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 important consideration 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 has also been some research into whether tadalafil may influence hormone markers in men. Some small studies have reported changes in oestradiol and testosterone-to-oestrogen ratios, although the evidence is limited and tadalafil is not used as a treatment for hormone imbalance in men already taking TRT.
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, some men notice tadalafil becomes more effective - improving erection quality.
More recently, researchers have also become increasingly interested in the wider cardiovascular effects of PDE5 inhibitors.
A 2024 meta-analysis found that men taking PDE5 inhibitors had lower rates of major cardiovascular events and lower overall mortality compared with non-users. These findings are interesting, but most of the evidence is observational, so they do not prove that tadalafil itself directly protects the heart or extends life.
Erectile dysfunction itself can sometimes be associated with underlying cardiovascular risk, so a wider health assessment may be appropriate, particularly in men with other risk factors such as high blood pressure, raised cholesterol, diabetes or smoking.
Tadalafil is generally well tolerated in suitable patients, but it is not appropriate for everyone and should not be used with nitrate medications.
So while tadalafil remains primarily a treatment for erectile dysfunction and urinary symptoms associated with BPH, research into PDE5 inhibitors is increasingly looking at their wider effects on vascular and cardiovascular health.
For appropriately selected men, tadalafil may help support:
- stronger and more reliable erections
- improved urinary symptoms associated with an enlarged prostate
- sexual function as part of a wider treatment approach where testosterone deficiency is also present
Because tadalafil can be taken once daily in certain circumstances, some men find that it fits conveniently into a broader approach to managing their sexual and urinary health.
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 and may reduce the response to erectile dysfunction treatment. Where testosterone deficiency is properly diagnosed and treated, sexual function and response to PDE5 inhibitors may improve in some patients.
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.
What does the research say about tadalafil and cardiovascular health?
There is growing research interest in the relationship between PDE5 inhibitors and cardiovascular health.
Observational studies have reported lower rates of cardiovascular events and mortality among men taking these medications. However, this type of research cannot establish that tadalafil itself prevents cardiovascular disease or extends life, and tadalafil is not prescribed for this purpose.
Erectile dysfunction itself shares several risk factors with cardiovascular disease, so persistent erectile symptoms can also 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
- European Association of Urology. EAU Guidelines on Sexual and Reproductive Health. 2026. Section: Management of Erectile Dysfunction.
- European Association of Urology. EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms (LUTS). 2026.
- British Society for Sexual Medicine. Guidelines and practical guidance on the management of erectile dysfunction.
- Electronic Medicines Compendium. Cialis 5 mg film-coated tablets: Summary of Product Characteristics. Eli Lilly and Company Limited. Updated February 2026.
