Erectile dysfunction treatment starts with looking for likely causes and choosing an option that fits a person’s health, medicines, and preferences. Evidence-based care can include lifestyle changes, counseling, prescription medicines, vacuum devices, injectable or urethral medicines, and sometimes surgery. A clinician can help sort out the safest next step. 1
Not sure where to start? Take the 3-min clinical quiz.
See if you qualify →What treatments can help erectile dysfunction?
Erectile dysfunction (ED) has more than one possible treatment because it has more than one possible cause. Clinicians first address an underlying contributor when they can; when the cause is not clear or cannot be fully changed, treatment focuses on improving sexual function safely. 1
For many people, the best-supported choices are lifestyle changes, counseling when stress or relationship concerns contribute, and prescription phosphodiesterase type 5 (PDE5) inhibitors. Devices, injectable medicines, urethral suppositories, and penile implant surgery are additional options for selected patients. 1
| Situation | A sensible next discussion | Key trade-off |
|---|---|---|
| New or persistent erection difficulty | Review health history, medicines, blood pressure, metabolic risks, and emotional factors with a clinician | ED can have more than one cause, so a single quick fix may miss an important contributor. 1 |
| Stress, anxiety, or performance pressure seems important | Counseling or sex therapy, alone or alongside medical treatment | Counseling can address anxiety, but physical contributors still deserve review. 1 |
| Oral medicines are unsuitable or do not help enough | Ask about a vacuum erectile device, injections, or urethral medicines | These options can work but have different side effects and practical demands. 1 |
| Severe ED after other options have not worked | Referral to a urologist to discuss surgery | Implants require an operation and carry surgical risks. 1 |
What is erectile dysfunction, and when is it worth discussing with a clinician?
ED is ongoing difficulty getting or maintaining an erection that is firm enough for sexual activity. A single difficult experience during stress, fatigue, illness, or alcohol use does not by itself establish ED. Repeated problems, distress, or changes in sexual function are reasonable reasons to seek care. 1
ED is also a reason to take overall health seriously. A clinician may review cardiovascular and metabolic risk factors, nerve conditions, mental health, medication effects, substance use, and hormone symptoms as part of an evaluation. 1
Why erectile dysfunction at age 50 is common but still worth evaluating
Age can raise the likelihood of ED, but it is not a diagnosis. Blood-vessel health, diabetes, high blood pressure, medication use, prostate treatment, mood, and relationship factors can all matter. An evaluation is useful because it can identify treatable contributors rather than assuming the change is simply age-related. 1
What can cause erectile dysfunction?
Blood flow and nerve signaling are central to erections. Conditions that affect blood vessels or nerves may interfere with either process. Some medicines, alcohol, recreational drugs, injuries, and mental health concerns may also contribute. 1
- Blood-flow factors, including cardiovascular and metabolic health concerns. 1
- Nerve-related conditions or injuries that affect sexual response. 1
- Medication effects; do not stop or change prescribed medicine without speaking with the prescriber. 1
- Stress, anxiety, depression, relationship concerns, and pressure around sexual performance. Counseling may help when these factors contribute. 1
- Clinically confirmed low testosterone in some people. Testosterone is not a routine ED treatment for everyone. 1
Can lifestyle changes help erectile dysfunction?
Lifestyle changes can support erectile function and overall health, especially when smoking, alcohol, recreational drugs, inactivity, or weight-related health concerns are part of the picture. They are helpful foundations, but they are not a substitute for an evaluation when erection problems persist. 1
NIDDK lists stopping smoking, limiting alcohol, avoiding recreational drugs, increasing physical activity, maintaining a healthy body weight, and following a healthy eating plan among changes clinicians may discuss. Counseling can also help reduce stress and anxiety about sex. 1 For more on the emotional side of ED, read our guide to sex therapy for erectile dysfunction.
Which prescription medicines are used for erectile dysfunction?
PDE5 inhibitors are commonly used oral ED medicines. Sildenafil (Viagra) and tadalafil (Cialis) are examples. They work by supporting blood flow to the penis and may help a person get and keep an erection when sexually aroused. 1
These medicines are not appropriate for everyone. A clinician should screen for contraindications, interactions, and cardiovascular concerns before prescribing. Oral ED medicines can cause side effects, and urgent medical attention is needed for vision or hearing changes or an erection lasting more than four hours. 1
Testosterone may be considered alongside a PDE5 inhibitor when testing and clinical evaluation identify both ED and low testosterone. It should not be assumed to help ED when low testosterone has not been confirmed. 1 Our overview of hormone replacement treatment for men explains why testing and symptoms both matter.
3-min quiz
Talk through your sexual-health concerns online
Chia providers can review whether a sexual-health treatment may fit your history and current medicines. A prescription requires a medical evaluation and is never guaranteed. Learn about PT-141 nasal spray. Compounded medications are prepared by state-licensed US 503A pharmacies and are not FDA-approved.
What non-pill treatments are available for erectile dysfunction?
Vacuum erectile devices can be a non-drug option. A vacuum erectile device (VED) uses a tube and pump to draw blood into the penis; an elastic ring helps maintain the erection. Bruising, numbness, or a cold feeling can occur. 1
Clinicians may also discuss injectable ED medicines or urethral suppositories. These approaches can have side effects, including priapism, meaning a prolonged erection. Penile implants are surgical options generally considered after less invasive treatments have not met a person’s needs. 1
Which newer or heavily marketed erectile dysfunction treatments have important evidence limits?
