The most effective option for getting and staying hard is a prescription medication called a PDE5 inhibitor, which includes well-known drugs like Viagra (sildenafil) and Cialis (tadalafil). These work for the majority of men with erectile difficulty. But they’re not the only path. Depending on what’s causing the problem, supplements, exercise, hormone optimization, or addressing anxiety can all play a role.
Prescription Medications: The Most Reliable Option
PDE5 inhibitors are the first-line treatment for erectile dysfunction, and they work through a straightforward mechanism. During arousal, your body releases nitric oxide into the tissue of the penis, which triggers a chemical chain reaction that relaxes smooth muscle and allows blood to flow in. An enzyme called PDE5 normally breaks down that signal. These medications block that enzyme, keeping blood flow elevated so you can get and maintain an erection.
There are three main options, and they differ mostly in timing:
- Sildenafil (Viagra): Works in 20 to 30 minutes, peaks at about 60 minutes, and lasts 4 to 6 hours.
- Vardenafil (Levitra): Similar profile to sildenafil. Works in 20 to 30 minutes, peaks at 60 minutes, lasts 4 to 6 hours.
- Tadalafil (Cialis): Takes longer to kick in (60 to 120 minutes) but lasts 36 to 48 hours, which is why it’s sometimes called “the weekend pill.”
All three require a prescription. They don’t create arousal on their own. You still need to be sexually stimulated for them to work. A fatty meal can delay the onset of sildenafil and vardenafil, so taking them on a lighter stomach helps.
One Critical Safety Warning
If you take any form of nitrate medication for chest pain or heart conditions (nitroglycerin patches, sublingual tablets, isosorbide), you cannot take PDE5 inhibitors. The combination can cause sudden, severe drops in blood pressure that are potentially fatal. Research from the American Heart Association found that combining sildenafil with nitrates produced large and prolonged decreases in blood pressure and coronary blood flow, creating a dangerous feedback loop of dropping pressure and reduced oxygen to the heart. This isn’t a minor interaction. It’s the single most important thing to know before taking any ED medication.
Supplements That May Help
If you’re looking for something available without a prescription, a few supplements have some clinical backing, though none are as effective as prescription medication.
L-citrulline is an amino acid your body converts into L-arginine, which then helps produce nitric oxide, the same molecule that PDE5 inhibitors work to preserve. Studies have shown it can ease symptoms of mild to moderate erectile dysfunction at doses up to 6 grams per day. It works through the same general pathway as prescription drugs, just much less powerfully. Think of it as giving your body more raw material to produce the “relax and fill with blood” signal.
Korean red ginseng has the most clinical evidence of any herbal option. A double-blind crossover study published in The Journal of Urology used 900 mg three times daily and found it improved erectile function. The mechanism appears to involve increasing nitric oxide release from penile tissue while also having antioxidant effects. The recommended dose range is 0.5 to 2 grams daily, and side effects at these levels are rare.
Avoid Gas Station Pills
Those “herbal” male enhancement products sold at gas stations, convenience stores, and online are a genuine health risk. The FDA maintains a running list of contaminated sexual enhancement products and has found that many contain hidden pharmaceutical ingredients, often the same active compounds in prescription ED drugs but at uncontrolled doses. These products are falsely advertised as dietary supplements or all-natural treatments. You have no way of knowing what’s actually in them, at what dose, or how it might interact with other medications you take. The risk is especially high if you have any heart condition or take blood pressure medication.
Check Your Testosterone
Low testosterone is an underrecognized cause of erectile problems. The American Urological Association defines low testosterone as a total level below 300 ng/dL, measured on at least two separate mornings (testosterone peaks in the early morning and drops throughout the day, so timing matters). ED is specifically listed as a symptom associated with low testosterone, and the AUA recommends testing in all men presenting with erectile difficulty.
If your levels are low, testosterone therapy aims to bring you into the 450 to 600 ng/dL range, which is the middle of normal. Symptoms that often accompany low testosterone beyond erection problems include fatigue, reduced sex drive, loss of muscle mass, and mood changes. If those sound familiar, a blood test is a logical starting point. Correcting a hormonal deficit can sometimes resolve the problem without needing ED medication at all.
Exercise Works Better Than You’d Expect
Regular aerobic exercise is one of the most effective non-drug interventions for erectile function. The Sexual Medicine Society of North America reviewed multiple studies and found consistent improvement with moderate activity: cycling three times per week for 45 to 60 minutes, moderate exercise five times per week for at least 30 minutes, or walking five times per week for 30 to 45 minutes all showed benefits.
This makes sense physiologically. Erections depend on healthy blood vessels and efficient blood flow. Cardiovascular exercise improves both. It also reduces body fat, which lowers the conversion of testosterone to estrogen, and it improves mood and energy. For men with mild ED or those who want to support medication with lifestyle changes, a consistent exercise habit is one of the highest-impact things you can do.
When the Problem Is Mental, Not Physical
Performance anxiety is one of the most common causes of erectile difficulty in younger men, and it creates a frustrating cycle: you worry about losing your erection, the worry triggers a stress response that constricts blood vessels, you lose your erection, and that reinforces the worry for next time.
Breaking that cycle often starts with open communication with your partner. Talking about what’s happening reduces the pressure of trying to hide it. Expanding your definition of sex beyond penetration, using hands, oral, or toys, takes the spotlight off your erection and often reduces anxiety enough that the problem resolves on its own. Learning more about how arousal actually works can also help. Erections naturally fluctuate during sexual activity, and understanding that this is normal can prevent a momentary softening from spiraling into panic.
For anxiety rooted in relationship concerns or past trauma, working with a sex therapist offers a structured path forward. The American Association of Sexuality Educators, Counselors and Therapists maintains a directory of certified professionals. Some men also find that using a PDE5 inhibitor temporarily helps break the anxiety cycle by providing a few successful experiences, after which they no longer need the medication.