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Mainly through its incorrect use alongside nitro compounds (NO-donors). This can produce an acute drop in blood pressure that, combined with the increased oxygen required during sex, can be detrimental in men with heart disease. Clearly, this is the result of a series of conditions occurring simultaneously.

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A one year study of males with an average age of 54 showed an increase in testosterone of 5. 5 and a decrease in estrogen of 15.]