Complete Guide to ED Treatment Options

March 10, 2025/Andrew Le

You might wonder if there’s truly an effective way to address the problem of Erectile dysfunction (ED).

Prescription medications can often provide real relief. They don’t just help temporarily; they can significantly improve your overall quality of life. But with so many treatments out there, choosing the right one can get confusing. You probably have lots of questions. What medication is best? How do they actually work? And what should you expect in terms of effectiveness and side effects? 

In this article, you’ll discover clear answers to these questions and explore different treatments to help you regain confidence and control in your sexual health.

🔑 Key Takeaways

➤ Pills like Viagra and Cialis help about 70% to 80% of men with ED, but only when sexually stimulated.

➤ Testosterone therapy alone usually doesn’t greatly improve ED, but it can help if combined with pills.

➤ Alprostadil injections provide fast relief and don’t require sexual stimulation to work.

➤ Vacuum pumps are effective for many men, but the erection can feel less natural.

➤ Lifestyle changes like losing weight, eating healthy, and exercising regularly can improve ED without medications.

➤ Acupuncture might help men whose ED is linked to stress, but more research is needed.

Prescription Treatments for ED

Here are some of the common prescription treatments for ED:

PDE5 Inhibitors (Oral Medications: Sildenafil, Tadalafil, Vardenafil, Avanafil)

Phosphodiesterase type 5 (PDE5) inhibitors are the most common medications doctors prescribe for ED. They include:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)
  • Avanafil (Stendra)

These medications help by improving blood flow to the penis. Better blood flow allows men to achieve and keep an erection. But remember, PDE5 inhibitors won’t boost your sexual desire. They only work when there’s sexual stimulation.

Effectiveness

How effective are these medications? PDE5 inhibitors successfully treat ED in about 70% to 80% of men, but everyone is different. Your results might depend on how severe your ED is or other health conditions you may have.

For example, men with nerve damage from prostate surgery, diabetes, or heart disease might not respond as effectively to these drugs. This can make treatment more challenging.

One large study looked at 23 systematic reviews covering 154,796 participants. It found that sildenafil at a 25 mg dose was most effective at improving erections. Interestingly, a higher dose of 100 mg sildenafil led to more side effects and caused more men to stop using the medication. So higher isn’t always better.

What about tadalafil? Low-dose daily tadalafil might actually be better than taking high doses only when needed. This daily low dose could be a helpful long-term choice for many men managing ED.

How Quickly They Work and How Long They Last

Each PDE5 inhibitor has a different onset time and duration:

MedicationOnset TimeDuration
Sildenafil (Viagra)30-60 minutes4-5 hours
Tadalafil (Cialis)30-45 minutes24-36 hours
Vardenafil (Levitra)30-60 minutes4-5 hours
Avanafil (Stendra)15-30 minutes6-12 hours

For the best absorption, these medications should not be taken with food, as a heavy meal can delay their effects.

Side Effects and Safety Considerations

PDE5 inhibitors can sometimes cause side effects. The most common ones are:

  • Headaches
  • Upset stomach
  • Nasal congestion
  • Muscle pain
  • Facial flushing

Usually, these side effects are mild and go away after a few hours. However, Viagra tends to cause side effects more often than other medications in this group.

Safety is important to consider, too. For example, PDE5 inhibitors lower blood pressure. If you’re taking nitrate medications for heart problems, these drugs might not be safe for you. Men taking alpha blockers for an enlarged prostate need to be careful as well. 

To avoid a dangerous drop in blood pressure, take PDE5 inhibitors at least four hours apart from alpha blockers.

🧑‍⚕️ Doctor’s Note

But what if PDE5 inhibitors don’t work well for you? Men with low testosterone (hypogonadism) might benefit from adding testosterone replacement therapy. Studies show this combination improves erectile function better than using PDE5 inhibitors alone.

Other treatments could help too. For instance, focused shockwave therapy and platelet-rich plasma (PRP) therapy have shown good results, especially for men who don’t respond to regular medication.

Testosterone Therapy (Hormone Replacement)

Doctors sometimes suggest testosterone therapy, also called hormone replacement, for men who have ED. This treatment is common in men with low testosterone levels.

