Erectile dysfunction treatment

ED medicines are prescription treatments with serious interactions, so the evaluation comes first.

What it treats

erectile dysfunction, trouble getting or keeping an erection

Main medicines

sildenafil and tadalafil, PDE5 inhibitors that are FDA-approved for ED^1,2

Before you start

a medical assessment to find underlying causes, including your heart health and the medicines you take^1,2

Never with

nitrates in any form, or riociguat^1,2

Get emergency help for

an erection lasting more than 4 hours, chest pain during sex, or sudden vision or hearing loss^1,2

Office or video

at your local office or by secure video

ED medicines widen blood vessels and lower blood pressure, and sex itself is physical exertion, so your provider checks that your heart can handle both.^1,2

The labels say ED treatments should not be used by men for whom sexual activity is inadvisable because of their cardiovascular status, and that an ED evaluation should identify underlying causes through a medical assessment.^1,2 Your provider asks about chest pain, heart disease, blood pressure, diabetes and the medicines you take, including any nitrates, blood pressure medicines and alpha-blockers.

The AUA guideline puts shared decision-making at the center: you should hear about every treatment that is not ruled out for you, with its benefits and burdens, and your partner can be part of that conversation.⁴

When medicine fits, your provider chooses between two FDA-approved options and explains why.

Both need sexual stimulation for an erection to happen, and both are taken as your provider directs.^1,2 If an ED medicine isn't right for you, your provider explains the other treatment options.⁴

The main risks are low blood pressure, dangerous interactions with nitrates, and rare but serious effects on erections, vision and hearing.^1,2

• Nitrates and riociguat: never together with sildenafil or tadalafil; the combination can drop blood pressure dangerously.^1,2
• Low blood pressure: more likely with alpha-blockers or other blood pressure medicines^1,2, and with tadalafil after heavy drinking.²
• Prolonged erection: get emergency care if an erection lasts more than 4 hours.^1,2
• Sudden vision loss in one or both eyes: stop the medicine and get care right away.^1,2
• Sudden decrease or loss of hearing: stop the medicine and get care right away.^1,2
• Chest pain or other symptoms when sex begins: stop and get medical attention.²
• Common side effects include headache, flushing, indigestion, nasal congestion and changes in vision.^1,2

Read the Important Safety Information for ED medications

Low testosterone and ED can happen together, but they are separate problems with separate treatments. In a large trial of men aged 45 to 80 with heart disease or high cardiovascular risk, low testosterone and low libido, testosterone treatment did not improve erectile function.³

If your symptoms point to testosterone as well, your provider can order morning testosterone labs, and testosterone replacement therapy has its own evaluation and risks.

Care starts with a call with your coordinator, then a visit with a licensed provider at your local office or by secure video, with labs if your provider needs them.

• Your coordinator explains each step and its cost and books your visit. You get a direct line.
• Your provider reviews your symptoms, heart health, medicines and history, and orders labs if they're needed.
• If a medicine fits, your coordinator goes over the order and its cost before you pay, and each new supply needs your provider's prescription and your OK. If it doesn't fit, nothing is prescribed. How it works

You pay for each step as you reach it, and costs are explained before you pay. You get a receipt by email. No long-term contract, no membership and no automatic billing. How pricing works

Start at your local office, or by secure video where your state allows. Find an office

Prescription treatment requires an evaluation by a licensed healthcare provider, who decides whether treatment is appropriate for you. Not everyone qualifies. Completing an assessment, booking a visit, or paying a fee does not guarantee a prescription.

1. DailyMed. Sildenafil (generic), prescribing information: indication, contraindications, warnings and precautions (Northstar Rx; label effective 2026-10-23) dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8127ff38-2761-49ec-8ce7-7f971f521cfb
2. DailyMed. Tadalafil (generic), prescribing information: indications, contraindications, warnings and precautions (Northstar Rx; label effective 2026-10-23) dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a10d464a-6ea7-4e5a-befa-71eceacc5039
3. Pencina KM, et al. Effect of Testosterone Replacement Therapy on Sexual Function and Hypogonadal Symptoms in Men with Hypogonadism (TRAVERSE Sexual Function Study). J Clin Endocrinol Metab. 2023 (abstract) pubmed.ncbi.nlm.nih.gov/37589949/
4. Burnett AL, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200:633 (abstract) pubmed.ncbi.nlm.nih.gov/29746858/

Medical services are provided by independently licensed physicians, nurse practitioners and physician assistants of affiliated professional corporations and their affiliated professional entities. Vitality Testosterone Replacement Therapy provides administrative and technology support and does not practice medicine. All treatment decisions are made at the sole discretion of the treating provider. Medications are dispensed by licensed pharmacies. This website is an advertisement for medical services and is not medical advice. If you have a medical emergency, call 911.