Erectile Dysfunction Treatment: 10 Options, Explained by a Urologist

Medically reviewed by Michael G. Wierschem, MD, MBA, FACS board-certified urologist | Last updated: September 28, 2026

Key takeaways

• Erectile dysfunction (ED) is common. It affects as many as 30 million men in the United States, and about half of men between 40 and 70 report some degree of it.
• Most men start with lifestyle changes and an oral medication such as sildenafil or tadalafil. When pills do not work or are not safe for you, injections, vacuum devices and penile implants are well-established next steps.
• Shockwave therapy and platelet-rich plasma (PRP) are newer options used off-label. Research is growing, but results vary from man to man.
• ED can be an early sign of heart disease, diabetes or low testosterone, so the best treatment starts with finding the cause.

The main treatments for erectile dysfunction are lifestyle changes and counseling, oral PDE5 inhibitor medications (sildenafil, tadalafil, vardenafil and avanafil), a topical gel, urethral suppositories, penile injections, vacuum erection devices, testosterone therapy when levels are truly low, and penile implants. Shockwave therapy and PRP injections are newer options. The right choice depends on what is causing your ED, your other health conditions and the medications you already take.

This guide walks through each option the way a urologist would in an exam room: how it works, how fast it acts, who it suits and what the tradeoffs are.

Erectile Dysfunction Treatments Compared

Start Here: The Cause Decides the Treatment

An erection needs healthy blood vessels, working nerves, adequate hormones and a relaxed mind. When any one of those breaks down, erections suffer. The most common causes are:

• Reduced blood flow from high blood pressure, high cholesterol, diabetes, smoking or heart disease. This is the most common cause in men over 40.
• Hormone problems, especially low testosterone, which usually shows up first as lower desire.
• Nerve damage from diabetes, spine problems or prostate surgery.
• Medications, including some blood pressure drugs, antidepressants and stimulants.
• Psychological factors such as stress, depression and performance anxiety, which are especially common in younger men.

ED matters beyond the bedroom. Because the arteries in the penis are smaller than those around the heart, erection problems can appear before heart disease causes any other symptoms. That is why a proper evaluation looks at your whole health, not just your erections. For a closer look at the warning signs, read early signs of erectile dysfunction you should not ignore and why erectile dysfunction happens.

Not sure what is causing your ED? A board-certified urologist can find the cause and match the treatment to it.

1. Lifestyle Changes and Counseling

Lifestyle changes will not reverse every case, but they improve the blood vessels every other treatment depends on, and they make medications work better. The changes with the strongest evidence are regular aerobic exercise, losing excess weight, quitting smoking, limiting alcohol and getting sleep apnea treated if you snore heavily or wake up tired.

When stress, depression or performance anxiety is part of the picture, counseling or sex therapy can help, sometimes on its own and often alongside medication. Many men find that a few successful experiences with medication break the anxiety cycle.

If excess weight is a factor, a supervised medical weight loss program can improve both metabolic health and sexual function.

2. Oral Medications (PDE5 Inhibitors)

Pills are the first treatment most men try, and for good reason: they are effective for a majority of men, inexpensive in generic form and easy to use. They work by blocking an enzyme called PDE5, which allows more blood to flow into the penis when you are sexually aroused. They do not create an erection without arousal.

Why ED pills sometimes do not work

Many men decide pills do not work after one or two tries. Common reasons include taking the pill too close to sex, taking sildenafil after a large meal, expecting an erection without arousal, a dose that is too low, and untreated low testosterone. A urologist will usually adjust the dose, timing or medication before moving on to other options.

Safety

Never combine PDE5 inhibitors with nitrate medications such as nitroglycerin, because the combination can drop blood pressure dangerously. Use caution with alpha-blockers taken for prostate or blood pressure problems. Common side effects include headache, flushing, nasal congestion, indigestion and back pain. Seek emergency care for any erection that lasts longer than four hours.

3. Topical Gel

In 2023 the FDA authorized the first over-the-counter topical gel for ED, sold as Eroxon®. It is applied to the head of the penis and is thought to work by stimulating nerve endings that trigger an erection. It has been studied mainly in men with mild ED, so it suits men who want a non-pill option for milder symptoms rather than men with severe ED.

4. Urethral Suppositories

A urethral suppository places a tiny pellet of the medication alprostadil into the opening of the penis with a small applicator. An erection typically develops within 5 to 10 minutes. It is an option for men who cannot take pills and do not want injections, although it tends to be less reliable than injections and can cause a burning or aching sensation.

