Why is everyone suddenly talking about tadalafil?

For years, tadalafil was seen mainly as an erectile dysfunction medication. But increasingly, doctors are using it much more broadly in men’s health - and not just for erections.

At H3 Health, it’s become one of the medications we discuss most commonly with men looking to improve erections, urinary symptoms and overall quality of life.

Of course, erections are still the main reason most men first hear about tadalafil. It works by relaxing blood vessels and improving blood flow to the penis during arousal, helping support firmer erections and improved sexual confidence. Unlike Viagra, tadalafil can also remain active for up to 36 hours, which many men find feels more natural and less “timed”.

But one of the reasons tadalafil has become so widely discussed is because doctors are increasingly seeing benefits outside the bedroom too.

For men over 40 in particular, urinary symptoms caused by an enlarged prostate often become a frustrating issue - needing to urinate more frequently, weaker flow or waking during the night. Tadalafil is now approved for these symptoms too, helping relax smooth muscle around the bladder and prostate to improve urine flow and urinary comfort.

Another particularly interesting area is testosterone.

Some studies suggest tadalafil may modestly support natural testosterone production in certain men who are not taking TRT - particularly those with erectile dysfunction, metabolic syndrome or lower baseline testosterone levels. Researchers believe this may be linked to improved blood flow, better sleep, increased sexual activity and an overall healthier hormonal environment.

There’s also growing interest in how tadalafil interacts with hormone balance in men already taking TRT. Some studies suggest it may help improve testosterone-to-oestrogen ratios, which may be relevant for men experiencing symptoms linked to higher oestrogen levels such as low mood, fluid retention, reduced libido or breast tenderness.

Interestingly, tadalafil also often works particularly well alongside TRT itself. Testosterone helps regulate some of the key signalling pathways involved in erections, meaning tadalafil may feel less effective when testosterone levels are low. Once testosterone levels are restored, many men notice tadalafil becomes much more effective - improving erection quality, spontaneity and overall sexual confidence.

More recently, researchers have also become increasingly interested in tadalafil’s wider cardiovascular and anti-inflammatory effects.

A 2024 meta-analysis found men taking PDE5 inhibitors had lower rates of cardiovascular events and even lower overall mortality compared with non-users. Large Swedish registry studies involving more than 43,000 men after heart attacks also found lower mortality rates among men using these medications.

Importantly, these studies show association rather than proof that tadalafil itself directly protects the heart. However, they are one reason tadalafil is now increasingly entering the wider “healthspan” and longevity conversation, alongside medications such as metformin and GLP-1 drugs like semaglutide.

That doesn’t mean every man over 40 should automatically take tadalafil. But it does mean the medication is now being viewed very differently from how it was 10 or 15 years ago.

For many men, daily low-dose tadalafil may help support:

• stronger erections
• improved urinary symptoms from an enlarged prostate
• support for testosterone production in some men
• possible cardiovascular and longevity-related benefits

And because daily low-dose tadalafil is generally well tolerated, many men find it fits naturally into a broader modern men’s health approach.

Frequently Asked Questions About Daily Tadalafil

Does tadalafil increase testosterone?

Some studies suggest tadalafil may modestly support natural testosterone production in certain men, particularly those with erectile dysfunction, metabolic syndrome or lower baseline testosterone levels.

In men already taking TRT, tadalafil also appears to improve testosterone-to-oestrogen ratios and erectile responsiveness.

Is tadalafil better than Viagra?

Tadalafil has become one of the most popular erectile dysfunction medications because it lasts much longer than Viagra and allows for greater spontaneity.

Viagra usually lasts around 4–6 hours, whereas tadalafil can remain active for up to 36 hours and can also be taken as a low daily dose.

Can you take tadalafil and TRT together?

Yes - tadalafil and testosterone replacement therapy (TRT) are commonly used together and can work particularly well alongside each other.

Low testosterone can reduce some of the signalling pathways involved in erections, meaning some men respond less effectively to tadalafil alone. Once testosterone levels are restored with TRT, many men notice tadalafil becomes much more effective.

Should every man over 40 take tadalafil?

Not necessarily — but it’s a question being discussed increasingly often in men’s health and longevity medicine.

Researchers are increasingly interested in tadalafil’s possible wider benefits for blood flow, vascular health, urinary symptoms, inflammation and overall quality of life.

Some doctors have even compared tadalafil to “healthspan” medications such as metformin or semaglutide - not because they work similarly, but because they may offer benefits beyond the condition they were originally designed to treat.

Large observational studies have linked PDE5 inhibitors with lower cardiovascular event rates and reduced mortality, although this does not yet prove tadalafil itself directly improves lifespan.

At the moment, tadalafil is not recommended routinely for every man over 40. However, for men experiencing erectile symptoms, reduced sexual confidence, urinary symptoms from an enlarged prostate or certain cardiovascular risk factors, it may offer broader benefits than many people realise.

Contact us to find out more about how we help you maintain your health.

References

1. Soulaidopoulos et al., 2024 – European Heart Journal. Long-term effects of phosphodiesterase-5 inhibitors on cardiovascular outcomes and death: a systematic review and meta-analysis
2. Washington et al., 2010 – Drug Des Devel Ther. A once-daily dose of tadalafil for erectile dysfunction: compliance and efficacy
3. Greco et al., 2006 – J Sex Med. Testosterone:oestrogen ratio changes associated with long-term tadalafil administration: a pilot study
4. Bai et al., 2021 – Front Med. Tadalafil 5 mg daily improves BPH symptoms significantly
5. Anderson SG et al., 2018 – Heart. PDE5 inhibitors and cardioprotective mechanisms
6. Rosano GMC et al., 2005 – Circulation. Tadalafil and endothelial function
7. Ozcan L et al., 2017 – Andrologia. Tadalafil and endogenous testosterone changes in men with metabolic syndrome
8. Hackett G et al. – BSSM Guidelines, 2018
9. EAU Guidelines on Sexual & Reproductive Health, 2025
10. BSSM Practical Guide on Managing Erectile Dysfunction, 2024