Comparing ED treatments, what do men try first?

The Key Points

• Most men start with Sildenafil or Tadalafil.
• Sildenafil works for 4 to 6 hours and is popular for its short action.
• Tadalafil lasts up to 36 hours and offers flexibility, including daily dosing.
• Your choice depends on lifestyle, comfort, and health needs, and it’s okay to switch later.

When you first start looking into erectile dysfunction treatments, the sheer number of options can be overwhelming. Tablets, creams, different brand names, various strengths, it’s a lot of information. What if you pick the "wrong" thing, or it doesn’t work the way you expect.

The good news? There's no such thing as the perfect first choice that works for everyone. Most people find their ideal treatment through a bit of trial and error, which is completely normal.

Which treatments do most men try first?

Based on what we see in practice, the majority of those wanting to start ED treatment are prescribed either Sildenafil or Tadalafil as their first option.

There are several reasons why these two ED treatments tend to be prescribed first. The first is just plain familiarity. Most people looking for help with erectile dysfunction have heard of Sildenafil or Tadalafil, or at least their brand names. These medicines have decades of use and research behind them (1)(2).

The second is the flexibility in their use. Both are oral tablets and can be used ‘on demand’, while Tadalafil, at a lower dose, has the extra option of being taken as a daily pill to be ‘always on’.

Neither is right or wrong, it depends on your preference and your doctor’s advice.

Comparing these two options

Here are a few other things worth knowing about Sildenafil, Tadalafil, and other ED treatments. 

Sildenafil 

Sildenafil typically works within 30-60 minutes, and its effects last for around 4-6 hours. Many people like this predictable timeframe, especially when first starting. Interestingly, our first-time patients often prefer to try Sildenafil first, possibly because its shorter duration (4-6 hours) feels less ‘risky’ than Tadalafil's longer action (up to 36 hours). With this medicine and Tadalafil, you still need to be sexually stimulated for it to be effective.

Tadalafil

Tadalafil gives you a little more wiggle room with timing. Although it takes a similar amount of time to kick in as Sildenafil, its effects can last up to 36 hours. This longer window means you don’t necessarily need to expect or plan for sexual activity before taking. 

With Tadalafil, there are two choices: on-demand tablets or lower daily doses that maintain a constant level in your system.

Regardless of the type, you need to be sexually stimulated for it to be effective.

Other treatment options

If you’re not sure about taking tablets, there are other ED treatments. Creams like Vitaros are applied directly and can be helpful for those who can't take oral medications. 

For more advanced, complex cases, such as after prostate surgery, treatments like injections or pumps might be recommended.

Though these are usually only considered after trying oral medicines first.

Lifestyle changes, therapy for performance anxiety, or addressing underlying health conditions can be effective treatments in their own right. Sometimes they are enough to help manage ED or can be a complement to erectile dysfunction medicines.

What matters most when choosing a treatment?

Your lifestyle plays a big role in what might work best. If spontaneity is important, Tadalafil's longer duration might be a better choice. Whereas, if you prefer more control over timing and duration, choosing Sildenafil might feel more suitable.

Your current health will influence your options. Certain medications, heart conditions, or blood pressure issues may make one treatment more suitable than another. This is why we ask about your health history during our ED consultation.

Side effects vary between people and treatments. Common side effects can include headaches, flushing, or a stuffy nose.

 Although there are common side effects across both ED medicines, you may react differently or more severely with one over the other. Always read the Patient Information Leaflet for any medicine you are prescribed.

There's no rule that says you have to stick with one treatment forever. You might try one, see how you get on, and then change – whether that's changing the dose, switching to a different medicine, or combining with lifestyle changes. This process is perfectly normal and part of finding what works best for you.

You don't have to figure it out alone

Finding an ED treatment isn't something you need to tackle alone. Nor does it mean you have to face the sometimes awkward GP visit.

At Oxford Online Pharmacy, our pharmacist-led approach means you're getting expert clinical help throughout the process. Our independent, UK-registered doctors review every consultation to support you with the most suitable treatment option, based on your medical history, current medications, and personal preferences.

We know how uncomfortable making that first step toward addressing ED is, and we aim to make the whole process as easy as possible. The consultation process is designed to be discreet and thorough, with no face-to-face appointments, and discreet delivery from our regulated pharmacy.

So, whether you're leaning towards Sildenafil, curious about Tadalafil, or wondering about other approaches, we are here to help you make the best choice for your health.

References

1. Smith BP, Babos M. Sildenafil [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023.
2. Lilly ICOS’ Cialis (tadalafil) Makes Impressive Strides in First Six Months on the U.S. ED Treatment Market | Eli Lilly and Company [Internet]. Eli Lilly and Company. 2024.