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Here are the main causes of impotence. Modern drug therapy for ED made a significant advance in 1983, when British physiologist Giles Brindley dropped his trousers and demonstrated to a shocked Urodynamics Society audience his papaverine-induced erection.[30] The drug Brindley injected into his penis was a non-specific vasodilator, an alpha-blocking agent, and the mechanism of action was clearly corporal smooth muscle relaxation. Although they are generally safe and free of side effects (unlike chemical drugs), it is important to know that the quality of their extraction and preparation processes varies widely. To date, its effects on treating impotence and other sexual dysfunctions have been extensively studied. Ultrasound is then used to see vascular dilation and measure penile blood pressure. Furthermore, studies have shown that lack of testosterone leads to a range of other sexual performance problems, including premature ejaculation and low sex drive. The practice, which involved inspection of the complainants by court experts, was declared obscene in 1677. Other studies have suggested that Tribulus also acts by increasing the level of dehydroepiandrosterone (DHEA), a naturally occurring substance in the body believed to be important for a healthy sex drive. The active ingredient of Tribulus acts as a natural precursor to these hormones and is converted into its final forms by the body's own natural enzymes. Penile erection is managed by two mechanisms: the reflex erection, which is achieved by directly touching the penile shaft, and the psychogenic erection, which is achieved by erotic or emotional stimuli.

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In all, these studies proved that Tribulus works very well in curing sexual dysfunctions and maximizing sexual performance when taken regularly. In fact, almost 100% of men who use cocaine regularly are impotent. As testosterone and other male sex hormone levels start to drop after reaching middle age, low testosterone level is often the culprit in most intermittent impotence problems, especially in older men. Although middle-aged and older men are more likely to be impotent than younger men, impotence can strike at any adult age.

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