Why is tadalafil increasingly discussed in men’s health?
For years, tadalafil was seen mainly as an erectile dysfunction medication. But increasingly, doctors are looking at it more broadly in men’s health.
At H3 Health, men's health experts, it’s become one of the medications we discuss most commonly with men looking to improve erections, urinary symptoms and overall quality of life.
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 sexual arousal, helping men with erectile dysfunction achieve and maintain an erection.
One of the characteristics of tadalafil is its relatively long duration of action. Following an on-demand dose, it can remain active for up to 36 hours. This does not mean an erection lasts for 36 hours — sexual stimulation is still required for the medication to work.
But tadalafil also has another established role in men’s health.
For men over 40 in particular, urinary symptoms associated with an enlarged prostate can become a frustrating issue — needing to urinate more frequently, experiencing a weaker flow or waking during the night. Tadalafil is also licensed for the treatment of signs and symptoms of benign prostatic hyperplasia (BPH).
Erectile dysfunction and urinary symptoms also frequently occur in the same men, particularly as we get older, which is one reason the two problems are often worth considering together.
Another particularly interesting area is testosterone.
Low testosterone can contribute to reduced libido and sexual dysfunction in some men, although erectile dysfunction does not automatically mean that testosterone levels are low.
There has also been research into whether PDE5 inhibitors such as tadalafil may influence testosterone and other hormonal markers. This remains an area of research rather than an established clinical use, and tadalafil is not licensed to increase testosterone or to treat testosterone deficiency.
What is more clinically important is recognising when erectile symptoms may be part of a wider hormonal picture. If erectile difficulties occur alongside symptoms such as reduced libido, fatigue or loss of morning erections, appropriately timed testosterone blood tests may be worth considering.
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. Tadalafil is not licensed as a cardiovascular or longevity treatment.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 Tadalafil
Does tadalafil increase testosterone?
There has been research into whether tadalafil and other PDE5 inhibitors may influence testosterone and other hormonal markers.
However, tadalafil is not licensed as a treatment for low testosterone or for the purpose of increasing testosterone levels, and this should not be considered an established reason for taking it.
If symptoms suggest testosterone deficiency, this should be assessed separately using symptoms, appropriately timed blood tests and the wider clinical picture.
How long does tadalafil last?
When tadalafil is prescribed for erectile dysfunction on an as-required basis, its effect can remain present for up to 36 hours.
This does not mean that an erection lasts for 36 hours. Sexual stimulation is still required for tadalafil to help produce an erection.
Tadalafil can also be prescribed as a once-daily treatment in certain circumstances, depending on the clinical indication and the individual patient.
Can you take tadalafil and TRT together?
Tadalafil and testosterone replacement therapy (TRT) may sometimes be prescribed to the same patient where each treatment has an appropriate clinical indication.
Low testosterone can contribute to sexual symptoms in some men, but persistent erectile dysfunction should still be assessed for other physical, psychological, cardiovascular or medication-related causes.
TRT should be used to treat appropriately diagnosed testosterone deficiency rather than simply as a treatment for erectile dysfunction.
Can tadalafil help urinary symptoms?
Yes. Tadalafil is licensed for the treatment of signs and symptoms of benign prostatic hyperplasia.
However, urinary symptoms can have several possible causes, so persistent or worsening symptoms should be assessed rather than assuming that an enlarged prostate is responsible.
Does tadalafil have cardiovascular or longevity benefits?
There is research interest in the relationship between PDE5 inhibitors and cardiovascular health, including observational studies looking at cardiovascular outcomes.
However, this type of research cannot establish that tadalafil itself prevents cardiovascular disease or extends life, and tadalafil is not licensed for either purpose.
Erectile dysfunction itself shares several risk factors with cardiovascular disease, so persistent erectile symptoms can be a useful opportunity to review blood pressure, cholesterol, blood sugar and other aspects of cardiovascular health.
Should every man over 40 take tadalafil?
No.
Tadalafil should be used where there is an appropriate clinical indication and after considering medical history, other medications, potential risks and individual circumstances.
For men experiencing erectile symptoms, reduced sexual confidence or urinary symptoms from an enlarged prostate, a men’s health assessment can help identify possible causes and discuss the treatment options that may be appropriate.
If erectile problems occur alongside reduced libido, fatigue or other symptoms of possible testosterone deficiency, assessment can also look at hormone health alongside cardiovascular and metabolic risk factors.
Contact us to find out more about how we help you maintain your health.
References
- 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
- Washington et al., 2010 – Drug Des Devel Ther. A once-daily dose of tadalafil for erectile dysfunction: compliance and efficacy
- Greco et al., 2006 – J Sex Med. Testosterone:oestrogen ratio changes associated with long-term tadalafil administration: a pilot study
- Bai et al., 2021 – Front Med. Tadalafil 5 mg daily improves BPH symptoms significantly
- Anderson SG et al., 2018 – Heart. PDE5 inhibitors and cardioprotective mechanisms
- Rosano GMC et al., 2005 – Circulation. Tadalafil and endothelial function
- Ozcan L et al., 2017 – Andrologia. Tadalafil and endogenous testosterone changes in men with metabolic syndrome
- Hackett G et al. – BSSM Guidelines, 2018
- EAU Guidelines on Sexual & Reproductive Health, 2025
- BSSM Practical Guide on Managing Erectile Dysfunction, 2024
