Dear Dr G,First of all, Gong Xi Fa Cai and Happy New Year to your family and all readers celebrating.I have read with interest all the articles you wrote about “love pills”. I agree that the medication is unavoidable when ageing or unhealthy men are affected by erectile dysfunction.Although you have provided reasonable scientific evidence that the blue pills are safe, I have several concerns.You may think these concerns are myths, but I need to put you on the spot to debunk them before“Chinese Valentine’s Day” or Chap Goh Meh.First of all, is there evidence that taking too many of the pills at an early age can result in dependency?Secondly, by taking the pills earlier in life, does it mean higher doses will be needed as we age?Also, can too many blue pills cause renal failure?Lastly, I often hear about sudden death associated with taking the pills. Has this happened?Mythical Mike Despite decades of clinical use and extensive research, phosphodiesterase type-5 inhibitors (PDE5 inhibitors) remain surrounded by persistent myths. These medications influence blood vessels and sexual function, so they often cause anxiety and attract misinformation. Concerns about dependency, tolerance, kidney damage and sudden death continue to circulate, even though there is scientific evidence that clears the air. One of the most common fears is that people who use PDE5 inhibitors will become dependent on them. This belief likely arises from confusion with medications that affect the brain’s reward system, such as opioids or sedatives. PDE5 inhibitors, however, do not act on addiction pathways in the brain. They do not produce cravings, withdrawal symptoms, or chemical dependence. Their action is purely physiological, as they enhance blood vessel relaxation. When the medication is stopped, the body does not experience withdrawal. Instead, in some cases, individuals may develop psychological reliance because they feel more confident or comfortable when the medication works reliably. This form of reliance is comparable to using glasses for vision correction rather than a sign of drug addiction. The underlying condition remains unchanged, and the medication simply helps manage its symptoms. Another widespread misconception is that long-term use inevitably leads to tolerance, meaning the body becomes accustomed to the drug and requires increasing doses. This idea is common with substances such as alcohol or certain pain medications, and it is often incorrectly applied to PDE5 inhibitors. Long-term clinical studies have shown that these medications maintain their effectiveness over many years without the need for progressively higher doses. When patients report that the medication seems less effective over time, the most likely explanation is progression of the underlying health condition rather than tolerance to the drug. Erectile dysfunction is frequently linked to ageing, diabetes, high blood pressure and cardiovascular disease. As these conditions worsen, symptoms may become more severe, creating the impression that the medication is losing effectiveness. In reality, the disease may be progressing while the drug’s pharmacological action remains stable. Concerns about kidney damage represent another enduring myth. Many people think that any medication processed by the body must place strain on the kidneys. PDE5 inhibitors are primarily metabolised by the liver and are then eliminated through both urine and stool. In individuals with healthy kidney function, these medications are not known to cause kidney damage when used as prescribed. For patients with severe kidney disease, physicians may recommend lower doses because the drug can remain in the bloodstream for a longer period. This adjustment reflects careful medical practice rather than evidence of toxicity. In fact, ongoing research is exploring whether or not PDE5 inhibitors might offer protective benefits in certain cardiovascular and kidney conditions because of their positive effects on blood vessel health and circulation. Perhaps the most alarming myth is the claim that PDE5 inhibitors can cause sudden death. This fear gained attention shortly after the first medication in this class became widely available, when media reports highlighted isolated cases of heart attacks occurring during sexual activity. The crucial context often overlooked is that sexual activity itself is a form of physical exertion. Many individuals who use PDE5 inhibitors are older and may already have cardiovascular disease, which increases the risk of heart events regardless of medication use. Large studies have demonstrated that PDE5 inhibitors do not independently cause sudden death when prescribed appropriately. The primary safety concern involves combining these medications with nitrate drugs used to treat chest pain. This combination can cause a dangerous drop in blood pressure and is strictly avoided. Some research even suggests that they may improve cardiovascular health by enhancing blood vessel function and circulation. These myths persist partly because the medications were highly publicised when introduced, and because they are associated with sensitive topics such as sexual health and heart disease. Public discussions often lack the nuance of scientific research, allowing fear to spread more easily than accurate information. Over time, repeated misconceptions can become accepted as fact despite the lack of supporting evidence. In conclusion, the myths that PDE5 inhibitors cause dependency, tolerance, kidney damage, or sudden death are not supported by scientific research. These medications work by enhancing natural vascular processes and have been studied extensively for decades. When used under proper medical supervision and with attention to contraindications, they have an established safety profile. Understanding the difference between myth and evidence allows patients to make informed decisions based on science rather than fear. American astronomer Carl Sagan once said: “Extraordinary claims require extraordinary evidence.” When Dr G is put on the spot to debunk love pill myths before “Chinese Valentine’s Day”, his response is: after 28 years of overwhelming evidence, why are there still extraordinary claims?