5. Penile Injections

When pills fail, penile injections are one of the most effective next steps. A very fine needle delivers medication into the side of the penis, which relaxes the blood vessels and produces an erection within 5 to 20 minutes, with or without arousal. Options include alprostadil alone or compounded combinations such as Trimix, which are prepared by a pharmacy and are not FDA-approved as a combination product.

Most men are surprised by how little it hurts once they are shown the technique. The first dose should always be tested in the clinic, because the most important risk is priapism, an erection that will not go away. Any erection lasting longer than four hours needs emergency care. Repeated injections can also cause scarring.

6. Vacuum Erection Devices

A vacuum erection device is a plastic cylinder placed over the penis. A pump removes air, drawing blood into the penis, and a tension ring at the base holds the erection. It works regardless of the cause of ED and involves no medication. The ring should not stay on longer than 30 minutes, and the erection can feel cooler and look slightly bluish. Some men use a vacuum device together with pills or injections.

7. Testosterone Therapy (When Levels Are Truly Low)

Low testosterone rarely causes ED on its own, but it lowers desire and can make ED medications less effective. The American Urological Association uses a total testosterone level below 300 ng/dL, confirmed on two separate early morning blood tests, together with symptoms, to diagnose low testosterone.

When testing confirms low levels, testosterone replacement therapy can improve libido, energy and mood, and may help ED medications work better. If your levels are normal, testosterone will not fix your erections. Learn the typical symptoms in 6 signs of low testosterone.

8. Shockwave Therapy

Low-intensity shockwave therapy applies focused acoustic waves to the penis over a series of short, in-office sessions. The goal is to improve blood vessel health in the penis, so it is most often considered for mild to moderate ED caused by reduced blood flow. Results develop gradually over weeks rather than on demand.

Extracorporeal shockwave devices, including the one we use, are authorized in the United States for other medical indications. Using such a device to treat erectile dysfunction is off-label use by a licensed physician. Research results vary with the device and the patient, which is why the evaluation comes first. See how shockwave therapy for ED works at our clinic.

9. Platelet-Rich Plasma (P-Shot®)

Platelet-rich plasma (PRP) is made from a small sample of your own blood, concentrated to raise the level of platelets and growth factors, then injected into the penis. The P-Shot® is one well-known PRP procedure. Because it uses your own blood, many men are drawn to it as a regenerative option.

PRP is not FDA-approved for ED, and the American Urological Association considers it experimental. Published trials are small and their results are mixed, so it is best viewed as one option within a complete plan rather than a replacement for proven treatments.

Comparing regenerative options? Talk through shockwave, PRP and standard treatments with a urologist who offers all of them. [CTA BLOCK: Book a Consultation button + click-to-call (214) 894-1008]

10. Penile Implants

A penile implant is the most definitive treatment for ED. A urologist surgically places a device inside the penis. The most common type is an inflatable implant: squeezing a small pump hidden in the scrotum fills cylinders in the penis to create a firm erection, and a release valve returns it to a relaxed state. The device is completely internal.

Implants are generally considered after other treatments have not worked or are not suitable. Satisfaction rates in published studies are commonly above 90 percent. The tradeoffs are that it is surgery, it carries a small risk of infection or mechanical failure, and natural erections are no longer possible once an implant is in place. Dr. Wierschem has published peer-reviewed research on penile implant surgery in the Journal of Urology.

What About Supplements and Natural ED Remedies?

Herbal and over-the-counter “male enhancement” supplements are not regulated like medications, and the evidence behind most of them is weak. There is also a real safety risk: the FDA has repeatedly warned about sexual enhancement products that contain hidden prescription drug ingredients, including sildenafil and tadalafil, which can interact dangerously with nitrates and other medications. If you want a natural approach, the lifestyle changes in option 1 have far stronger evidence than any supplement.

Is There a Cure for Erectile Dysfunction?

Sometimes. ED can resolve when its cause can be removed: switching a medication that caused it, losing weight, treating confirmed low testosterone, or working through performance anxiety. When ED comes from long-standing blood vessel or nerve damage, it is usually managed rather than cured, and treatments like pills, injections and implants work very well for that. Either way, almost every man with ED has an effective option.

Which ED Treatment Is Right for You?

