People with penises often experience erectile dysfunction (ED), or episodes where the penis is not able to stay hard and/or come. It happens to everyone with a penis, but if it happens too many times, it can be frustrating. Most of what we know about ED comes from studying cisgender men, ED can start at any age and becomes more common with age. Diet, medications, and health conditions—such as heart disease, kidney disease, high cholesterol, high blood pressure, hypertension, low testosterone, etc.—are all factors that can contribute to ED. Fatigue, stress and relationship issues can also affect sexual function. Typically when ED occurs, less blood flow goes to the penis to promote sexual stimulation during sexual activity. Likewise, the condition contributes to a lack of ejaculation. This added stress can contribute to “sexual dysfunction” and impact sexual relationships. While the word ‘dysfunction’ implies that something isn’t functioning properly, we want to reassure you that nothing is wrong with you. We will use this language for shorthand, but ED is an extremely common phenomenon and there are things that can be done.
Most of what we know about ED comes from studying cisgender men, or a man who both is assigned sex at birth and self-identifies as male. ED can start as early as age 20 and becomes more common with age. Diet, medications, and health conditions—such as heart disease, kidney disease, high cholesterol, high blood pressure, hypertension, low testosterone, etc.—are all factors that can contribute to ED.
However, ED doesn't just impact cisgender men. In our community, another common cause of ED is the use of estrogen GAHT/HRT and testosterone blockers. Trans women, trans femmes, and non-binary or intersex trans people can all experience a decrease in sexual function after starting estrogen. For some persons, this is a desired side effect and can decrease dysphoria. But this can be a frustrating experience for those who have just started hormone therapy, but fortunately, treatments are available to anyone who was assigned male at birth and still has a penis.
Don’t worry: ED is fairly common and it can be treated.
Currently, there are four pills available to help ensure your body is ready for sex at just the right time. These common ED prescription medications are called PDE-5 inhibitors, which increase blood flow to the penis allowing it to stay harder, longer. It essentially stops the chemical responsible for stopping an erection. When this happens, certain muscles and blood vessels relax, which leads to a good erection that lasts longer. Of course, these medications alone don’t produce an erection—sexual arousal is still part of the process! Right now, ED meds are used only in those who are born with and still have a penis.
Treatment options for ED include prescription oral medications. Here's a quick look at the different medications available:
Although there's a thriving alternative market for “men's health” products, the Food and Drug Administration (FDA) warns against consuming fraudulent products falsely marketed as "dietary supplements" or even "food" as they often contain unlisted, harmful ingredients.
ED medications have side effects like all prescription drugs, however, the side effects are almost never bad enough to stop using them. The most common side effects include:
- Back pain and muscle aches
- Mild headache
- Flushing (happens more with Sildenafil)
- Temporary blue-tinged vision (happens more with Sildenafil)
- Nasal congestion
- Low blood pressure
- Indigestion/upset stomach
As with all medications, there will be a few people who have serious side effects (which are rare). There will also be some who cannot take pills for ED because of health conditions or other medications that have a dangerous interaction with ED pills. For instance, those who take nitrates or nitroglycerin for heart problems will have to talk further with their clinicians. Persons taking nitrogen based medications need to delay taking this medicine if they have taken ED medicine. Those who have had a heart attack, a stroke, other serious heart problems or take various blood pressure medications may be able to use ED pills, but will also have to talk to their healthcare providers about the risks. Persons with liver or renal disease may be able to take ED medications but at lower doses after discussing with their provider.
If you're new to FOLX and are looking for ED evaluation and treatment, you can sign up for a clinician visit here. If you're an existing FOLX member interested in ED medications, notify your clinician through your Athena patient portal that you're interested; there isn't a need to book a separate virtual healthcare visit if you are already a FOLX member. If you have other questions about ED and estrogen HRT, read more here. For non-members with further questions, reach out to us at email@example.com.