Low-intensity extracorporeal shockwave therapy (LI-ESWT) has mixed evidence and varied protocols. A 2022 meta-analysis of 16 randomized trials involving 1,064 participants found improved erectile-function scores versus control groups, but outcomes, devices, and treatment approaches differed across studies. 2 A sham-controlled trial also studied focused linear shockwaves, but one study does not settle which protocol is best or how durable benefits are. 3
Platelet-rich plasma (PRP) has been evaluated in a prospective randomized, double-blind, placebo-controlled ED trial, but that alone does not establish broad effectiveness, long-term durability, or who is most likely to benefit. 4 Stem-cell approaches remain investigational: a 2025 systematic review found promising signals but concluded that longer comparative studies are needed. 5
Acupuncture has also been studied in a randomized trial, but limited individual studies do not establish it as a replacement for established ED evaluation or treatment. 6 Be cautious with any service that promises to permanently restore erections without discussing causes, risks, and uncertainty.
What role could PT-141 have in a clinician-reviewed sexual-health plan at Chia?
PT-141, also called bremelanotide, is a peptide-based sexual-health option that needs careful clinical review. Bremelanotide has an FDA-approved product for acquired, generalized hypoactive sexual desire disorder in premenopausal women—not erectile dysfunction. That approval does not establish effectiveness for ED or for compounded nasal formulations. 7
At Chia, we offer compounded PT-141 nasal spray, with plans currently starting at $159 per month. A licensed US provider reviews an online health questionnaire and may prescribe only when clinically appropriate. Our providers consider health history, current medicines, symptoms, and safety concerns; a prescription is not guaranteed.
If prescribed, medication is compounded in the US by a state-licensed 503A pharmacy and shipped to the patient’s door. Patients can message their care team through the portal between visits. You can also read our detailed PT-141 evidence and safety guide and our explanation of getting ED treatment online safely.
How can someone seek erectile dysfunction treatment safely?
A safe ED evaluation includes a medication and health review before treatment. Bring up current prescriptions, supplements, alcohol or recreational drug use, cardiovascular history, diabetes or metabolic concerns, hormone symptoms, and emotional or relationship factors. Do not buy prescription medicines from unverified sellers or change other prescribed medicines on your own. 1
Seek urgent care for an erection lasting more than four hours. Contact a clinician promptly for vision or hearing loss after oral ED medicine. 1 These symptoms can signal serious complications and should not wait for an online message.
Lifestyle changes, reducing alcohol or recreational drug use, improving activity habits, and counseling may help when they address contributing factors. Persistent ED still deserves a clinician review because physical and emotional causes often overlap. 1
The goal is an erection adequate for sexual activity, not a prolonged erection. An erection lasting more than four hours is an emergency and needs urgent care. 1
ED becomes more common with age, but ongoing symptoms are still worth discussing with a clinician. Blood-flow health, medicines, hormones, stress, and other factors may contribute. 1
Yes. Anxiety, stress, depression, relationship concerns, and performance pressure can affect erections. Counseling or sex therapy can be useful, while a clinician can also check for physical contributors. 1
It can be associated with blood-vessel, metabolic, nerve, medication-related, or hormone-related factors. That is why a health review is useful when ED is persistent or changing. 1
No. Bremelanotide has an FDA-approved product for a specific low-sexual-desire condition in premenopausal women, not for ED. Chia’s compounded PT-141 nasal spray is not FDA-approved and is evaluated individually by a licensed provider. 7
3-min quiz
Start with a clinician-reviewed next step
If sexual-health concerns are affecting your quality of life, Chia can review your questionnaire online and discuss whether a treatment option may be appropriate. A prescription requires a medical evaluation and is not guaranteed. Chia’s medications are compounded by state-licensed US 503A pharmacies and are not FDA-approved.
References
- 1.National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Erectile Dysfunction. National Institutes of Health, 2024.
- 2.Yao H, et al. Systematic Review and Meta-Analysis of 16 Randomized Controlled Trials of Low-Intensity Extracorporeal Shock Wave Therapy for Erectile Dysfunction. American Journal of Men's Health. 2022.
- 3.Sramkova T, Motil I, Jarkovsky J, et al. Erectile Dysfunction Treatment Using Focused Linear Low-Intensity Extracorporeal Shockwaves: Single-Blind, Sham-Controlled, Randomized Clinical Trial. Urologia Internationalis. 2020.
- 4.Masterson TA, Molina M, Ledesma B, et al. Platelet-rich Plasma for the Treatment of Erectile Dysfunction: A Prospective, Randomized, Double-blind, Placebo-controlled Clinical Trial. The Journal of Urology. 2023.
- 5.Stem cell therapy for erectile dysfunction: promise or reality? Systematic review and meta-analysis. 2025.
- 6.Zhu M, Quan F, Xue K, et al. Acupuncture for erectile dysfunction: a randomized controlled trial. Zhongguo Zhen Jiu. 2024.
- 7.U.S. Food and Drug Administration. Vyleesi (bremelanotide) prescribing information. 2019.
- 8.Cui H, Liu B, Song Z, et al. Efficacy and safety of long-term tadalafil 5 mg once daily combined with sildenafil 50 mg as needed at the early stage of treatment for patients with erectile dysfunction. Andrologia. 2015.
About this article
Chia Health Editorial Team — Evidence-reviewed health education
This article is for educational purposes only and is not a substitute for individualized medical advice. Talk to a licensed clinician before starting, stopping, or changing any prescription.
AI tools may assist with research and drafting. Chia's editorial team reviews source use, clarity, treatment information, and safety framing before publication. A clinician is named only after explicit sign-off. Read our editorial standards.
Get a personalized plan
Find what fits your body and your goals.
Our 3-minute clinical quiz is reviewed by a US-licensed clinician. Treatment delivered to your door.
