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Tadalafil (Cialis) best place to buy viagra online canadian viagra for sale Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage. Patients also have claimed that other oral drugs—including yohimbine hydrochloride, dopamine and serotonin agonists, and trazodone—are effective, but the results of scientific studies to substantiate these claims have been inconsistent. Improvements observed following use of these drugs may be examples of the placebo effect, that is, a change that results simply from the patient's believing that an improvement will occur. Because as many as 25 percent of cases of erectile dysfunction are due to medication side effects,4 the patient's drug therapy should be reviewed. Common pharmacologic causes of this disorder include antihypertensive drugs, most notably the centrally acting agents, beta blockers and diuretics. Antipsychotic and antidepressant drugs are also frequently implicated. Other drugs that can cause erectile dysfunction include spironolactone (Aldactone), cimetidine (Tagamet) and finasteride (Proscar).5,7 Excessive alcohol intake, heroin use and cigarette smoking are also known causes (Table 2).4,7,8 A penile prosthesis does not change sensation on the skin of the penis or a man's ability to reach orgasm. Ejaculation is not affected. Once a penile prosthesis is put in, however, it may destroy the natural erection reflex. Men usually cannot get an erection without inflating the implant. If the implant is removed, the man may never again have natural erections.