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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19458
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hi I have suffered from ED all my life which has caused a lot

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Hi I have suffered from ED all my life which has caused a lot of pain and anguish. I am 39 years old.
3 years ago I bought a compound supplement online called Vigrx containing a number of natural ingredients. Also another compound containing eurycomia longifolia.
After a month my problem was completely reversed for the first time in my life and finally I managed to sustain a healthy relationship.
Two weeks ago the supplement stopped working.
I was recommended to try a different product Viaman with slightly different ingredients which I have swapped over to. I have stopped taking the eurycomia completely yesterday as this was not working either.
I have felt desperate so tried other more immediate affecting herbal supplements which again are not working.
My first question is have I developed a tolerance? If so will taking the alternative product work? (this also takes one month to infuse) Should I continue with the second product or take nothing for some time? My concern is if I have developed a tolerance is it of just the products or is it my receptors no longer working/ reacting and how long will it take for the Vigrx to work again if I try to take that again when do you think?
Sorry for all the questions but I am intensely depressed feeling my life has fallen apart and about to lose my relationship and dont know the best thing to do.
I can add that I have researched all this in some part and I'm not sure but it would seem that this is attached to my free testosterone production. It makes me think I have always had one teste that is much smaller than the other almost non existent. A doctor previously told me that this was nothing to worry about but I'm thinking that this may now be related?
Finally, is there alternative medical approach and procedure that I could try please?
I look forward to your reply. Thank you so much in advance.
Hello from JustAnswer.
It will help if you could provide some further information.
Have you had testosterone/free testosterone levels checked?
When the doctor said that this was nothing to be concerned about, was that in reference to testosterone levels or to the fact that one testicle was smaller than the other?
Have you tried any prescription medicine for the ED?
Customer: replied 3 years ago.


Thank you so much for coming back to me.

I havent had testosterone/ free testosterone levels checked but had a blood test last week where results said that there was no problem apart from slightly high cholesterol.

However I never asked to check for testosterone levels so I guess they would not have checked this?

The doctor who told me that there was nothing to worry about was in reference to one testicle being smaller than the other. I have not had testosterone levels checked.

I have tried Viagra but it gave me very bad headaches and made me feel sick. Also it was only potentially a fix at the wrong times when I had no idea when I would be having sex. Often I would take it for no reason and feel sick and ill.

As I say, the Vigrx and Eurycomia was a miracle cure with no side effects and allowed me to have very successful sex at any time.

Neither a testosterone level or a free testosterone level are done as part of routine labs at a regular check-up. However, if you were being evaluated for ED, then a testosterone level will frequently be done.

Were these lab tests done as part of an evaluation for ED?

The doctor that said that having one small testicle is not an issue is generally correct. A man will typically do fine with one testicle, both from the perspective of testosterone production and sperm production. There are times when we surgically remove one testicle, and these men typically do fine with just one testicle. However, it is possible that an infection of the testicles could have left one testicle smaller than the other, but also affected the testicle that is normal in size.

Do you remember whether it was an infection of the testicles that caused the one testicle to be small?
Customer: replied 3 years ago.

I have had the one testicle smaller as long as I can remember actually. the sack has always felt and looked quite deflated also.

I never had an evalaluation for ED. Onlle been quickly prescribed viagra and told it was psychological. I dont think it is at all now after taking these online compounds.

Thank you for the additional information. I am sorry for the length, but it is a comlex situation.

There are several issues to consider in this situation.

It is frequently difficult to differentiate physical and psychological causes of ED. The fact that a product helps ED does not rove that it is physical, as there are studies that show that Viagra and similar medicines have good effectiveness for men that have ED that is psychological in origin.

However, in a young man with ED, it is reasonable to perform a testosterone level. A free testosterone level is usually only needed if the total testosterone level is borderline or if there are specific conditions present that would be a risk factor for abnormal level of the protein that binds the testosterone. And many men with a low testosterone have testicles that are normal in size, so the consideration of checking testosterone levels would be true even if the testicles are normal.

As for the primary questions about these herbal products, it is important to realize that there are no clinical studies on the specific combination of substances that are used in these products. Consequently, there is no direct scientific knowledge that can clarify the nature of any tolerance that develops or the duration of that tolerance. However, there are some studies of individual ingredients and knowledge of how the body respond generally to tolerance.

If a product initially worked and then does not work, then yes, that would indicate tolerance. Tolerance is typically due to altered regulation of receptors, but it is unknown which receptors are affected by the Vigrx. Generally speaking, tolerance to non-addicting substances will frequently diminish over 3-6 months

The two products have no ingredients in common, so tolerance to the Vigrx will not indicate that there also would be tolerance to the Viaman.