But does testosterone therapy actually help ED? The science shows its effects are usually modest at best. Short-term research finds very little improvement in erections or sexual quality of life. As for long-term benefits, we still don’t have clear answers.

Short-Term Effects

A major review of 43 studies involving 11,419 men found testosterone therapy had almost no effect on erections compared to a placebo. While some men saw slight improvements, overall, the difference wasn’t meaningful.

This means testosterone isn’t usually the best choice to treat ED, especially if you don’t have a clear diagnosis of hypogonadism.

Still, could it help certain men? Another study found testosterone therapy might slightly help younger men diagnosed with hypogonadism. Even then, PDE5 inhibitors like sildenafil (Viagra) or tadalafil (Cialis) usually work better. Testosterone therapy is rarely the first option, but it may be helpful in some specific situations.

Combining TRT and PDE5 Inhibitors

If regular ED medications don’t work well for you, combining testosterone therapy with PDE5 inhibitors might offer a solution. One large analysis showed that adding testosterone therapy improved erections more effectively than PDE5 inhibitors alone for men with hypogonadism.

Specifically, daily tadalafil (5 mg) or sildenafil (50–100 mg as needed) combined with testosterone led to better results. However, doctors still aren’t sure about the best testosterone dose or how it should be given.

Long-Term Effects

While short-term studies show limited benefits, long-term results have not yet been determined. No reliable long-term research clearly shows whether testosterone therapy improves sexual quality of life or affects heart health over time. Without these studies, it’s hard to know if testosterone therapy is safe or beneficial in the long run.

Risks and Safety Concerns

Using testosterone therapy also has risks. According to the U.S. Food and Drug Administration (FDA), it may increase your risk of heart attacks and strokes. Other possible side effects include:

  • High red blood cell counts (polycythemia), which could cause blood clots
  • Prostate problems, including potential growth of prostate cancer
  • Worsening urinary issues
  • Possible infertility because testosterone therapy can stop your body from making testosterone naturally

Due to these risks, testosterone therapy should only be used if you have a clear diagnosis of hypogonadism. It isn’t recommended just for low testosterone caused by aging. Always talk to your doctor before starting this treatment to make sure it’s right for you.

Alprostadil Injections for Erectile Dysfunction (ED)

Alprostadil injections are a common treatment for ED. They belong to a treatment group called intracavernosal injection therapy (ICI). Alprostadil itself is a synthetic version of prostaglandin E1 (PGE1). This substance occurs naturally in your body, relaxing smooth muscles and widening blood vessels. When this happens, blood flows more easily into the penis, resulting in an erection.

How is alprostadil different from pills like sildenafil (Viagra) or tadalafil (Cialis)? Pills depend on sexual arousal to work. But alprostadil injections don’t need stimulation at all—they directly trigger an erection.

Doctors often recommend ICI therapy if pills haven’t helped. This is especially true for men who have tried PDE-5 inhibitors without success. Alprostadil was approved by the FDA in 1995. It quickly became popular after Adaikan and Ishii introduced it at the Second World Meeting on Impotence Research.

How Alprostadil Works

Alprostadil targets specific receptors, called EP prostaglandin receptors, in the penis. Once injected, it stimulates an enzyme called adenylate cyclase. This enzyme raises the levels of cyclic adenosine monophosphate (cAMP), a substance inside your cells. Higher cAMP levels reduce calcium in your cells. This decrease causes your penile arteries and tissues to relax, allowing more blood flow. And the result? An erection.

It also stops your nerves from releasing norepinephrine, a chemical that constricts blood vessels. It reduces angiotensin II as well—another substance that narrows blood vessels. All these actions work together, improving blood flow even more.

The drug doesn’t stay long in your body, though. It breaks down quickly at the injection site and in your lungs. With a short lifespan of just 30 to 60 seconds, alprostadil has fewer prolonged side effects.

Effectiveness of Alprostadil Injections

Clinical studies clearly show how effective alprostadil injections can be. In a large review involving 4,577 patients, more than 70% responded positively. Another European trial lasting four years was even more impressive. It found that between 89% and 97% of patients achieved successful intercourse when injecting alprostadil themselves.

