Researchers analyzed 6.2 million health insurance claims for men who received an ED diagnosis, and discovered that only 25 percent filled a prescription for treatment during the 12-month study period.
While the study didn’t delve into the reasons men passed up on treatment, one potential barrier is cost—many drugs don’t have generic versions yet, and some insurance companies provide limited or no coverage, says study author Kevin McVary, M.D. Men may also feel too embarrassed to drop off the prescription at the pharmacy, or believe ED isn’t a high-enough concern to bother addressing it, Dr. McVary says.
Whatever the reason for avoiding treatment, the consequence is undisputed: “Sexual health is an important aspect of the quality of a man’s life—and men live longer when they are sexually active,” says Dr. McVary. “This is a medical disease that warrants treatment.”
Having trouble rising to the occasion? There are several different treatments that will get you back in the saddle—but you’ll never know which one is right for you until you call your doc. Here are three options he might prescribe:
1. PDE5 Inhibitors
If you’ve just been diagnosed with ED, you’ll probably be asked to try a PDE5 inhibitor—the first-line treatment option. In fact, 75 percent of the men in the study were prescribed these meds.
There are three different kinds: sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Their effectiveness is about the same, and they work in the same way, says Dr. McVary. The drugs cause smooth muscles to relax and blood vessels to dilate, which helps you get an erection when you’re aroused.
But there are some important differences. Cialis lasts the longest—up to 36 hours—and you don’t have to worry about food interactions. With Viagra and Levitra, a high-fat meal could block the drug’s absorption, meaning that a bedroom romp after a big steak dinner might be off the table. So wait until 2 hours after your meal to pop those pills, Dr. McVary recommends.
All of the PDE5 inhibitors share the same side effects: You may experience headaches, facial flushing, or acid reflux. With Viagra, you may also find your color perception is a bit off—things can take on a blue or purple haze, says Dr. McVary. And with Cialis, you might be more likely to feel flank pain or side pain, possibly due to the blood vessels dilating.
So what happens if your pill doesn’t help you perform? You might be asked to try another kind of PDE5 inhibitor before moving on to other options, since some guys will respond to one kind but not another.
If you’ve failed pills—either they didn’t work for you, were too expensive, or you were bothered by the side effects—you may be asked to try alprostadil, a common second-line treatment, says Dr. McVary.
Alprostadil works by increasing blood flow and causing the smooth muscles to relax, which can help you get an erection. The drug can be given by an injection in your penis or a suppository in your penis’s opening.
Sounds horrifying, right? “Men can be squeamish about the first shot, but then after that, they say it’s not that big of a deal,” says Dr. McVary.
One potential side effect: a priapism, or prolonged erection. (It’s nearly unheard of in as-prescribed use of PDE5 inhibitors, despite what the commercials say, according to Dr. McVary.) Non-stop stiffies can cause scar tissue formation, hurting erectile function.
3. Androgen Replacement Therapy
Also known as testosterone replacement, this treatment was prescribed to 31 percent of the men in the study. But it should only be used in guys who have bona fide low T, says Dr. McVary. That means blood levels below 300 ng/dl for those under 65.
Low levels of testosterone can cause decreased sex drive, low energy, and ED. Replacement therapy can help alleviate those symptoms. You might be prescribed injections, which you’d get every few weeks, or daily patches or gels.
But if your levels are already adequate, supplementing T won’t help you get an erection—and might lead to some scary side effects. The therapy can boost your red blood cell count, making your blood sluggish and easier to clot, which raises your risk of heart attack or stroke.