Can You Take Avanafil and Testosterone Together?

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Avanafil and Testosterone: Understanding Combined Treatment for Erectile Dysfunction

Published: 6 November 2026

Avanafil and testosterone can generally be used together safely, as there is no direct pharmacological interaction between the PDE5 inhibitor avanafil (Spedra) and testosterone replacement therapy. Many men with erectile dysfunction have low testosterone levels, and treating both conditions may improve sexual function more effectively than addressing either alone. However, both treatments require careful medical assessment, and combining them should only be done under the supervision of a qualified healthcare professional who can monitor your response and adjust treatment as needed.

How Avanafil and Testosterone Work Differently

Avanafil (brand name Spedra) is a PDE5 inhibitor that works by increasing blood flow to the penis during sexual stimulation [6]. It acts quickly—usually within 15 to 30 minutes—and helps men achieve and maintain an erection when sexually aroused. Avanafil does not affect hormone levels; it simply improves the physical mechanism of erection by relaxing blood vessels in the penis.

Testosterone, on the other hand, is a hormone that plays a crucial role in male sexual desire (libido), energy levels, mood, and overall sexual function [2]. Low testosterone (hypogonadism) can contribute to erectile dysfunction, reduced sexual interest, and other symptoms. Testosterone replacement therapy aims to restore hormone levels to a normal range, which may improve libido and, in some cases, erectile function.

Because these treatments work through entirely different mechanisms—one mechanical, one hormonal—they do not interfere with each other pharmacologically. In fact, men with both low testosterone and erectile dysfunction may benefit from addressing both issues. A PDE5 inhibitor like avanafil can help with the physical ability to achieve an erection, while testosterone therapy may restore sexual desire and overall vitality.

Is It Safe to Take Avanafil with Testosterone Replacement?

There is no known direct drug interaction between avanafil and testosterone replacement therapy, whether testosterone is given as injections, gels, patches, or tablets [6][12]. The two treatments can be prescribed together when clinically appropriate. However, safety depends on your individual health profile, not just the absence of a direct interaction.

Before combining avanafil and testosterone, your prescriber will need to assess your cardiovascular health, blood pressure, prostate health, and blood counts. Testosterone therapy can sometimes increase red blood cell production (polycythaemia), raise blood pressure slightly, or affect prostate markers, while avanafil—like all PDE5 inhibitors—can lower blood pressure and is not suitable for men taking nitrates or those with certain heart conditions [3][6].

Your doctor will also check whether your erectile dysfunction improves with testosterone replacement alone before adding a PDE5 inhibitor. Some men find that restoring testosterone levels is enough to resolve ED, while others need both treatments. Regular monitoring of testosterone levels, blood pressure, and prostate health is essential when using these therapies together.

Who Should Not Combine These Treatments

Avanafil is contraindicated in men taking nitrates (such as GTN spray or isosorbide mononitrate), nicorandil, riociguat, or recreational drugs called 'poppers', as the combination can cause a dangerous drop in blood pressure [6]. It is also not suitable for men with recent heart attack or stroke, unstable angina, severe heart failure, very low blood pressure, or a history of sudden vision loss (NAION).

Testosterone replacement is not appropriate for men with prostate cancer, male breast cancer, untreated severe sleep apnoea, uncontrolled heart failure, or very high red blood cell counts [12]. If you have any of these conditions, your doctor will discuss alternative approaches to managing erectile dysfunction.

Does Low Testosterone Cause Erectile Dysfunction?

Low testosterone can contribute to erectile dysfunction, but it is rarely the sole cause [2]. Testosterone is essential for sexual desire, and men with very low levels often report reduced libido, fatigue, and mood changes. However, the physical ability to achieve an erection depends more on blood flow, nerve function, and the health of penile tissues.

Research suggests that about 20–40% of men with erectile dysfunction also have low testosterone, but treating low testosterone alone does not always restore erectile function [10]. Many men with low testosterone and ED benefit from testosterone replacement to improve libido and energy, combined with a PDE5 inhibitor like avanafil to address the mechanical aspect of erections.

If you are experiencing erectile dysfunction, it is important to see your GP for a full assessment. Blood tests can check testosterone levels, blood sugar (to screen for diabetes), cholesterol, and other markers. ED can be an early warning sign of cardiovascular disease or diabetes, so identifying and treating underlying health conditions is crucial [1][2].

Avanafil and Testosterone: What to Expect from Combined Treatment

When avanafil and testosterone are used together, the goal is to address both hormonal and mechanical factors contributing to erectile dysfunction. Testosterone replacement may take several weeks to months to reach its full effect on libido, mood, and energy. Avanafil, by contrast, works on demand—you take it 15 to 30 minutes before sexual activity, and it helps you achieve an erection when sexually stimulated [6][11].

Men using both treatments often report improved sexual desire (from testosterone) and better erectile function (from avanafil). However, results vary, and not everyone will experience significant improvement. Your prescriber will monitor your response and may adjust doses or try alternative PDE5 inhibitors if avanafil does not suit you.

It is important to continue regular follow-up appointments. Testosterone therapy requires monitoring of blood levels, red blood cell counts, and prostate markers (PSA). Avanafil is generally well tolerated, but side effects such as headache, flushing, nasal congestion, or back pain can occur. If you experience chest pain during sex, sudden vision or hearing loss, or an erection lasting more than four hours, seek urgent medical help [6].

