About 30 million men in the U.S. live with erectile dysfunction, and not everyone wants—or can—take Viagra. Maybe it didn’t work, caused side effects, or you worry about drug interactions. Good news: you have real choices. Below I’ll walk through the main alternatives and when each one makes sense.
If you want a pill but not Viagra, there are three common alternatives: tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra). Tadalafil lasts much longer—up to 36 hours—so it’s a popular choice for spontaneity. Vardenafil works similarly to sildenafil but may suit men who had side effects on Viagra. Avanafil often acts faster and can be taken closer to sex. Talk with your doctor about dose and any heart or blood pressure meds you take; combining ED drugs with nitrates can be dangerous.
If pills aren’t an option, there are medical alternatives your doctor can offer. Alprostadil can be injected into the penis or delivered as a tiny urethral suppository; both methods produce reliable erections for many men. Vacuum erection devices are noninvasive: a pump draws blood into the penis and a ring keeps it there. For long-term cases that don’t respond to other treatments, penile implants are a surgical option with high satisfaction rates.
Sometimes the simplest changes help a lot. Improving sleep, losing weight, exercising regularly, cutting back on alcohol, and quitting smoking all boost blood flow and testosterone. Pelvic floor exercises (Kegels) can improve control and firmness. If anxiety or relationship issues play a role, sex therapy or cognitive-behavioral therapy often improves outcomes—especially when ED has a psychological component.
Many men try supplements like L-arginine, Korean red ginseng, or citrulline. Some studies show modest benefits, but supplements vary in quality and can interact with meds. Always check with your doctor before trying them. Be careful buying ED meds or supplements online—counterfeit pills are common and can be unsafe.
Newer options include low-intensity shockwave therapy, which aims to improve blood vessel health in the penis. Early studies look promising, but insurance coverage and long-term data are still limited. Your urologist can advise if you’re a candidate.
Choosing the right alternative depends on what caused your ED, your health history, and personal preference. Start by discussing options with a healthcare provider who knows your medical history, especially if you have heart disease, diabetes, or take multiple medications. With the right approach, most men find an option that works and fits their life.