Compared to other injectable treatments like papaverine and phentolamine, alprostadil carries fewer risks. For instance, the chance of experiencing a dangerously prolonged erection, or priapism, is very low at just 0.35%. It’s also less likely to cause fibrosis—scar tissue buildup in the penis. Unlike papaverine, alprostadil doesn’t damage the cells lining penile blood vessels, making it safer for long-term use. Some studies even suggest that prolonged use might help you regain natural erectile function.

Dosage and Administration

You can find alprostadil under the brand name Caverject®, usually in prefilled syringes of 10 µg and 20 µg doses. Typically, your doctor will start you with a dose of 10 µg. They may adjust this later based on how your body responds and handles the drug.

When injecting alprostadil, always inject it into the side of your penis (the corpus cavernosum). You should avoid veins and areas of scar tissue. Proper injection technique matters, so it’s essential to get thorough training. Studies recommend at least two supervised sessions with a healthcare provider to master it safely.

Potential Side Effects and Risks

Like all treatments, alprostadil injections come with possible risks. Pain at the injection site is the most common issue, affecting up to half of the users. This pain might last anywhere from half an hour up to three hours, especially after intercourse.

Other side effects you should be aware of include:

  • Priapism (prolonged erection): Rare, happening in only 0.35% of users. But if it occurs, seek emergency medical care immediately.
  • Fibrosis and scarring: Far less common than with other injectables like papaverine, but still possible if you repeatedly inject in the same spot.
  • Mild bruising or bleeding: May occur if you accidentally hit a blood vessel.
  • Minimal effect on blood pressure: Unlike PDE-5 pills, alprostadil usually doesn’t significantly lower your blood pressure. This makes it safer for men with heart conditions.

Who Should Consider Alprostadil Injections?

Alprostadil injections might be right for you if:

  • Pills like sildenafil or tadalafil haven’t helped.
  • You can’t take PDE-5 inhibitors because of health issues like heart disease or nitrate medications.
  • You have diabetes, spinal cord injuries, or post-surgical ED, such as after prostate surgery.
  • You’re looking for quick-acting, targeted treatment with minimal systemic side effects.

However, alprostadil injections may not suit everyone. They might not be a good choice if you:

  • Have bleeding disorders or conditions like sickle cell anemia.
  • Suffer from severe penile fibrosis or Peyronie’s disease.
  • Feel extremely uncomfortable around needles or have trouble giving yourself injections.

Vacuum Erection Devices (Penis Pumps)

Vacuum erection devices, or penis pumps, offer a non-invasive solution for men dealing with ED. These pumps use suction to increase blood flow to the penis, helping achieve an erection without medication or surgery. 

The concept is not new: Dr. John King first introduced penis pumps in 1874. However, they became widely accepted only after gaining FDA approval in 1982. Today, they’re popular, especially among men with medical conditions causing ED.

If pills haven’t worked for you, or if you’ve had prostate surgery, a vacuum device might help. But how does the erection from a pump compare to a natural one? It’s a bit different—usually cooler, somewhat discolored, and less firm at the base because of how the device works.

How Vacuum Erection Devices Work

A vacuum erection device has three main parts: a plastic tube, a pump, and a special constriction ring. 

  1. First, you place the tube carefully over your penis to create an airtight seal. 
  2. Next, you use the pump—either manual or battery-powered—to remove air from inside the tube. Removing air creates suction, pulling blood into the penis to cause an erection.
  3. Once you have an erection, you slide a constriction ring onto the base of your penis. The ring traps blood inside, allowing you to maintain the erection for up to 30 minutes. But after 30 minutes, it’s important to remove the ring to avoid damaging the tissue.

Who Can Benefit from a VED?

Penis pumps are especially helpful if your ED is caused by problems with blood flow, nerve damage, or venous leakage. They can even help men whose ED is related to anxiety. Since the pump physically creates an erection, psychological stress won’t stop it from working.

Research confirms that penis pumps work well for many types of ED, making them a flexible treatment. Doctors frequently recommend pumps after prostate surgery because using one early may help you regain natural erections sooner and improve overall sexual function.

But penis pumps aren’t perfect for everyone. Younger men might feel less satisfied because erections from a pump often don’t feel fully natural. This can affect how enjoyable intercourse is for both partners.

