ArcaMax

DEAR DR. ROACH: I'm a 61-year-old man who is in very good health and works out regularly. I've begun to experience minor erectile dysfunction (ED). My general practitioner prescribed tadalafil (Cialis) at 20 mg. After the second dose (in a span of five days), I began to experience severe pain in the back of my legs and glutes.

Initially, I didn't think much of it, assuming it was due to an intense workout. But the pain continued to linger for a couple of days. I did some research on tadalafil and read that this type of leg and lower back pain is common and generally dissipates within 48 hours. Mine lingered for at least three days, then slowly went away.

The most frustrating aspect of this was that sitting or laying down did nothing to alleviate the pain, so it also impacted my sleep. While the pain was occurring, it actually felt better to remain upright. I have no interest in ever taking this medication again. Is my experience common? Are there other alternatives for ED other than a reduced dosage? -- D.M.

ANSWER: Muscle pains and backache are reported but aren't common side effects. These symptoms are more likely in people who are taking the drug intermittently at a high dosage (20 mg is the highest-approved dose). It's reported 6% of the time compared with 3% of men who were taking a placebo pill, according to Food and Drug Administration documents. The pain usually resolved after 24-48 hours, just as your research showed.

Many men take 5 mg of tadalafil daily, which is as effective (and possibly more effective) than the 20 mg as-needed dose for ED. The risk of back pain is significantly less -- only 1% above placebo. This would be a reasonable choice. You could also try one of the other as-needed oral agents such as sildenafil (Viagra) or vardenafil, both of which have lower rates of back and muscle pain than tadalafil.

DEAR DR. ROACH: I'm an octogenarian male who doesn't require any medication. (I attribute this mainly to a healthy diet and reasonable activity.) About two weeks ago, the very minimal hair on my arms and legs that was unchanged for years started to grow rapidly. However, the body hair on my chest and back is minimal and hasn't changed noticeably. Is the spurt of hair growth on my arms and legs something serious? If it is, how can it be treated, and which type of medical practitioner should it be treated by? -- P.P.

ANSWER: When I looked at your photos, it seemed to me that much of the new hair growth is fine, soft, unpigmented hair. This raises the concern for a rare condition -- acquired hypertrichosis lanuginosa, which can be associated with internal cancers like lung, colon and prostate cancers.

It'd be prudent to see your doctor to consider testing for these. But I don't think they're necessarily the cause, as the fine hair often occurs first on the face before spreading to the trunk and extremities. Low thyroid levels can also cause sudden, new hair growth, as can an uncommon disease called porphyria cutanea tarda.

In your case, I think it's much more likely to be a benign condition -- idiopathic acquired generalized hypertrichosis, which doesn't need treatment. Treatment is available for people who are concerned about the cosmetic appearance.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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