Tadalafil and Testosterone: Can You Take Them Together?

Takes less than 2 minutes to complete 100% online

Choose your treatment

Select from our recommended UK-licensed medications.

Answer quick questions

Select safe UK treatments. Quick answers.

Get it delivered fast

We will deliver direct to you as quickly as tomorrow.

At a glance

How Tadalafil and Testosterone Work Differently for ED

Tadalafil belongs to a class of medicines called PDE5 inhibitors, which work by relaxing blood vessels in the penis to allow increased blood flow when you're sexually aroused [4]. It does not affect your hormone levels or testosterone production; instead, it addresses the physical mechanism of achieving and maintaining an erection. Tadalafil is available as an on-demand treatment (10mg or 20mg taken at least 30 minutes before sex, with effects lasting up to 36 hours) or as a daily low-dose option (2.5mg or 5mg) for men who prefer spontaneity [4].

Testosterone is a hormone that plays multiple roles in male sexual function, including maintaining libido (sex drive), supporting the physical changes needed for erection, and contributing to overall energy and mood [2]. When testosterone levels fall below the normal range (a condition called hypogonadism), men may experience reduced sexual desire, difficulty achieving erections, fatigue, and mood changes. Testosterone replacement therapy aims to restore hormone levels to the normal range through gels, injections, or patches, and is only appropriate when blood tests confirm low testosterone [2].

Because these treatments target different aspects of sexual function, they are not interchangeable. A man with normal testosterone levels but vascular problems causing ED will typically respond well to tadalafil alone, while someone with confirmed low testosterone may need TRT, tadalafil, or both depending on their individual situation [2]. Your GP or specialist will determine the most appropriate approach based on blood tests, medical history, and symptom assessment.

Is It Safe to Combine Tadalafil and Testosterone Therapy?

For most men, using tadalafil and testosterone together is safe when both treatments are prescribed and monitored by a qualified healthcare professional [2]. There is no direct drug interaction between tadalafil and testosterone replacement therapy; they work through entirely separate pathways in the body. However, combination therapy requires careful medical oversight because both treatments can affect cardiovascular health, and testosterone therapy itself has specific contraindications and monitoring requirements [2].

Testosterone replacement is not suitable for men with prostate cancer, male breast cancer, or those planning to father children in the near future, as it can suppress sperm production [2]. Men on TRT need regular blood tests to monitor testosterone levels, haemoglobin and haematocrit (as testosterone can increase red blood cell production), liver function, and prostate-specific antigen (PSA) levels. Tadalafil, like all PDE5 inhibitors, is not suitable for men taking nitrates for angina, those with severe heart conditions where sexual activity is inadvisable, or men with very low blood pressure [4].

If you are already on testosterone replacement and considering tadalafil for ED, or vice versa, you must inform your prescriber about all current medications and treatments during your consultation. At Cured Pharmacy, our UK-registered prescribers review your complete medical history and current medicines before approving any prescription treatment. Never start, stop, or combine prescription treatments without professional guidance, even if you have read that the combination is generally safe.

When Combination Therapy May Be Recommended

Some men with erectile dysfunction have both low testosterone and vascular or other physical causes for their ED [2]. In these cases, testosterone replacement alone may improve libido and energy but not fully restore erectile function, while tadalafil alone may help with erections but not address the underlying hormonal deficiency or low sex drive. Research suggests that men with confirmed low testosterone who do not respond adequately to PDE5 inhibitors alone may benefit from adding testosterone therapy, and vice versa [2][8]. Your doctor will typically try one treatment first, assess the response over several weeks or months, and then consider adding the second treatment if needed. This stepwise approach helps identify which aspect of sexual function needs additional support.

Does Low Testosterone Cause Erectile Dysfunction?

Low testosterone can contribute to erectile dysfunction, but it is rarely the sole cause [2]. Testosterone plays an important role in maintaining sexual desire and supporting the complex physiological processes involved in erection, but most cases of ED are primarily due to vascular problems (reduced blood flow), nerve damage, psychological factors, or side effects of other medications [1][2]. Studies show that only about 10-20% of men with ED have clinically low testosterone as a significant contributing factor [10].

When testosterone levels are low, the most common sexual symptom is reduced libido (loss of interest in sex) rather than difficulty achieving erections [2]. However, some men with low testosterone do experience both reduced desire and erectile problems. It is important to understand that low testosterone and ED often share common underlying causes, such as obesity, type 2 diabetes, metabolic syndrome, and cardiovascular disease, which is why they frequently occur together [2].

If you have erectile dysfunction, your GP will typically check testosterone levels as part of the initial assessment, especially if you also have symptoms such as low sex drive, fatigue, reduced muscle mass, or mood changes [2]. A single low testosterone reading is not enough for diagnosis; levels should be checked on at least two separate occasions, ideally in the morning when testosterone is naturally highest. If low testosterone is confirmed, your doctor will investigate the underlying cause before starting treatment, as some causes (such as pituitary tumours) require specific management [2].