Effectiveness 

Studies repeatedly show penis pumps are effective at helping men achieve erections good enough for intercourse. In one study, researchers tested the firmness of erections from VEDs and found most men had erections strong enough for penetration. Another study checked how using a pump affected men’s sexual satisfaction over a year. It showed clear improvements in sexual function and overall satisfaction.

A 2010 review published in the International Journal of Impotence Research looked at 13 studies. Some studies reported success rates above 80%, but others found lower satisfaction due to the unnatural feel of the erection.

In general, though, men who use penis pumps for a longer period remain satisfied. Even if erections aren’t exactly like natural ones, the pumps still offer a reliable option, especially for couples struggling with other treatments.

Natural and Lifestyle-Based Treatments

If you prefer natural and lifestyle-based treatment, here are some you may consider:

Lifestyle Changes

Your weight can directly affect ED. Obesity often limits blood flow, leading to problems with sexual performance. Being overweight also puts strain on your heart, increasing the risk of ED.

One large study looked at 619 men who tried to lose weight to improve their ED. The results were clear: men who lost weight improved their sexual health. 

On average, these men lost about 18 kg (nearly 40 pounds). Their BMI dropped by 9.6 points, and their erectile function scores improved significantly. Losing extra pounds made a real difference. 

The Role of Diet

What you eat affects your sexual health. Eating healthy foods boosts blood flow and keeps your blood vessels clear, helping you maintain better erections. When your diet includes fewer unhealthy fats and more fruits, vegetables, and whole grains, your circulation improves.

Research confirms this. In one study, men who followed healthier diets and lost weight, regained erectile function more often. They achieved these benefits without medication or surgery. After all, sometimes the best treatment can be found right on your plate.

Exercise and ED

Exercise is another powerful tool for overcoming ED. Regular physical activity strengthens your heart, reduces stress, and even increases testosterone. All these things help support stronger erections.

In one analysis of 11 different studies, researchers confirmed that regular aerobic exercise significantly improved ED. Men who walked, jogged, cycled, or swam regularly saw their sexual function scores rise by a noticeable average of 2 to 5 points. And you don’t have to push yourself too hard—even simple activities like daily walking can make a big impact.

🩺 Doctor’s Note

Making one lifestyle change helps, but combining several can provide even greater results. Men who lose weight, eat well, and stay physically active tend to see the most improvement. The evidence is clear: simple changes in your everyday life could make a big difference in your sexual health.

Stress Reduction and Psychological Approaches

Stress and anxiety don’t just affect your mood—they can also cause ED. Psychological factors like these play a big role. In one analysis, researchers reviewed 11 clinical trials involving 398 men. They wanted to see how psychological treatments stacked up against medications, local injections, and vacuum devices. The findings showed that group therapy, especially when focused on sexual issues, improved erectile function for many men.

Men who took part in sex-focused group therapy saw better outcomes compared to those who got no psychological help. Those who used both group therapy and sildenafil (Viagra) saw even greater improvement. They were also less likely to stop treatment. 

Tackling emotional issues together with medical treatment can give men better results.

But how does therapy measure up against devices and injections? When psychological treatments were compared directly with local injections, vacuum devices, or other methods, researchers found no major differences. That means therapy alone can sometimes work just as well as medical treatments. 

Herbal and Nutritional Supplements

Herbal and nutritional supplements like ginseng, L-arginine, and yohimbine are often studied for ED. But how well do they really work? The evidence is mixed.

Ginseng

Ginseng is one of the most popular herbal treatments for ED. Many people think it boosts blood flow and improves sexual performance. One review looked at nine studies involving 587 men aged between 20 and 70. These men had mild to moderate ED and took ginseng supplements for up to 12 weeks.

Ginseng had only a small effect when measured by standard tests. Yet, when men were asked directly about their experiences, some said their erections improved. Still, researchers said the evidence was weak. This means ginseng might not work exactly as the studies suggest.

On the bright side, no major side effects were seen. Ginseng appears generally safe for most people. 

L-Arginine

L-arginine, an amino acid naturally found in your body. L-arginine helps make nitric oxide, which relaxes blood vessels. That means better blood flow—and possibly better erections. One meta-analysis reviewed 10 studies involving 540 men with mild to moderate ED. Participants took between 1,500 and 5,000 mg of L-arginine daily, either alone or combined with other supplements.

