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3) Retina. Cialis also effects PDE6 to a significant extent. PDE6 is another related phosphodiesterase enzyme and is present in the retina. Here are the kind of all-too-common side effects reported with regular tadalafil (Cialis) use: "Transient changes in vision, transient and mild impairment in color discrimination, eye pain, eyelid swelling, electroretinographic abnormalities, abnormal histopathologic findings,4 pupil-sparing third nerve palsy, and central serous choroidopathy have been reported."  Again, after decades of use, what is this going to do to your vision?
4) Cortisol. Cortisol is one of the biggest enemies of the middle-aged and beyond male. If too high for too long of a time, it decreases testosterone, increases visceral fat, increases insulin resistance and destroys neurons just for starters.  Now Cialis has also been found to improve the testosterone to estrogen ratio, but the truth is that we just do not know if the increase in cortisol could cause long term issues. Could it slightly increase the chances for visceral fat? metabolic syndrome? We just don't know.
CAUTION: If you have a medical condition or are on any medications, please discuss any changes with your doctor first. Certain supplements, foods and even juices can alter absorption rates of certain medications for example. Play it safe.
1) European Urology, Sep 2004, 46(3):362-369, "Efficacy and Treatment Satisfaction with On-Demand Tadalafil (Cialis®) in Men with Erectile Dysfunction"
2) J Neural Transm, 2007 Sep 7, "Appearance of antidepressant-like effect by sildenafil in rats after central muscarinic receptor blockade: evidence from behavioural and neuro-receptor studies"
4) Archives of Ophthalmology, Jul 2006, 124(7), "Tadalafil-Induced Subretinal and Choroidal Hemorrhage in a Patient With an Unsuspected Uveal (Choroidal and Ciliary Body) Melanoma"
5) J Clin Endocrinol Metab, 2008 Sep, 93(9):3510-4, Epub 2008 Jun 17, "The type 5 phosphodiesterase inhibitor tadalafil influences salivary cortisol, testosterone, and dehydroepiandrosterone sulphate responses to maximal exercise in healthy men"
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