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Sildenafil and Tadalafil are both an oral tablet, prescription medicines that are FDA approved to treat erectile dysfunction (ED).
Sildenafil and Tadalafil are in a group of medications called phosphodiesterase 5 (PDE5) inhibitors. Sildenafil and Tadalafil treat ED by increasing blood flow to the penis during sexual stimulation, which leads to an erection. Sildenafil is taken one hour before sexual activity and its effects last 4-6 hours. Tadalafil can be taken up to 36 hours before sexual activity and therefore is often known as the “weekender”.
ED medications work by relaxing the blood vessels in the penis, allowing for increased blood flow when sexually stimulated. This enhanced blood flow can lead to firmer and longer-lasting erections. The onset of action varies between different ED medications. Sildenafil and Tadalafil ideally are taken 1 hour before expected sexual activity but since Tadalafil gives you the ability to obtain an erection for up to 36 hours, Tadalafil gives you extra convenience. Daily Tadalafil at a lower dose (5mg) is also an option and this gives you the ability to obtain an erection without needing to time a dose to match expected sexual activity. ED medications don’t automatically cause an erection. Sexual stimulation is still required to trigger the response. The medication simply enhances the body’s natural response to sexual arousal.
Both medications should be taken with a full glass of water and can be taken on an empty stomach or with a normal-sized meal. It’s important to note that Sildenafil and Tadalafil will not give you an erection for the entire period that they are in your system. They simply allow you to achieve a satisfactory erection when you are sexually stimulated.
Sildenafil and Tadalafil are generally safe and well-tolerated by most men. However, like any medication, they can have side effects. Common side effects of ED medications may include:
Headache: This is one of the most common side effects reported with ED medications. It is usually mild and transient.
Facial flushing: Some men may experience redness or warmth in the face and neck.
Nasal congestion: Stuffy or runny nose can occur as a side effect.
Upset stomach: Some men may experience indigestion or gastrointestinal discomfort.
Dizziness: ED medications can cause a temporary drop in blood pressure, leading to dizziness in some individuals.
Vision changes: Some men may experience mild and temporary changes in vision, such as a blue tinge or blurred vision.
Back pain or muscle aches: These side effects are less common but can occur.
Priapism: This is a rare but potentially serious side effect. Priapism is a prolonged and painful erection that lasts for more than four hours. It requires immediate medical attention to prevent tissue damage to the penis.
It’s important to note that not everyone will experience these side effects, and they are usually mild and temporary. If you do experience any of these side effects and find them bothersome or persistent, you should contact your healthcare provider.
It’s also essential to be aware that ED medications may not be suitable for everyone, especially men with certain medical conditions or those taking specific medications. For example, men who have severe heart disease, uncontrolled hypertension, or are taking nitrates for chest pain should avoid ED medications due to potential interactions and health risks.
For Sildenafil (all strengths) or Tadalafil (10mg or 20mg), take 1 tablet as needed for sexual activity. Do not take any more than is directed by your doctor. If you are taking daily Tadalafil (5mg), take your dose around the same time each day. If you miss a dose, take that dose once you remember if it’s still within the same-day. If you completely miss your daily dose, do not double up the next day. You can just get back on your normal dosing schedule as prescribed by your doctor.
Keep this medication in the original container that you received it in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Every prescription has trade-offs. Your physician reviews these with you before approving treatment.
Possible side effects:
- Headache
- Facial flushing
- Nasal congestion
- Upset stomach
- Dizziness
- Vision changes
- Back pain
- Priapism (rare)
PT-141 (Bremelanotide) is a centrally acting melanocortin receptor agonist used to enhance sexual desire and arousal in both men and women. Originally developed to treat sexual dysfunction, it is FDA-approved for hypoactive sexual desire disorder (HSDD) in premenopausal women and is also commonly used off-label in men with low libido or erectile dysfunction—especially when psychological or central causes are suspected. Unlike traditional ED medications, PT-141 works through the brain rather than blood flow.
PT-141 stimulates the brain's arousal centers through the melanocortin system:
- CNS-Based Arousal Enhancement
- PT-141 activates melanocortin receptors (MC3R and MC4R) in the hypothalamus, increasing sexual desire and drive by acting on the central nervous system.
- Independent of Blood Flow
- Unlike PDE5 inhibitors (like sildenafil or tadalafil), PT-141 does not depend on nitric oxide pathways or vascular mechanisms—making it effective for both genders and for arousal-related dysfunction.
- Rapid, On-Demand Effect
- Administered via subcutaneous injection 45–60 minutes before sexual activity, PT-141 enhances arousal, responsiveness, and sensitivity for several hours.
