Sven Wombwell
Article by: Sven Wombwell
Estimated 5 minutes read
Quick summary
ED medications like Viagra or Cialis, combined with testosterone replacement therapy (TRT), can effectively treat erectile dysfunction and low testosterone symptoms. This combination has no adverse reactions and is considered perfectly safe. Many physicians advise men to take ED meds and TRT together due to having a host of health benefits.

Can You Take Viagra or Cialis with TRT?

The simple answer to the question is it safe to take ED meds and TRT together? Is yes. ED meds and testosterone combined offer an excellent solution for guys with ED and symptoms of low T.

ED meds:

  • Offer relief from erectile dysfunction
  • Improves oxygen flow around the body


  • Increase sexual desire and energy levels
  • Relieve many of the symptoms of low testosterone associated with ED
  • Increase nitric oxide production, making it easier to become erect

What's the Connection Between Testosterone and Erections?

Testosterone replacement significantly increases sexual desire1 and can improve responsiveness to ED medications. However, ED meds alone will not increase libido. They only increase blood flow to the penis and can be ineffective without mental or physical stimulation.

If you experience erectile dysfunction and medications, such as Viagra®, don't work as well as you had hoped, don't worry. Other options available could improve your sexual function and benefit other areas of your overall health.

Can Low Testosterone Cause ED?

Low testosterone alone may not directly cause ED, but ED is a common symptom for those with low T. It's clear that low testosterone levels are related to many chronic conditions that play a role in erectile dysfunction

Heart hands

Symptoms of Low T? See if TRT Can Help

Symptoms of low T that can cause erectile dysfunction:

  • Type 2 diabetes
  • Loss of libido
  • Obesity and visceral fat
  • Depression
  • Metabolic syndrome
  • Atherosclerosis (clogged arteries)

These conditions are common risk factors that restrict blood flow to the penis, making it more challenging to get erect. If you suffer from any of these, it's certainly worth taking our free assessment to see if TRT could help.

Guys with lower testosterone tend to gain weight, lose muscle definition, and suffer from a lack of energy and libido. As a result, it can severely dent a man's sexual confidence and desire to have sex. Erectile function is also affected by your mental state, which can have devastating effects on your ability to become aroused.

Erectile Dysfunction Could Indicate Cardiovascular Problems.

ED can be a symptom of cardiovascular disease (heart disease). One early indicator of heart disease is a condition called endothelial dysfunction. This disorder stops blood vessels from dilating (opening) properly. Often affecting the blood vessels in the penis, endothelial dysfunction could be the first hint that something isn't right. It could also indicate the beginnings of heart disease.

Erectile Dysfunction and Diabetes

High blood sugar levels associated with type 2 diabetes can damage blood vessels and nerves responsible for gaining an erection. Two particular studies highlight how low T and diabetes are linked. The first2 shows how prevalent ED is amongst those with low T. The second study3 observed 580 men and revealed fascinating facts about ED, testosterone, and men with type 2 diabetes.

  • Diabetes is one of the most common comorbidities of ED.
  • ED among diabetic men varies from 35 to 90%.
  • Forty-three percent of men with type 2 diabetes had reduced total testosterone
  • 57% of men with type 2 diabetes have reduced free testosterone.

Does TRT Help Erectile Dysfunction?

Testosterone levels can impact aspects of health that can cause ED. Before the days of Viagra® and Cialis®, many doctors would prescribe TRT as a 'go-to' treatment for ED. TRT as an ED treatment makes sense. Notably, testosterone is at the core of sexual arousal, the desire for sex and some specific mechanics of getting an erection.

Without getting too technical, testosterone helps your body release an enzyme called nitric oxide. This chemical helps relax blood vessels meaning blood can flow freely into the penis. Many men with ED also have atherosclerosis (hardened arteries). If your arteries become hardened, it becomes difficult for nitric oxide to relax the blood vessels. Unfortunately, men with low T tend not to produce enough nitric oxide, which makes it harder to get hard. This response is particularly significant because ED drugs like Viagra and Cialis are less effective if nitric oxide is low. So, for those with low T, ED meds may be less effective or not work at all.

  • Testosterone is essential for erections and male sexual behavior and attitudes.
  • Testosterone replacement therapy (TRT) in hypogonadal patients with ED should be the first treatment considered.
  • TRT alone might not be adequate in all cases of ED because of the many cause of the disorder
  • In these cases, combination therapy with ED medication might improve outcomes.

Take our free assessment to see if testosterone could help reignite your sex life.

Combining Testosterone and Erectile Dysfunction Treatments May Improve Results

For some guys with low testosterone, TRT can restore erectile function without needing ED meds. Taking ED meds and TRT together helps those who don't respond to one single treatment.

If you take ED meds and TRT Together, especially for those with type 2 diabetes, vascular disease, and obesity, it can target many causes of ED. Many men can reverse some of these causes with long-term testosterone treatment and lifestyle changes. Interestingly, studies4 even show that Sildenafil (Generic Viagra®) helps increase testosterone levels in men via direct action on the testes.

Using PDE5 inhibitors such as Viagra® or Cialis® with testosterone is typically safe for men with low T and ED. Our providers at Male Excel often prescribe both to benefit sexual and overall health. Significantly, TRT can relieve symptoms of low T, such as low energy, low libido, and even weight and cardiovascular problems. ED medications can increase blood flow to the penis; studies now show it may improve pulmonary hypertension. Crucially, strong evidence5 shows that combining these treatments may benefit men with both low T and ED.

man holding belly

How you feel tomorrow starts today!

Rizk PJ, Kohn TP, Pastuszak AW, Khera M. Testosterone therapy improves erectile function and libido in hypogonadal men. Curr Opin Urol. 2017;27(6):511-515. doi:10.1097/MOU.0000000000000442
Giugliano, F., Maiorino, M., Bellastella, G. et al. Determinants of erectile dysfunction in type 2 diabetes. Int J Impot Res 22, 204–209 (2010).
Mathis Grossmann, Merlin C. Thomas, Sianna Panagiotopoulos, Ken Sharpe, Richard J. MacIsaac, Sophie Clarke, Jeffrey D. Zajac, George Jerums, Low Testosterone Levels Are Common and Associated with Insulin Resistance in Men with Diabetes, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 5, 1 May 2008, Pages 1834–1840,
Spitzer M, Bhasin S, Travison TG, Davda MN, Stroh H, Basaria S. Sildenafil increases serum testosterone levels by a direct action on the testes. Andrology. 2013;1(6):913-918. doi:10.1111/j.2047-2927.2013.00131.x
Shabsigh R, Rajfer J, Aversa A, Traish AM, Yassin A, Kalinchenko SY, Buvat J. The evolving role of testosterone in the treatment of erectile dysfunction. Int J Clin Pract. 2006 Sep;60(9):1087-92. doi: 10.1111/j.1742-1241.2006.01101.x. PMID: 16939550.
Ferrini, M. G., Gonzalez-Cadavid, N. F., & Rajfer, J. (2017). Aging related erectile dysfunction-potential mechanism to halt or delay its onset. Translational andrology and urology, 6(1), 20–27. doi: 10.21037/tau.2016.11.18.
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