As for alternative treatments, if the testosterone levels are low, then testosterone replacement would be appropriate. For most men with ED, the Viagra and similar medicines are the option that is most likely to be effective, both for the short and the long term. However, if you developed side effects to the Viagra, it may be better to try once daily Cialis. This uses a smaller dose of a longer acting product, so that there are not the sudden changes in blood levels of the drug that are seen with Viagra, so is better tolerated by many men.

There also are treatments that use alprostadil, either by suppository or injection. There also is a compounded injection that combines the alprostadil with two other medicines that improve blood flow, called Trimix

So, it would be OK to use the Viaman, and the tolerance to Vigrx does not indicate any likelihood of tolerance for the Viaman. It would be appropriate to check testosterone levels, and if low, to start on testosterone replacement. Another option that has good evidence to support its use would be daily Cialis and if this is not effective, use one of the alprostadil based treatments.

If I can provide any further information, please let me know.
Customer: replied 3 years ago.

Thank you very much for your detailed answer. I appreciate it.

Can I ask if you looked at the different ingredients for Viaman and Vigrx and confirm that you are advising that I should continue taking Viaman to expect results? I have been taking the Viaman for just over a week now actually alongside the Vigrx which I have now stopped taking together as I didnt see the point when the Vigrx is clearly not working. The Viaman is advertising as taking one month to start working.

While I am taking the Viaman is my tolerance to Vigrx diminishing?

My concern and question to ask is, if the Viaman affects the same receptors as the Vigrx will it still be able to work? I am worried that is it the receptors that have stopped working. Is this possible and wont this mean that nothing will work whatever the ingredients? What do you mean by 'altered regulation of receptors'?The other short term supplements I have tried again have not worked.

Can I also ask if the Cialis is a daily long term medication now? I thought this was only an ad hoc medication to be administered at certain times like Viagra?

Can I take the Cialis at the same time as the Viaman?

I will ask my GP for a testerone check. Will this be a blood test?

Is the alprostadil also a long term course rather than an ad hoc administration?

I guess I'm asking for advice on both a short term and long term procedure.

So sorry for all the questions but I am in a very bad place mentally with all this and really appreciate your replies.


Since there are no studies that support either product, I typically do not advise either product. Even the studies that look at the individual ingredients do not provide evidence that any of the ingredients are very effective. However, I do have patients that have tried these and similar products, and if they ask, my advice is that they are OK to try and if they are effective, they can be continued.

Yes, since the Viaman and the Vigrx have different ingredients, the tolerance to the Vigrx is diminishing while the Viaman is being taken.

The levels of receptors are regulated by the cells, and altering the levels of the receptors would change how the cells respond to the substance. It may be an increase or a decrease in receptors, depending upon the specific situation, but there is not sufficient knowledge of the Vigrx to know which receptors are affected. Since the specific receptor is not known, nor whether it is an increase or a decrease in the receptor, I use the generic phrase of altered regulation of receptors.

The Cialis is available as either a dose to be taken when desired or a dose to be taken daily. The as needed dose is usually 10 mg and can be increased to 20 mg if the 10 mg dose is ineffective. The daily dose is usually 2.5 mg and can be increased to 5 mg if the 2.5 mg dose is ineffective. Since the daily use dose is lower, it is better tolerated by many men. The Cialis can be taken with the Viaman (or Vigrx, if you resume the Vigrx in the future).

The alprostadil treatments can be used long-term, although only taken when needed to achieve erections.
Customer: replied 3 years ago.

Thank you.

One last clarification:

Are all my receptors permanently inaffective now or would you say this is just a tolerance of the Vigrx product? Is it a surprise to you that after 3 years this stopped working?

At a guess, do you think that Viaman will work now for me based on your knowledge of receptors and the Vigrx becoming inaffective?

Given that the cialis can be taken with the Viaman are you saying that all these medications work on different receptors? Surely there are only certain receptors that achieve these results?

Can you tell me what is involved in testosterone replacement?

These really are my last questions. Thank you.

The receptors are usually not permanently affected. Since the Viaman has different ingredients, the likelihood that it will help you would be the same as if the Vigrx had not been previously taken, but there are no studies that can say the likelihood that it will work.

There are many different receptors that are involved, even when we know which receptors are involved. The Viagra and Cialis work by a different mechanism than testosterone, and both are different than the alprostadil and the other ingredients added to the Trimix.

Testosterone replacement can be done by injection or topical treatments. The topical treatments are becoming more popular, as most patients prefer to avoid injections when possible. The dose is adjusted to achieve a normal level of testosterone.
Customer: replied 3 years ago.

Thanks. I will rate your service as excellent.

Can I ask how you know the ingredients to Vigrx and Viaman are different?

I looked up the ingredients to each product online.
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