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Viagra and Virility
 Ric Margolis, a hip, 38-year-old urologist, is a popular guy. Wherever he goes - in the office, at the gym, to parties - guys in their 30s and 40s follow. Even at the hospital, colleagues sidle up, one fella to another. They want to know: Can that little blue pill he prescribes re-create those invincible college days?
"They all say the same thing: 'It's not as good as it used to be,' just like they're not as good at sports as they used to be," Margolis says of their sex life. "These are men who can still have sex and satisfy their partners, but they just want more. So I write them a scrip."
General practitioners and urologists like Margolis have seen a stunning migration in the average age of Viagra users, as the drug proliferates among healthy, virile, middle-aged guys hoping to become King Kong, at least for a night. Some are looking for a psychological life preserver against the hefty expectations of modern dating. Others are recent divorcés nervously back in the game. But perhaps most common of all in the suburbs, doctors say, are married fellows in their 40s -stressed out men who simply want to feel pumped again. "The typical guy I see is in a stable, healthy marriage, but he works too hard, he's exhausted and his kids are driving him crazy, all of which stress his love life," says Harrington Park internist Stephen Brunnquell, who counsels his patients to make more time for their marriage. "When you're 22 years old, nothing stops you. When you're older, it's a lot harder to be hot and heavy if you're sleep deprived or worried about your teenager. Are there a lot of healthy guys in their 40s using it? You bet. Do I think that's a problem? Not at all." Brunnquell, like others, advises patients of the risks. Common side effects include headache, facial flushing, upset stomach and blurred vision. The drugs can be deadly if taken with nitrates, a common medicine for angina and high blood pressure. The long-term effects are unknown.
Nevertheless, with the onslaught of seductive advertising by Viagra and its competitors, it's no wonder younger men are paying attention. Pfizer dumped its spokesman, septuagenarian Bob Dole, for Rafael Palmeiro, a 39-year-old home run slugger who says he's used Viagra even though he doesn't have problems in the sack. Levitra, which runs ads during National Football League games, promises "higher quality erections," which suggests more of a lifestyle fix than a medical one.
"Get back to mischief," entreats one Viagra campaign, as devil horns appear behind a smirking middle-aged guy's head. Or consider Pfizer's current TV ad, featuring a couple that look to be about 40. As the actors suggestively raise their eyebrows, a sultry voiceover narrates: "Remember that guy who used to be called 'Wild Thing'? The guy who wanted to spend the entire honeymoon indoors?... Yeah, that guy. He's back."
Despite denials by pharmaceutical companies that they're promoting the drugs like viagra for recreational sex or penis enhancement, the profile of users has changed dramatically since Viagra debuted in 1998.
In a recent study published in the International Journal of Impotence Research, scientists analyzing a random sample of about 5 million people found that while older men continued to flock to the drug between 1998 and 2002, younger men had become the new devotees - in droves. Among men aged 18 to 45, reliance on Viagra had vaulted more than 300 percent in just four years. Among men aged 46 to 55, use had more than doubled. Last year, sales of Viagra hit $1.1 billion nationwide, with 16,317,000 prescriptions dispensed at a cost of more than $10 a pill. Around the globe, nine tablets were sold every second. Though Viagra continues to dominate the market, Levitra - introduced last August - has gained a foothold, claiming 10.6 percent of the market as of July, according to IMS Health, a pharmaceutical information company. And Cialis, also known as "the weekender" because it lasts 36 hours compared with Viagra's four, has also done well. Introduced last November, it captured 10.9 percent of the market by July and accounted for 1.2 million scrips in just seven months.
The journal study by Express Scripts - which manages pharmacy benefits for 50 million members - also identified another trend: Fewer men were using Viagra for medical reasons. To determine that, researchers reviewed whether the men had filled prescriptions for conditions that contribute to erectile dysfunction, such as diabetes or hypertension. Of course, the actual number of users under 45 is probably considerably higher, because the study doesn't include the Web-savvy - presumably younger - men who are buying Viagra on-line or its competitors, including illegal "generic viagra". Health professionals worry about men who buy the drug that way or get it from friends, without medical advice. Some also suspect that the drug's ubiquitousness - and the intensified obsession with all aspects of sex - has spawned anxiety among middle-aged men who never before thought they had anything to worry about. "The effect of Viagra and Cialis is not that men are any less worried about performance; they're as worried as ever, perhaps even more than before," says Barnaby Barratt, president of the American Association of Sex Educators, Counselors and Therapists, who nonetheless believes the drugs have been a godsend to dissatisfied men. Still, he says, "The marketing of these drugs has created a sort of tyranny on men, that the effects of normal aging are no longer acceptable."
Experts also have another fear: Young men active in the party scene often rely on Viagra to offset the effects of hallucinogenic drugs like Ecstasy and crystal meth, which fuel desire but weak erections. Public health officials suggest that combination is responsible for a recent surge in sexually transmitted diseases, particularly among gay men, because they enable longer-lasting and more frequent encounters. A 2002 survey in San Francisco found that men who used the drugs together were six times more likely than non-users to have unprotected sex. But in North Jersey, most men trying Viagra or Cialis aren't on the party circuit or headed for sex clubs.
Richard Garden, a 43-year-old Westwood urologist, says 20 to 30 percent of his waiting room is filled with regular Joes in their 40s who are neither party animals nor sufferers of classic erectile dysfunction: the repeated inability to achieve or keep an erection firm enough for intercourse. They're just nostalgic for their Romeo days.
"Viagra has been so widely promoted, and the idea of an improved sex life is so widely accepted, that a lot more people are scrutinizing their performance than in the past," says Garden. "Some people who wouldn't have felt inadequate before now ask for the drug because they know it's out there. Others just ask because they're curious.
"My philosophy is pretty loose. If they think it'll improve the quality of their lives, and if they're in good health and have no medical contraindications, I have no problem prescribing it. I had a guy a few years ago who was in a new relationship and was having a hard time consummating his fifth encounter of the evening, and he wanted Viagra to help him get there. So I gave him the pills. I don't presume to judge what's right or wrong, as long as it's medically safe."
Sam Fields
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