open to sex. It works similarly to an antidepressant. Has it shown itself to be as effective as what the men take? No is the truth but then it works on the brain not the genitals and female libido can maybe be a bit more complex.

12:07I actually think the idea of female Viagra is an interesting one because there's a distinction between arousal and desire in that female arousal is usually a physiological response to stimulation whereas desire is more about how we feel and what with thinking and this can be very fleeting in women which again is why female libido medications look to work on the brain. Adye has had criticism for its efficacy so one study found that women had more sex quote unquote only once or twice more a month so not big numbers but to give the flip side argument if you're going from no sex to sex once or twice a month that's a 100 % improvement.

12:44I think another interesting perspective is the lack of research into libido for women and possibly this idea that we should only develop drugs that work on the brain rather than giving us women more of a genital stimulant. You could also say that there's an argument that we've over-indexed on the psychological factors to do with female low libido and dismiss the idea that there could be more of a biological reason that women are struggling. And I'm thinking here of the many perimenopausal and menopausal women on testosterone who've reported that it's done incredible things for their libido, which is not to say that there may not be psychological factors, but the lack of research has possibly obfuscated our understanding of female sexuality because we're quite complex creatures.

13:27Either way, because of our yeast side effects, a lot of experts think a more holistic approach is better for women. Interesting. So what are the alternatives for women? I've already mentioned testosterone and this isn't to be underestimated if you're on HRT. Testosterone isn't currently licensed to treat the symptoms of menopause, but a specialist doctor can prescribe it. And again, it's been a game changer for so many women's libido. I will say that you need to have good levels of estrogen before you can go on to testosterone or it will just convert into estrogen. But let's talk supplements. And there are a few that have some small scale studies behind them.

14:05L-arginine is an amino acid that might help by increasing blood flow, similar to how Viagra works in men. Some small studies suggest it can improve arousal, but the results aren't conclusive. Macaroot is a plant extract sometimes referred to as a natural viagra due to its claims it can increase sexual desire. While some small studies have shown positive effects, again, more robust research is needed. Antripulus terrestris is a herb that's thought to increase testosterone levels, which again could enhance libido. But studies are inconclusive and the results really do vary quite widely. As always, check with your GP before you take any supplement, especially if you're on other medications.

14:46And again, as always, remember how unregulated the supplements industry is. Back to Nathan Bryant, and he has nitric oxide supplements, which are meant to be coming to the UK, I hope. So both men and women can take these. And personally, I'd avoid any other nitric oxide supplements without the kind of research that Nathan has. Because as we all know, Amazon can be the Wild West with all kinds of brands making all kinds of claims. The other thing I want to touch on is mushrooms and specifically the cordyceps mushroom because you may recall we had a great chat with Tom Baxter from Bristol Fungarium about this and certainly there's growing data that cordyceps boosts sex drive in both men and women and in men can help with erections.

15:28Cordyceps has been used for thousands of years by Tibetans, Nepalese, Chinese and many other cultures as quite a potent natural aphrodisiac. As a little background, I was reading that Tibetan farmers apparently first noticed the effects of cordyceps on libido when their yaks began to display notable signs of friskiness and twigged that they were grazing on cordyceps. There's now a grown body of evidence that shows cordyceps supplementation improves sex drive in women. For example, one study in China demonstrated an 86 % increase in female libido. Gosh, that's a lot. Yeah, it's huge. Other studies show similar and significant improvements in sexual desire and function.

16:08Research has found it to increase testosterone, while a review concluded that it could enhance libido and sexual performance. Researchers think that cordyceps supports the adrenal and reproductive organs and improves cellular energy and oxygenation. So if you're struggling with libido, whether you're male or female, I think that cordyceps could be an interesting route to try. Do check for the efficacy of any brands and certainly we'd recommend Bristol Fungarium and do scroll back to Tom's episode from the spring.

16:36Dr Sophie Shotter:Yeah I take cordyceps from Tom and I do think they make a difference anyway. Any final thoughts? I just want to reassure men that ED is far more common than they might think. The most commonly cited statistic is that the percentage of men experiencing erectile dysfunction is close to the age so 40 % of 40 year olds, 70 % of 70 year olds and so on. These are estimates of course and most of the data is self-reported but the upshot is that no matter what age you are if you're having issues getting or staying hard you're certainly not alone. Also many men with ED will keep trying to have sex despite the fact that their penis is telling them something's wrong.

17:14So if you start experiencing issues see a doctor if nothing else some causes of erectile dysfunction can be cardiovascular or perhaps something more serious. I'd also say that as far as we know, Viagra and Cialis don't produce physical dependence, but they can and often do create psychological dependence. So many doctors advise men to think about using them to get yourself going, particularly if you're in a stressful period of life, then come off them when you feel ready. That being said, there's no shame in using them longer term under the guidance of your doctor.

17:45Dr Sophie Shotter:Well, thank you so much, Sophie. I mean, there's so much shame often attached to these things isn't there and we don't I mean we talk so much about female health and we've really I think done a lot of men a favour with this episode so thank you. Thank you Fee. And that ends this week's podcast. If you want to find out more about me and my work or maybe book a consultation head to drsophyshotter.com and you can find me on socials at dr sophie shotter and again thank you so much for listening