• Mild ED, or ED linked to stress: lifestyle changes, counseling and a trial of a PDE5 pill.
• ED with low desire or fatigue: a testosterone blood test before anything else.
• Pills did not work after a proper trial: a dose or timing adjustment, then injections or a vacuum device.
• You take nitrates or cannot take pills: injections, a suppository or a vacuum device.
• Mild to moderate ED from blood flow and a preference for non-drug options: shockwave therapy may be discussed alongside standard care.
• Nothing else has worked: a penile implant consultation.
• ED together with a curve in the penis: an evaluation for Peyronie’s disease, which changes the treatment plan.

When to See a Urologist, and What Happens at the Visit

See a doctor if erection problems happen more often than not, last longer than a few weeks, or come with other symptoms such as chest pain, curvature, pain or low desire. A urologist is the specialist who treats ED and the only one who can offer every option on this list, from pills to implants.

At Dallas Men’s Health, your visit with Dr. Wierschem, a board-certified urologist with more than 25 years of experience, starts with a conversation about your symptoms, health history and medications, followed by a focused exam and lab work when it is needed. From there you get a plan built around the cause of your ED and your goals. If you are in North Texas, learn more about erectile dysfunction treatment in Dallas, or read what to expect during an erectile dysfunction exam.

How Much Does ED Treatment Cost?

Costs vary widely by treatment. Generic sildenafil and tadalafil are among the least expensive options. Office-based treatments such as shockwave therapy and PRP are usually paid out of pocket, because insurance typically does not cover off-label treatments. Penile implants may be covered when they are medically necessary, depending on your plan. Your exact cost is quoted after your evaluation, and financing options are available.

Frequently Asked Questions

What is the most effective treatment for erectile dysfunction?

For producing a reliable erection on demand, a penile implant is the most effective treatment, but it is surgery and is usually reserved for men who have tried other options. Among non-surgical treatments, oral PDE5 inhibitors work for a majority of men, and penile injections are highly effective when pills are not.

What is the newest treatment for erectile dysfunction?

The newest options include an over-the-counter topical gel authorized by the FDA in 2023, low-intensity shockwave therapy and platelet-rich plasma injections. Shockwave and PRP are used off-label, and research on them is still developing.

Is there a cure for erectile dysfunction?

ED can go away when its cause is removed, such as a medication side effect, excess weight, low testosterone or performance anxiety. ED from long-term blood vessel or nerve damage is usually managed rather than cured, and effective treatments exist for nearly every man.

How do I know if I have ED?

If you regularly have trouble getting or keeping an erection firm enough for sex, and it has lasted for several weeks or more, you may have ED. A urologist can confirm it and find the cause with a history, exam and blood work.

How can I get a harder erection naturally?

Regular aerobic exercise, losing excess weight, quitting smoking, limiting alcohol, sleeping well and managing stress all improve blood flow and erection quality. Pelvic floor exercises may also help some men. Avoid supplements that promise instant results, since some contain hidden prescription drugs.

What kind of doctor treats erectile dysfunction?

A urologist is the specialist for ED. Primary care doctors can prescribe pills, but a urologist can offer every treatment, including injections, shockwave therapy, PRP and penile implants, and can check for related conditions.

Can young men get erectile dysfunction?

Yes. ED is less common in younger men but not rare. In men under 40, anxiety, stress, alcohol, recreational drugs and some medications are frequent causes, although blood vessel and hormone problems should still be checked.

Does insurance cover ED treatment?

Insurance may cover the evaluation, lab work and some medications, and it may cover penile implants when they are medically necessary. Off-label treatments such as shockwave therapy and PRP are typically paid out of pocket. Coverage depends on your plan.

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Definition and Facts for Erectile Dysfunction.
2. Feldman HA, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology, 1994.
3. Burnett AL, et al. Erectile Dysfunction: AUA Guideline. Journal of Urology, 2018.
4. Mulhall JP, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. Journal of Urology, 2018.
5. U.S. Food and Drug Administration. Tainted Sexual Enhancement Products.
6. U.S. Food and Drug Administration prescribing information for sildenafil, tadalafil, vardenafil and avanafil (DailyMed).
7. Wierschem M, Perito P. A Novel Video-Based Patient Education Program to Reduce Penile Prosthetic Surgery Cancellations. Journal of Urology, 2019.

This article is for general education and is not a substitute for medical advice. Treatment options depend on an individual evaluation. Priapus Shot® and P-Shot® are registered trademarks of Charles Runels, MD, used under license. Viagra®, Cialis®, Stendra® and Eroxon® are trademarks of their respective owners.