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Youth appeal

Men without diagnosed problems are now turning to anti-impotence drugs.

August 30, 2004|Valerie Reitman | Times Staff Writer

Hawkers in popular bars now sell anti-impotence drugs, whispering that they have "blues" available for 5 bucks a pop, less than the pharmacy price.

Friends pass their pills along to others, often drug users who use them to counter the effects of drugs such as methamphetamines or Ecstasy, which can leave them unable to get an erection.

Websites sell the drugs -- or counterfeits -- to nearly anyone who requests them.

And many healthy young men with normal sexual functioning are asking their general physicians for Viagra, Levitra or Cialis to help them conquer anxiety or offset the effects of smoking and partying.

Meanwhile, the makers of the erectile-dysfunction drugs are running racier-than-ever campaigns targeting younger men and straying from the depictions of the drugs as medicine. "Get back to mischief," woos the latest Viagra slogan, with devil's horns seeming to emerge from behind a middle-aged man's ears.

These are all part of the new and rapidly changing face of erectile dysfunction drugs. Since the first impotence drug, Viagra, debuted in 1998 to address a physical problem for some men, it and newer sister drugs Levitra and Cialis have been used increasingly by healthy younger men for perceived performance-enhancement purposes or as psychological life-preservers to alleviate performance anxiety.

"When Viagra first came out, the whole emphasis was on older men, with Bob Dole doing the marketing and the age group being around 70," says Dr. Abraham Morgentaler, a urologist and associate professor at Harvard University. "Now we're seeing the bar lowered, not just for men wanting it but for physicians giving it out to those who are younger and less severely affected."

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Breathing easier

And while physicians say the drugs have been a godsend to many men who need them, the expanding usage is raising questions about whether insurers should continue to pay for the drugs, whether the drugs may be a factor in the increase in sexually transmitted diseases and whether the newest ads promote the drugs more as lifestyle-accouterment than medical necessity.

Other countries have already taken action to address some of these concerns. Most private and government insurance plans in Europe do not cover the drugs, and amid vigorous debate, the United Kingdom's national health insurance has severely limited its coverage of the pills.

Another concern is that the drugs may be psychologically addictive, says Morgentaler, author of "The Viagra Myth," a book about the common misperceptions surrounding the drug. Healthy men may begin to feel inadequate without the pill, he says.

"For younger men to feel the need to take a pill to be deemed adequate is a lost opportunity to find out that who they are is enough and that they can be loved for who they are."

Many seem to have gotten the wrong idea about what the drugs can and can't do. One cardiologist tells of a healthy man in his 20s with no apparent functional problems who asked for a prescription to help him celebrate his anniversary in Las Vegas. And a sex therapist says that men as young as 16 have sought her help, thinking they need Viagra to have sex or that it might compensate for having a smaller penis.

In fact, the pills enable some men who have hypertension, diabetes or prostate problems to get an erection by increasing blood flow to the penis, provided the brain kicks in with some sexual stimulation. They don't make people better lovers, instantly mend broken relationships or enlarge penises.

Still, many doctors and drug companies don't believe the drugs are being overused and, in any case, see little danger in them. About 75% of the erectile drugs are now prescribed by general practitioners rather than urologists or cardiologists.

Dr. Louis Kuritzky, a clinical assistant professor at the University of Florida's department of community health and family medicine, says he generally gives a prescription when asked. "There's no way to prove they have it any more than a woman having menstrual cramps or headaches. We trust them unless there's reason to believe otherwise."

Even if the cause is psychologically rooted, Kuritzky says, many people can't afford the money or the time that therapy would require. The pills, he adds, can offer a temporary quick fix to restore confidence, which may be all that's needed.

"When you have garbage that is rotting, the best thing to do is to take it out," he says. "But if you can't, sometimes it's best to spray perfume on it. Sex therapy is a luxury for only the economically elite."

Pfizer, which sold $1.9 billion worth of Viagra last year and says 23 million men worldwide have tried it, maintains that it is not promoting the drug for enhancement purposes. Spokesman Daniel Watts says the company believes that if a man is troubled enough by erection problems, then he should consult a doctor about a possible underlying condition.

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