Starting Treatment: What Your Prescriber Will Check

Before prescribing avanafil and testosterone together, your doctor or prescriber will take a full medical history and may arrange blood tests. They will check your testosterone level (usually measured in the morning), cardiovascular risk factors, kidney and liver function, and prostate health. They will also review all your current medicines to ensure there are no contraindications.

If you are already taking testosterone replacement and want to add avanafil for erectile dysfunction, an online consultation with a UK-registered prescriber can assess your suitability. At Cured Pharmacy, every prescription for avanafil (Spedra) is reviewed by a qualified prescriber after you complete a confidential health questionnaire. You should declare your testosterone therapy and any other medicines or health conditions during the consultation.

Other Medicines and Interactions with Avanafil and Testosterone

Avanafil is metabolised by the liver enzyme CYP3A4, so medicines that strongly inhibit this enzyme—such as ritonavir, cobicistat, ketoconazole, itraconazole, and clarithromycin—can raise avanafil levels and increase the risk of side effects. Avanafil is contraindicated or requires dose adjustment with these medicines [6]. Always tell your prescriber about all medications you take, including over-the-counter and herbal products.

Alpha-blockers (such as tamsulosin or doxazosin, used for prostate symptoms or high blood pressure) can interact with avanafil, causing dizziness or low blood pressure. If you take an alpha-blocker, your prescriber will start you on the lowest dose of avanafil and ensure you are stable on the alpha-blocker first [6]. Other blood pressure medicines can also add to the blood-pressure-lowering effect of avanafil, but this is usually manageable.

Testosterone replacement does not have major drug interactions with avanafil, but it can interact with anticoagulants (such as warfarin), diabetes medicines, and corticosteroids [12]. Your doctor will monitor these interactions if relevant. Grapefruit juice can increase avanafil levels, and heavy alcohol can worsen erectile dysfunction and add to the risk of low blood pressure, so moderation is advised.

Accessing Avanafil and Testosterone Treatment in the UK

Avanafil (Spedra) is a prescription-only medicine available in 50 mg, 100 mg, and 200 mg tablets. At Cured Pharmacy, Spedra is available from £20.95 for a pack of four tablets (first order with code Ednew: £16.76). You will need to complete an online consultation, which is reviewed by a UK-registered prescriber. If approved, your treatment is dispensed by our GPhC-registered pharmacy and delivered discreetly to your door.

Testosterone replacement therapy is also prescription-only and is usually initiated and monitored by a GP or specialist. If you suspect you have low testosterone, see your GP for blood tests and a full assessment. They can refer you to an endocrinologist or urologist if needed. Testosterone is not available through online ED consultations at Cured Pharmacy, as it requires ongoing monitoring and specialist oversight.

If you are already on testosterone replacement and want to add a PDE5 inhibitor for erectile dysfunction, you can use our online service. We also offer other PDE5 inhibitors, including sildenafil (generic Viagra) from £0.45, tadalafil (generic Cialis) from £7.95, and vardenafil (generic Levitra) from £16.95. Your prescriber will help you choose the most suitable option based on your health, preferences, and how quickly you want the medicine to work.

Why See Your GP First for New Erectile Dysfunction

If you are experiencing erectile dysfunction for the first time, it is important to see your GP before starting treatment. ED can be an early sign of cardiovascular disease, diabetes, or hormonal imbalances that need investigation and management [1][2]. Your GP can arrange blood tests, check your blood pressure and cholesterol, and discuss lifestyle changes that may improve your symptoms.

Once any underlying health issues are identified and managed, your GP can prescribe ED treatment or refer you to a specialist if needed. Online pharmacies like Cured Pharmacy are a convenient option for ongoing treatment once you have been assessed, but they are not a substitute for a full medical evaluation when ED is new or worsening.

Scientific References

1. NHS. (n.d.). Erectile dysfunction (impotence). NHS website. https://www.nhs.uk/conditions/erection-problems-erectile-dysfunction/ [accessed 6 November 2026]
2. National Institute for Health and Care Excellence. (n.d.). Erectile dysfunction. Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/erectile-dysfunction/ [accessed 6 November 2026]
3. Joint Formulary Committee. (n.d.). Sildenafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/sildenafil/ [accessed 6 November 2026]
4. Joint Formulary Committee. (n.d.). Avanafil. British National Formulary. NICE. https://bnf.nice.org.uk/drugs/avanafil/ [accessed 6 November 2026]
5. Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: Results of the Massachusetts Male Aging Study. Journal of Urology, 151(1), 54–61. https://pubmed.ncbi.nlm.nih.gov/8254833/ [accessed 6 November 2026]
6. National Institute for Health and Care Excellence. (2014). Erectile dysfunction: avanafil (ESNM45). https://www.nice.org.uk/advice/esnm45 [accessed 6 November 2026]
7. Electronic Medicines Compendium. (n.d.). Summaries of Product Characteristics and Patient Information Leaflets. https://www.medicines.org.uk/emc/ [accessed 6 November 2026]

Information on this page is for educational purposes only and is not medical advice. Prescription treatments require clinical assessment by a UK-registered prescriber. Always consult a qualified healthcare professional before starting or changing any medication.