- A systematic review of small-scale studies has shown that combining erectile dysfunction (ED) treatments may be more effective than using just one, including using multiple ED drugs.
- Because everybody is unique — and combining drugs can have unexpected effects — it’s not recommended to combine medications without a doctor’s agreement and supervision.
- The study also points to non-invasive techniques that might help and offer less medical risk.
Are two ED treatments better than one? For some men, maybe. Medicine is inherently conservative, which is what you want when the stakes are high. Yet evidence is beginning to emerge that multiple treatments for ED may work better than one. Read on to learn why and how to find out if combination treatment for ED is the right choice for you.
Should I Combine ED Treatments?
Are two ED treatments better than one? The answer depends on how you define “treatment.”
If we’re defining treatment as a mix of approaches to achieve different goals, then the answer is sometimes. Any doctor will tell you that ED is a complex problem with multiple causes and multiple solutions.
That’s why anybody with ED is advised to get more exercise, eat more vegetables, cut back on alcohol, and quit smoking, generally under the heading of lifestyle changes.
These are generally seen as relatively easy for people to do, and will have wide-ranging benefits for anybody. The absolute worst thing that will happen is you’ll be in better shape and your body won’t process as many toxic chemicals.
It’s also why doctors will ask you about your emotional health. ED can both be a symptom of emotional health or relationship struggles and a cause of them. So seeing a mental health professional, again, has benefits outside of its potential effect on erectile dysfunction.
If we’re talking about medical interventions, however, the picture gets hazier. Doctors are sworn to “first, do no harm,” and any pill or surgery has some degree of risk. Those risks can compound when treatments are combined.
This makes doctors understandably conservative when you ask, say, to combine Viagra and Cialis. They want some firm science behind it before they make any recommendation.
Which leads us to a review of studies that point towards possible combination approaches.
Are Two ED Pills Better Than One?
Before we discuss the evidence, we have to emphasize that it’s never a good idea to mix medication without a doctor’s supervision. And that’s especially true with ED treatments.
Most “first-line” treatments are phosphodiesterase-5 (PDE5) inhibitors, which cause the blood vessels in the body, including your penis, to relax. This drops your blood pressure, which in normal circumstances isn’t clinically significant.
That said, if your blood pressure is already low, or there’s an issue that reducing your blood pressure may aggravate, that can be a serious problem.
Combining two drugs that lower blood pressure raises that risk. By how much and to what degree is an open question, but essentially you’re gambling with your health. Keep in mind that something as simple as sitting too long can have meaningful effects on blood pressure, as well.
In other words, don’t try mixing medications at home.
That said, let’s have a look at the recent study.
A 2021 systematic review of studies looking at “combination” therapies versus taking just one pill did have some intriguing results. The review looked only at randomized clinical trials and prospective interventional studies, that is, studies that were specifically designed to look at this particular issue.
It came up with 44 studies that had 3853 participants among them. The studies reviewed looked at methods that included daily tadalafil, low-intensity shockwave therapy (LiST), vacuum pumps, folic acid, the diabetes medication metformin, or angiotensin-converting enzyme (ACE) inhibitors.
Importantly, the researchers noted limitations to the study. For example, there was only one study for each of these combination therapies, so we have to be careful of drawing broad conclusions. Still, each study found improvement for men using two ED therapies over those taking just ED medication.
The study also found that men with issues such as prostatectomy-induced ED had better outcomes.
Treatment for ED and treatment of chronic conditions that can cause ED may overlap. If you have heart problems or diabetes, you’ve probably dealt with the frustration that these conditions can cause ED while also making it risky to take ED medication.
This early data points to a potential way out of this thicket, by coordinating the blood pressure effects of different medications to achieve the same effect as a full dose of a PDE5 inhibitor.
Non-invasive treatments for ED may be combined with medication. “Non-invasive” just means that a treatment doesn’t involve surgery or drugs, things that might change your body in ways that might not be expected.
That said, some techniques, like low-intensity shockwave therapy, still need to be examined to understand exactly how they work, especially for ED. But with so much still unknown about combining drugs, ED medication with a vacuum pump might be worth considering.
The causes of ED may matter less for long-term treatment. Prostatectomy-induced ED is practically its own topic, involving healing and rehabilitation. While this study found, however small the sample size, that multiple treatments can help ED, researchers need to look into the question more thoroughly.
What Does This Mean For People With ED, Practically Speaking?
In terms of treating ED, it may be worthwhile to bring this study up with your doctor and ask them what they think. Don’t expect them to immediately sign off on giving you two different medications for the same problem, however.
Instead, ask the following questions:
- What risks are there in combining ED medications?
- Do you recommend combining medications? If not, why not?
- Do you recommend combining medication with other techniques, like LiST or a vacuum pump?
- Would any of these recommendations change if there was a substantial change in my health?
- Would they change if more evidence emerges of the safety of combining medications?
Those last two questions are particularly important. Our bodies change over time and with lifestyle choices we make, and doctors change their approaches as scientific evidence evolves.
Remember, when it comes to ED, you’re your own best advocate. Follow our blog to stay on top of the science and changing views of erectile dysfunction.
Dan is a long-time freelance writer focusing on technology, science, health, and medicine, with a lifelong interest in physics, biology, and medicine. His work has taken a particular focus on scientific studies “beyond the headlines,” reading the study to more closely examine the results.