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A serum thyroid-stimulating hormone evaluation is appropriate in select patients.
Pavelka's conviction that biking had led to his problem was soon backed up by medical authority. Irwin Goldstein, MD, a specialist of erectile dysfunction with the Boston University Medical Center, was widely quoted in the press saying that all male cyclists risked erectile dysfunction, and that they should consider giving up the sport if they enjoyed sex.
The main active component of each extract was tested against an enzyme known as phosphodiesterase-5A1 (PDE5A1), which regulates blood supply to the penis. Inhibition of this enzyme results in more blood flow to the penis, resulting in an erection.
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The risk of heart attack or abnormal heart rhythms during sex is higher in men with unstable angina (angina that occurs at rest or with minimal exertion), poorly controlled hypertension, moderate to severe heart failure, moderate to severe disease of the heart's valves, recent heart attack (less than 2 weeks previously), potentially life threatening disorders of heart rhythm such as recurrent ventricular tachycardia, and moderate to severe disease of the heart's muscle. In these men, doctors usually stabilize or treat the heart conditions before prescribing sildenafil.
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