[ch0I9daAiO]

For finasteride I agree, as it decreases DHT, which is not exactly a useless hormone. It shouldn't be prescribed to anyone, as you have said. I don't necessarily agree for the Viagra/Cialis. Generally cialis is safer than viagra, with less side effects. But their mechanism of action is quite simple and doesn't cascade to a lot of other body functions, inhibition of PDE5. Viagra also inhibits PDE6 more, thats why you get a blue-ish tint to your vision, and PDE1, which is more dangerous and can cause tachycardia. Cialis inhibits PDE11 more, which affects skeletal muscles and the prostate. That's why Cialis is sometimes prescribed for BPH, and why bodybuilders take cialis as a supplement (drive more blood into the skeletal muscles, decrease blood pressure).

Getting to your point of "other psychological issues" that can result in ED. Cialis and Viagra are there for one specific case of ED, which isn't caused psychologically. If you can get an erection in the morning, while you're sleeping, PDE5 inhibitors won't help.

Of course, the less drugs you take, the better, easier on your kidneys and liver. No drugs are without side effects, PDE5 inhibitors have them, but they are mild and can be diagnosed easily. Of course, dose is important, and health issue history needs to be taken into consideration.

[robbiep]

I agree that viagra/cialis are generally safe for the majority of people. I guess the question with regard to the subscription prescription model is what are the subset of medications that fall into the right risk profile for the model to work effectively? It's a pretty small subset without adequate safeguards!

[zaroth]

> If you can get an erection in the morning, while you're sleeping, PDE5 inhibitors won't help.

Did you mean to say can’t?

[ch0I9daAiO]

Nope. If you can get an erection in the morning, the vasodilatation mechanism works, so Cialis/Viagra won't help. If the mechanism works, but you still cannot get an erection when you're with your partner, the problem could be psychological, say you're not attracted anymore to your partner, anxiety, stress, all stopping you from getting aroused. And you need those neurons or endotheliums to fire. Another example is drugs that are vasoconstricting, stimulants like amphetamines or cocaine, which even though create a high arousal state, they are so vasocontricting that it's hard to achieve an erection (so Cialis/Viagra helps, but it's not indicated to combine drugs that combat eachother).

[zaroth]

Interesting, and thank you for the clarification.

I think it’s probably more of a spectrum and not a binary thing, and so you can have layers of physiological and psychological impediments, and one could also feed the other.