Compared to a placebo, L-arginine significantly improved men’s erections. They reported better overall satisfaction, intercourse satisfaction, and stronger erections. However, their sexual desire didn’t change. Mild side effects were seen in about 8.3% of men taking L-arginine versus 2.3% taking a placebo. None of these side effects were serious.

Researchers believe L-arginine might be helpful for men with mild to moderate ED, especially those looking for natural options. However, dosage and treatment length varied widely in these studies. Because of this, it’s hard to say exactly how much L-arginine you should take, or for how long, to achieve the best results.

Yohimbine

It comes from the bark of the Pausinystalia yohimbe tree and has been used as an aphrodisiac for hundreds of years. Yohimbine is thought to boost blood flow and trigger nerve pathways linked to sexual arousal. A review analyzed eight trials involving 460 men with ED, and the findings were mixed.

On its own, yohimbine provided only slight improvements. The difference between yohimbine and placebo wasn’t strong enough to prove effectiveness. When combined with other supplements (like L-arginine), yohimbine worked much better. Men who used these combinations had a much higher chance of improving their ED.

However, some men had side effects like:

  • Increased heart rate
  • Anxiety
  • Blood pressure spikes

These side effects make yohimbine risky if you have heart issues. Because of this, yohimbine seems safer and more effective when paired with other treatments. Alone, it might not be your best choice for ED.

Acupuncture

Acupuncture is a key practice in Traditional Chinese Medicine (TCM). It involves inserting thin needles into certain points on your body. This method aims to stimulate nerves and improve blood flow. 

Effectiveness for ED

One large review explored acupuncture’s impact on ED. It looked at 22 randomized controlled trials with 1,751 participants. The findings suggested that acupuncture might help some men, especially those whose ED is related to stress or emotions. Yet, the overall evidence remains weak and unclear.

Scientists still aren’t exactly sure how acupuncture works for ED. Some believe it stimulates nerves and affects important chemicals in the brain, like norepinephrine and acetylcholine. These chemicals are linked to sexual arousal. Other research suggests acupuncture improves circulation and relaxes blood vessels, similar to how medications like Viagra work.

In Traditional Chinese Medicine, ED comes from an imbalance in your body’s energy (Qi), particularly related to the kidneys. Acupuncture tries to balance your Qi and boost circulation by targeting special points such as:

  • Guan Yuan (CV4)
  • San Yin Jiao (SP6)
  • Shen Shu (BL23)
  • Zu San Li (ST36)

Some practitioners also use moxibustion, which applies heat to these acupuncture points.

Safety and Side Effects

Most studies reported few side effects from acupuncture. When side effects did occur, they were usually mild and short-lived, such as:

  • Facial redness
  • Dizziness
  • Needle discomfort
  • Slight itching

Compared to medications, which might cause headaches, nausea, or heart problems, acupuncture seems relatively safe. 

Final Words

You might find that medications like Viagra or Cialis provide exactly the boost you need, or maybe injections like Alprostadil are your answer. For some, penis pumps offer a drug-free option, even if erections feel slightly less natural. 

And remember, small changes like healthier eating, regular exercise, or even reducing stress can significantly improve your sexual health. 

It’s always best to talk with your doctor to find the solution that works best for you. After all, the goal isn’t just treating ED—it’s helping you feel confident, comfortable, and ready to enjoy life again.

Frequently Asked Questions

Are erectile dysfunction medicines safe for everyone?

Not always. For example, you shouldn’t use ED pills if you take nitrate medicines like nitroglycerin. Always talk to your healthcare provider first.

Can stress or anxiety cause erectile dysfunction?

Yes, stress, anxiety, and depression can cause erectile dysfunction or make it worse. Counseling can help you lower stress and improve sexual function.

Do erectile dysfunction medicines always work?

Not always. Erectile Dysfunction pills like Viagra help improve blood flow but still require sexual stimulation. They don’t work for everyone, and some men may need to try different treatments.

What if medicines don’t help my erectile dysfunction?

If medicines don’t help, your doctor might suggest injections, suppositories, vacuum devices, or surgery.

Sources

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