Best pills for erection: what works for different men (informational guide, not a substitute for medical advice)

Erectile dysfunction (ED) is common and treatable, yet the “best pills for erection” are not the same for everyone. Age, cardiovascular health, medications, psychological factors, and lifestyle all influence which option is safest and most effective. This guide segments recommendations by audience so you can better understand risks, benefits, and when to seek medical care. It is for educational purposes only and does not replace consultation with a qualified healthcare professional.

Who it is especially relevant for

This article is particularly helpful for:

• Men experiencing occasional or persistent difficulty achieving or maintaining an erection.
• Individuals over 40 with new-onset ED, as it may signal cardiovascular disease.
• People with diabetes, hypertension, obesity, or depression.
• Those considering buying ED medication online and wanting to avoid unsafe products.

Sections by audience segment

Adults

Typical features: In men aged 18–60, ED is often linked to stress, performance anxiety, relationship issues, smoking, alcohol use, metabolic syndrome, or early vascular disease. Many respond well to first-line oral medications known as PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil).

Medication overview:

• Sildenafil (e.g., Viagra): works in 30–60 minutes; lasts ~4–6 hours.
• Tadalafil (e.g., Cialis): onset 30–60 minutes; lasts up to 36 hours; also available as daily low-dose.
• Vardenafil and avanafil: similar mechanism, slightly different onset and duration.

When to see a doctor:

• ED persists for more than 3 months.
• You have chest pain, shortness of breath, or reduced exercise tolerance.
• You take nitrates or alpha-blockers.

General safety measures:

• Never combine PDE5 inhibitors with nitrates (risk of severe hypotension).
• Limit alcohol intake when using ED medication.
• Address lifestyle factors: weight control, exercise, sleep hygiene.

For more on how lifestyle affects sexual performance, see our men’s health basics guide.

Elderly

Typical features: In men over 60–65, ED is more often associated with atherosclerosis, diabetes, prostate surgery, or multiple medications. Kidney and liver function may affect drug metabolism.

Risks and considerations:

• Higher likelihood of cardiovascular comorbidities.
• Polypharmacy increases risk of drug interactions.
• Greater sensitivity to blood pressure changes.

When to see a doctor:

• Before starting any ED pill for the first time.
• If you experience dizziness, fainting, vision or hearing changes.

General safety measures:

• Start with the lowest effective dose.
• Review all medications with your physician or pharmacist.
• Monitor blood pressure regularly.

Older adults should treat ED as a possible marker of systemic vascular disease rather than an isolated issue. A cardiovascular risk assessment is often recommended.

Women (pregnancy/breastfeeding context)

ED medications are not indicated for women, including during pregnancy or breastfeeding. However, this segment is relevant for couples planning conception.

Considerations for couples:

• PDE5 inhibitors act on the male partner and do not directly impair sperm quality in most cases, but underlying conditions (e.g., diabetes, obesity) may affect fertility.
• If fertility is a concern, a medical evaluation is preferable to long-term self-medication.

When to see a doctor:

• If conception has not occurred after 12 months (or 6 months if the female partner is over 35).
• If there is known endocrine or urologic disease.

Adolescents and young adults under 18

Pills for erection are not approved for minors for routine sexual performance concerns. In this age group, erectile issues are usually psychological, anxiety-related, or associated with pornography overuse.

Risks:

• Unsupervised use may mask underlying hormonal or mental health disorders.
• Online “enhancers” may contain undeclared pharmaceutical ingredients.

Action: Seek evaluation by a pediatrician, adolescent medicine specialist, or mental health professional rather than using ED drugs without supervision.

People with chronic conditions

This group includes individuals with diabetes, hypertension, coronary artery disease, chronic kidney disease, liver disorders, depression, or after prostate surgery.

Symptom features:

• Gradual onset ED.
• Reduced morning erections.
• Coexisting neuropathy or vascular symptoms.

Risks:

• Cardiovascular instability.
• Drug interactions (nitrates, certain antifungals, protease inhibitors).
• Potential need for dose adjustment.

When to see a doctor:

• Before starting any PDE5 inhibitor if you have heart disease.
• If ED began after initiating a new medication (e.g., SSRIs, beta-blockers).

General safety measures:

• Optimize control of blood sugar and blood pressure.
• Consider psychological support if depression or anxiety is present.
• Discuss alternative treatments (vacuum devices, injections, hormone therapy if indicated).

Read also our overview on managing chronic disease and sexual health and safe medication use principles.

Infographic: how erection pills work

Sexual stimulation 
      ↓
Nitric oxide release in penile tissue
      ↓
↑ cGMP levels (smooth muscle relaxation)
      ↓
Improved blood flow to corpora cavernosa
      ↓
Erection

If ED present:
Risk factor (e.g., diabetes, stress, atherosclerosis)
      ↓
Impaired blood flow or signaling
      ↓
Insufficient erection
      ↓
Action: medical evaluation → PDE5 inhibitor if appropriate → lifestyle modification

Segment → specific risks → what to clarify with doctor

Segment	Specific risks	What to clarify with doctor
Adults	Undiagnosed cardiovascular disease, alcohol interaction	Cardiac risk level, correct dosage, frequency of use
Elderly	Hypotension, polypharmacy, renal impairment	Dose adjustment, interaction check, blood pressure monitoring
Couples planning pregnancy	Underlying infertility factors	Need for semen analysis or endocrine testing
Under 18	Psychological dependence, unsafe online products	Assessment for anxiety, hormonal disorders
Chronic conditions	Drug interactions, cardiovascular instability	Safety of sexual activity, alternative therapies

Mistakes and dangerous online advice

• Buying “herbal Viagra” without verification: Many supplements contain undisclosed sildenafil-like substances.
• Ignoring chest pain history: ED can precede heart attack by several years.
• Doubling the dose if the first pill fails: This increases side effects without improving safety.
• Combining with recreational drugs (“poppers”): Can cause life-threatening hypotension.

Reliable information is more important than promotional claims. Visit our evidence-based health articles section for medically reviewed topics.

Sources

• American Urological Association (AUA). Erectile Dysfunction Guideline.
• European Association of Urology (EAU). Guidelines on Sexual and Reproductive Health.
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Erectile Dysfunction.
• Kloner RA, et al. Cardiovascular safety of PDE5 inhibitors. Journal of the American College of Cardiology.
• FDA (U.S. Food and Drug Administration). Tainted Sexual Enhancement Products Consumer Updates.