- Inject 1 hour before sexual activity (typically 1.75mg dose)
- Onset: 45–60 minutes, duration: 6–12 hours
- Do not exceed 1 dose in 24 hours or 8 doses per month (per FDA guidelines for women)
- Results improve with repeated, consistent use over time
- Safe to combine with TRT, HRT, or PDE5s (under supervision)
- Missed dose? PT-141 is on-demand—only use when needed
Taking 1 tablet daily helps most men reduce their PE issue. It may take a few weeks for the medication to reach its full effect, so be patient and continue following your doctor's instructions. Sertraline needs to be taken daily. If you skip days or doses, you may not receive the full benefit for PE.
Common Side Effects:
- Nausea (transient)
- Flushing or warmth
- Headache
- Injection site reactions
Less Common / Monitor If Present:
- Elevated blood pressure (temporary)
- Fatigue or yawning
- Dizziness
- Darkening of gums or skin (rare with prolonged use)
Every prescription has trade-offs. Your physician reviews these with you before approving treatment.
Possible side effects:
- Nausea
- Flushing
- Headache
- Injection site reactions
- Elevated blood pressure
- Fatigue
- Skin darkening (rare)
Finasteride (Oral)
Decreased libido or erectile dysfunction (1–2%)
Lower ejaculate volume
Contraindicated in women of childbearing age (Category X)
Rare persistent sexual side effects
Finasteride (Topical)
Scalp irritation, pruritus, or erythema
Fewer systemic effects compared to oral
Minoxidil (Oral)
Fluid retention or ankle swelling
Elevated heart rate
Hypertrichosis (unwanted body/facial hair)
Rare: pericardial effusion, chest pain
Minoxidil (Topical)
Scalp dryness or burning
Eczema, dermatitis, or redness
Spironolactone (Oral)
Elevated potassium (hyperkalemia)
Dizziness, dehydration, or lightheadedness
Menstrual irregularities
Breast tenderness or GI symptoms
Generally well tolerated in monitored doses
Initial shedding may occur in the first 4–6 weeks
Visible improvements begin around 3–4 months
Most patients see significant improvement at 6–9 months
Full regrowth potential is typically seen at 12 months
Daily adherence is essential—missed doses reduce efficacy
Discontinuation can reverse results in 3–6 months
Finasteride belongs to a group of drugs called 5-alpha reductase inhibitors. It works by blocking the conversion of Testosterone to DHT by up to 70% and therefore lowers DHT levels in the body and at the scalp. Lowering DHT will allow your hair to start the process of growing back.
Results will begin appearing after 3-4 months but significant results may not be apparent for 6-9 months after starting the medication. Full results are usually seen approximately 1 year after starting treatment with Finasteride and using the medication on a daily basis. Patients who skip treatment days, weeks, or months may find that the medication does not work as effectively and does not produce the results they were expecting.
Finasteride comes as a tablet to take by mouth. It is usually taken once a day with or without food. Take Finasteride at around the same time every day. Follow the directions on your prescription label carefully. Take Finasteride exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Finasteride is a medication primarily used to treat male pattern hair loss (androgenic alopecia) and enlarged prostate (benign prostatic hyperplasia). Like any medication, it can have potential side effects. The most common side effects of Finasteride include:
Sexual side effects: This is the most well-known side effect of Finasteride. It may include decreased libido (sex drive), erectile dysfunction, and decreased ejaculate volume. In some cases, these side effects may persist even after discontinuing the medication.
Breast enlargement and tenderness: Some men may experience breast enlargement and tenderness, a condition known as gynecomastia.
Allergic reactions: Rarely, some individuals may experience allergic reactions to Finasteride, which may manifest as rash, itching, swelling, dizziness, or difficulty breathing.
It’s important to note that not everyone experiences these side effects, and most people tolerate Finasteride well. If you are prescribed Finasteride, your healthcare provider will monitor your progress and discuss any potential side effects with you. If you notice any troubling side effects while taking Finasteride, it is crucial to discuss them with your doctor as soon as possible.
It is important that women of child-bearing age do not take or handle Finasteride as it may cause birth defects. The most common side effects of Topical Finasteride typically occur on the scalp and may
include
Scalp Pruritus
Burning Sensation
Irritation
Contact Dermatitis
Erythema (redness on the skin)
If you forget to take your daily dose of Finasteride, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
Keep this medication in the original container that you received it in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Every prescription has trade-offs. Your physician reviews these with you before approving treatment.
Possible side effects:
- Decreased libido
- Erectile dysfunction
- Decreased ejaculate volume
- Gynecomastia
- Allergic reactions