Illustrations by Leo Mateus.
To put it simply: Erectile function is driven by testosterone. When testosterone levels decrease in the body with estrogen use, especially when used together with a testo-blocker, it can cause erectile dysfunction (ED) for some people. ED happens when someone stops being able either to have as much of an erection as they would like or to have an erection for as long as they would like.
If the ability to get an erection is not important to your sexual function or health, then read no further! But, if having or maintaining an erection matters to you, there are things you can do while continuing HRT.
If ED is caused by low testosterone levels from taking estrogen, there are medication options.
First off, for most people, ED medications are generally safe. The most common medications are Sildenafil (Viagra) and Tadalafil (Cialis), which work by increasing the blood flow to the penis which leads to an erection. Beyond those two medications, there are many other options that you might choose depending on your goals, past experiences with these medications, or if you are on certain meds.
ED medications can help you get and maintain an erection, but don’t affect sex drive.
Some of them are on-demand (taking a pill will lead to an erection in that moment), and some help with spontaneous erection (won’t get an erection right away, but it will be easier to get and maintain an erection when you are aroused). These medications unfortunately cannot help increase someone’s libido or sex drive or change their ability to ejaculate.
ED medications do come with some potential side-effects.
Some people can experience flushing (reddening of the skin), headache, stomach upset, or nasal congestion. Some may notice a slight change in vision like blurriness or a slight blue tinge to their vision. Less common side effects are dizziness or lightheadedness related to a decrease in the blood pressure. Much more rarely, people can experience effects that require immediate medical attention such as a loss of vision or hearing, or an erection that does not go away on its own after 4 hours. Alcohol intake should be limited, as increased drinking can worsen the side effects. Also, those taking ED medication should avoid drinking grapefruit juice as it can affect the levels of the medication in your body. Who knew! You and your clinician should also discuss any previous health conditions before taking ED meds.
There are also other options if ED medication isn’t the answer.
If someone’s ED is related to estrogen HRT, there are options to alter the estrogen/anti-androgen levels to increase testosterone levels to help regain some erectile function while staying in line with overall effects of estrogen HRT.
Vacuum/pump devices can be used to help increase blood flow to cause an erection, followed by the use of a ring to prevent the blood from flowing back out of an erection. The vacuum should not be applied for more than 30 minutes, and while orgasm can be achieved, there may not be any release of fluid as the path of the fluid on its way out may be blocked by the ring. Vacuum and ring devices can be readily obtained in stores and online without a prescription!
There are also additional injection and surgical options that can be discussed with a urologist if the medications and the pump either cannot be used or have not worked.
Above all, it’s important to remember there are other causes for erectile dysfunction beyond HRT effects, such as overall physical health, preexisting medical conditions, and mental well-being.
For those ready to get started with FOLX for erectile medication, the process begins here. For existing FOLX members with questions about ED, don't hesitate to schedule time with a clinician. And for those who’ve just got some more questions, read up on ED here and feel free to reach out to us at firstname.lastname@example.org.