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Health // Doctor in the House
Rasa Fournier

When Viagra Doesn’t Work

Dr. Charles Arakaki
Chief physician at Hawaii Male Medical Clinic

Where did you receive your schooling/training?

I got my undergraduate degree at the University of Hawaii, as well as my medical degree at the John A. Burns School of Medicine.

How long have you been practicing?

I was in private practice for four years, until the Hawaii Male Medical Clinic opened last October.

What are the main issues you address at the clinic?

Men’s sexual function and low testosterone, or andropause, which is the slow decline of hormones that occur in men, similar to menopause in women.

Are you able to help men who have not had success with some of the popular male potency products like Viagra?

We have different forms of medication, which work much faster than the ingested tablets. We also have injectable medications that are a combination of FDA-approved medications, which cause the vessels of the penis to dilate in order to create an erection.

What is the difference in potency between injectable and oral medicines?

Oral medications, because they go systemic, do not only affect the penis, but also may affect other areas of the body as well. Common side effects may include flushing of the face, headaches, stuffy nose or congestion. With the injectables, the medication takes about seven to 10 minutes to be effective and has very few side effects.

Are there ever side effects like you see in movies, where someone has a persisting erection, even for hours?

Priapism (a persistent erection) is a very real concern, even in our clinic. Because our medications are very effective and powerful, we have to custom-tailor every single prescription to each patient. We take into consideration age, medical condition, and very important, a complete history, in order to avoid those complications. In the rare case of a priapism, we have a 24-hour emergency line and our doctors are on call 24 hours a day, seven days a week.

Do you also address symptoms like premature ejaculation?

Yes, we treat premature ejaculation, both with topical medications, which decrease the sensitivity of the penis – we’ve been very successful with these medications – as well as with injectable medications. With the injectables, we can cause an erection for a specified period of time, and you can have multiple ejaculations within that period of time and continue to have the erection, so you can continue to please your partner.

Are these issues age-related or are there preventative measures men can take?

Erectile dysfunction is very common and often starts in the 40s and gets progressively worse. Probably the most common cause of erectile dysfunction is some sort of vasculature disorder where there’s narrowing of the arteries. Many cardiologists consider erec-tile dysfunction an early indicator of atherosclerosis, or narrowing of the arteries. However, there are other medical conditions, mainly diabetes, which can affect men’s sexual health.

In general, for prevention, do what your primary care physician will tell you: Keep healthy nutrition, get enough rest, take your multivitamins and exercise in order to prevent the common disorders from occurring, like obesity and diabetes.

You mentioned you also address low testosterone.

It’s a very common condition that’s progressive as we age. Different people have different levels at which they start to feel the effect of low testosterone, like lower sex drive, lower energy, decreased muscle strength, and a decrease in good sleep and overall feeling of health. That’s something very important that we address, because we know that with healthy testosterone levels, not only do they get the benefit of general health, but our medications also work better.

Anything else you’d like to add?

We do a full evaluation of each patient, including blood levels to determine any number of things that can affect sexual health. We’re looking for obvious diseases like heart disease, diabetes, obesity – common things that affect the strength of a man’s erection or will affect his libido. We do a Doppler exam to be sure that the blood flow is proper into the penile region, and we go more in depth than most doctors as far as drilling down into the history of the patient and the patient’s family to understand what issues they have now, what issues might not have been detected, and then we find a treatment customized to what the patient needs. Sometimes it might be just a singular medication and other times it’s a combination of two medicines.

The medicine we have at Hawaii Male Medical Clinic has a strong positive effect on a man’s lifestyle. For instance, does he have intimacy with his partner? That goes to a strong relationship. Part of his medical evaluation is finding out where the man is physically and where he wants to go as far as his sexual health or his hormonal health.

We make the necessary adjustments as the man’s body changes. As we age, we all keep changing chemically and physically, that’s part of the care that we offer that’s different.

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