Can Trans Women Take Erectile Dysfunction Medication?

Erectile dysfunction (ED) is frequently discussed in mainstream media and ads (though not nearly enough given how common it is), but for trans women, the topic involves unique and nuanced considerations. Considerations that aren’t so readily available or easily accessed.

The real tea is that hormone therapy, a cornerstone of gender-affirming care, can affect sexual function, including the ability to maintain an erection. So let’s get to it: Can trans women take ED medications like Viagra or Cialis? 

The quick answer is yes—but with nuance. To help unpack how these medications fit into the broader conversation about trans women’s sexual health in 2024,  I reached out to Dr. Yonah Krakowsky, Urologist, MD, FRCSC to get the most up to date information and answers.

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Is it Common for Trans Women to Have a Harder Time Getting Erections?

Regarding erectile function in trans women, there isn’t much data to work with, especially with rates of erectile dysfunction (ED) in those taking testosterone blockers or those who’ve undergone orchiectomy, meaning testicles have been removed.

Here’s what we do know: “Testosterone plays a role in the function of a penis and we know that in general populations, lower T and DHT (a byproduct of testosterone) leads to increased rates of ED and sexual dysfunction,” Krakowski says. 

That said, many people with little to no testosterone can still experience erectile function, which suggests there’s more at play here than just hormone levels. To better determine a more nuanced answer, more research is required.

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Can Trans Women Take ED Medications?

Yes, trans women can take ED medications like Sildenafil (commonly known as Viagra), which enhances blood flow to the penis. 

Sildenafil was the first PDE-5 inhibitor, gaining widespread notoriety after its landmark clinical trial in 1998. This trial, conducted by Pfizer, marked a major breakthrough in the treatment of erectile dysfunction, showcasing the drug's effectiveness in helping individuals maintain erections. It was the first oral treatment for ED approved by the FDA.

However, the world was a very different place in the late 90s. The trials were conducted in highly heteronormative contexts, focusing exclusively on cisgender men in heterosexual relationships, with little to no consideration for LGBTQ+ individuals or gender-diverse populations. 

While ED medications weren’t initially designed with trans women in mind, many in the community safely and effectively use them today. 

“There have been clinical trials published that ED medications can increase arousal and blood flow to the clitoris,” Krakowski says. “It’s safe and effective for all these people!”

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How ED Medications Work for Trans Women and Cisgender Men

ED medications function the same way for trans women and cisgender men—they target and reduce an enzyme that inhibits blood flow to the penis, improving blood inflow and trapping it to create and maintain an erection. The side effect profiles for these medications remain the same across as well.

What’s unique for trans women is that their hormonal levels are different, particularly for those on testosterone blockers. While testosterone plays a role in mediating erections, it’s not necessary for an erection to occur. For example:  “Folks who’ve had prostate cancer treatments tend to have very low levels of testosterone,” Kraykowski says. “Sildenafil or Tadalafil can generate better erections without touching their testosterone levels, so it’s an effective treatment.” 

The Canadian Urological Association recently updated their guidelines on erectile dysfunction treatment, emphasizing that for patients with erection issues and low testosterone levels, the first line of treatment should be ED medications. They advise against altering testosterone levels initially, as ED medications tend to be more effective for erections than hormone adjustments. 

While testosterone plays a key role in penile tissue and health, it’s not the end-all-be-all for achieving or maintaining an erection. For trans women and others with unique hormonal profiles, this makes ED medications a practical and reliable solution.

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Will Taking ED Medication as a Trans Woman Mess with HRT?

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No, taking ED medications will not interfere with hormone replacement therapy (HRT) or alter how it works in your body. 

These medications function in trans women exactly as they do in cisgender men—by improving blood flow to the penis through the reduction of an enzyme that inhibits blood flow. HRT and ED medications operate independently, so there’s no reason to worry about negative interactions. If you have any concerns about medication interactions, it’s best to speak with your healthcare practitioner. 

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Do Erections Feel the Same for Trans Women Who Are on HRT?

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“They might, there’s no model to predict when people should start HRT, and what their erections will be like — it really depends on the person, " Krakowski says. “There are many who don’t have any issues with erections, but there are many who do experience issues with having an erection on HRT.”

Unfortunately, trans people were not included in the major clinical trials of the late 90s for HRT, so research on this topic remains limited.

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What are some alternatives to ED Medication for Trans Women?

If ED medications isn’t your first choice, there are a number of other approaches to explore:

• Psychosocial approach/lifestyle modifications, i.e. reducing stress, improving sleep, ensuring you’re eating a balanced diet, exercise, reducing alcohol consumption
• Counseling
• Penile implants
• Intracavernosal injections
• Penis pumps
• Tension rings
• L-arginine
• Acupuncture 

For a deeper dive into these alternatives, check out this blog post at Felix.ca

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When to Talk to a Practitioner About ED Treatments as a Trans Woman

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The right time to seek help is when you feel like you need it—there’s no specific threshold or timeline.

If you want support, don’t hesitate to reach out to a professional. You don’t have to suffer in silence, as there are experts available to help you navigate these challenges.

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This blog post was made possible in partnership with our friends at Felix.ca. Check out our two part articles with them; All about Chemsex and explorations into why Erectile Disfunction in Gay Men is so common