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    Alex Shteynshlyuger is a board-certified urologist, who specializes in all aspects of care for sexual problems in men including ED, premature ejaculation and other sexual concerns. He helps men of all ages who experience impotence to regain confidence and erections. Many men of all ages use Viagra to help them get and keep great erections. Sometimes, Viagra stops working as well as it did previously – either the erections are not as hard as they used to be or it is more difficult to get and keep erections. It is rare for people to develop tolerance to Viagra; for the most part, the drug works for the long haul. – you may not have taken it properly or did not give it enough time to work. If Viagra did not work once, try it again before giving up. If a man has low testosterone, Viagra may not work as well as it did before. At New York Urology Specialists we successfully treat men with low testosterone and erection problems. However, I want to cover another important reason for Viagra failure here: lack of baseline nitric oxide production in men that are 40 . (And sometimes failure occurs with these PDE5 Inhibitors due to nasty side effects including headaches and hearing, vision and stomach disturbances.) I have already documented many reasons for their lack of effectiveness in my link on Why Viagra Doesn't Work. These drugs fail and fail miserably for them - they simply do not work. Well, not for a huge percentage - around a third - of middle-aged and beyond men. This point was emphasized in a Recent Interview with Nathan Bryan, one of the world's foremost experts on nitric oxide. Bryan explained how PDE5 Inhibitors work, which is by inhibiting the activity of an enzyme that breaks down nitric oxide. In other words, and as I have explained often on this site, Viagra and other similar drugs do not actually directly increase NO, they merely allow it to stay in your system longer. This is only effective if you have sufficient baseline nitric oxide production in the first place. Bryan put it, "Without production of NO, this pathway does not and cannot work.

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