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But that makes it a true rarity among the nonprescription methods of male enhancement. Most are a waste of money, and some are downright dangerous, doctors say. Instead of furtively turning to untested methods, men with persistent concerns should consider opening up about them with their doctors. That's because performance problems sometimes act as an early warning signal for serious health problems. Your doctor might be able to prescribe something that can really help, or least provide a valuable dose of perspective about what constitutes "normal" sexual performance.

Sexual performance declines naturally as men age, doctors say. But a rapid or severe decrease in performance or libido can be a red flag. Most importantly, erectile dysfunction may be an early predictor of heart disease. Atherosclerosis , a condition in which fatty deposits build up inside arteries , may restrict blood flow to the penis and cause erection difficulties. For men with ED who are at risk of heart disease , prescribing Viagra or its cousins isn't enough, Boyle says.

These men should be also be controlling their weight and cholesterol level, limiting their alcohol intake, and quitting smoking. Evidence shows that these changes in themselves can have a positive effect on sexual function, Boyle says. Sometimes men with erection problems or a diminished libido have low levels of testosterone , Boyle says.

Testosterone deficiencies can also affect mood and energy levels. Boyle tests for testosterone levels and prescribes it as a topical gel, though she warns it is only safe when prescribed and monitored by a physician. Nonprescription testosterone, such as the kind used by some bodybuilders, is dangerous, she warns. For men with performance issues who are physically healthy, Boyle often prescribes counseling, such as marriage counseling for men with relationship issues or psychiatric help for men who are preoccupied with a problem in penile appearance.

For young men with sexual performance problems and no signs of physical problems, Boyle may prescribe counseling and a low dose of Viagra as they work out issues of insecurity. The FastSize Extender device promises results, but it's far from quick and easy.

Just ask Bob, a retail manager from New Jersey. He says he's gained over 2 inches of erect length. All it took was 25 months and over 2, hours wearing the device, typically five hours a day, seven days a week. Richard, the mechanic from New York, got results faster than Bob, but still wore the device under his clothes for about eight hours a day.

Richard's wife has also been supportive. She also says the lengthening has enhanced their sex life, though she had no complaints before. Chicago urologist Laurence A.

Levine, MD, director of the male fertility program at Rush University Medical Center, tested the FastSize Extender on 10 men afflicted with Peyronie's disease , which can cause bending and shrinkage of the penis. At the end of the six-month study, which was funded by the maker of the FastSize Extender, Levine found increased penile length and reduced curvature in every man and increased girth in seven of the men.

Calling the results "remarkable," Levine now prescribes the device to many of his Peyronie's patients and reports no significant complications. Levine has also worked as a paid consultant to FastSize Extender. Could FastSize work on men of normal penile length? Levine says it might.

Penis-lengthening surgery is also an option for men, but it is a highly controversial procedure. The American Urological Association says a common form of lengthening surgery involving cutting the suspensory ligament of the penis has not been shown to be safe or effective.

The group also refuses to endorse surgeries that inject fat cells in the penis with the goal of increasing penile girth. Many doctors question whether the benefits of lengthening surgery outweigh the risks. Men who are overly preoccupied with penis length tend to have unrealistic expectations of surgery and should seek counseling instead, the authors wrote.

Thousands of years before Viagra, men were consuming everything from horny goat weed to powdered rhino horn in hopes of boosting sexual performance.

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