What you need to know

• Tadalafil and testosterone can be used together safely when prescribed and monitored by a healthcare professional.
• Tadalafil improves blood flow for erections; testosterone replacement addresses hormonal deficiency affecting libido and energy.
• Low testosterone contributes to ED in only 10-20% of cases; most ED is vascular or psychological.
• Testosterone therapy requires specialist assessment and regular blood tests; tadalafil is available after online consultation.
• Lifestyle changes like weight loss, exercise, and quitting smoking support both treatments and improve outcomes.

Tadalafil and Testosterone: What to Expect from Treatment

If you are prescribed tadalafil for erectile dysfunction, you should notice an improvement in your ability to achieve and maintain an erection when sexually aroused, typically within the first few doses [4]. Tadalafil does not cause automatic erections; sexual stimulation is still required. On-demand tadalafil (10mg or 20mg) works within 30 minutes to an hour and can remain effective for up to 36 hours, while daily low-dose tadalafil (2.5mg or 5mg) builds up in your system to provide continuous support for spontaneous sexual activity [4].

Testosterone replacement therapy works more slowly, as it takes time for hormone levels to stabilise and for the body to respond [2]. Most men begin to notice improvements in energy, mood, and libido within 3-6 weeks of starting TRT, but the full benefits may take 3-6 months. If low testosterone was contributing to your erectile dysfunction, you may see gradual improvement in erectile function as your levels normalise, though this is not guaranteed and depends on whether other factors are also present [2].

When both treatments are used together, tadalafil typically provides more immediate support for erectile function, while testosterone therapy addresses the hormonal aspect over a longer timeframe. Your healthcare provider will schedule follow-up appointments to assess your response, adjust doses if needed, and monitor for any side effects or complications. It is important to attend these reviews and report any concerns, including lack of improvement, side effects, or changes in your overall health.

Common Side Effects and What to Watch For

Tadalafil is generally well tolerated, but common side effects include headache, indigestion, back pain, muscle aches, flushing, and nasal congestion [4]. These are usually mild and temporary. Rare but serious side effects include prolonged erection lasting more than 4 hours (priapism), sudden vision or hearing loss, and chest pain during sex, all of which require urgent medical attention [4]. Testosterone replacement can cause side effects such as acne, oily skin, increased red blood cell count, fluid retention, mood changes, and worsening of sleep apnoea [2]. Long-term TRT requires monitoring for effects on the prostate and cardiovascular system. If you experience any unexpected or concerning symptoms while on either treatment, contact your prescriber or GP promptly.

Getting Tadalafil and Testosterone Treatment in the UK

Testosterone replacement therapy is a prescription-only treatment that must be initiated and monitored by a specialist or GP with experience in hormone therapy [2]. You cannot obtain TRT through a standard online ED consultation; it requires face-to-face assessment, blood tests to confirm low testosterone and rule out contraindications, and ongoing monitoring with repeat blood tests every 3-6 months. Your GP can refer you to an endocrinologist or urologist if testosterone deficiency is suspected, and treatment is typically managed through NHS or private specialist services.

Tadalafil, by contrast, is available through online consultations with UK-registered prescribers for men with erectile dysfunction who do not have contraindications [4]. At Cured Pharmacy, you complete a detailed medical questionnaire that is reviewed by a UK prescriber. If tadalafil is suitable and safe for you, a prescription is issued and your medication is dispensed by our GPhC-registered pharmacy (GPhC 9012511) and delivered discreetly to your door. You must declare all current medications, including testosterone replacement, during your consultation so the prescriber can check for any interactions or concerns.

If you are already on testosterone therapy and wish to add tadalafil for erectile dysfunction, the online consultation process can assess whether tadalafil is appropriate for you. Conversely, if you are taking tadalafil but suspect low testosterone may be contributing to your symptoms, you should see your GP for blood tests and specialist referral if needed. Never purchase testosterone or other hormone treatments from unregulated online sources, as these products may be counterfeit, contaminated, or inappropriately dosed, and using them without medical supervision carries serious health risks.

When to get urgent help

• Erection lasting more than 4 hours (priapism) – go to A&E immediately to prevent permanent damage
• Sudden loss of vision or hearing while taking tadalafil – stop the medicine and seek urgent medical help
• Chest pain during or after sex – stop activity, call 999, and do not take more tadalafil
• Severe allergic reaction (swelling of face, lips, tongue, or difficulty breathing) – call 999 immediately

Call 999 or go to A&E in an emergency, or contact NHS 111 for urgent advice.

Lifestyle Changes to Support Tadalafil and Testosterone Therapy

Whether you are using tadalafil, testosterone replacement, or both, lifestyle modifications can significantly improve treatment outcomes and overall sexual health [1][2]. Maintaining a healthy weight is particularly important, as obesity is strongly linked to both low testosterone and erectile dysfunction. Losing even 5-10% of body weight can improve testosterone levels naturally and enhance erectile function [2]. Regular physical activity, including both cardiovascular exercise and resistance training, supports healthy testosterone production, improves blood flow, and reduces cardiovascular risk factors that contribute to ED [1][2].

Diet also plays a role: a balanced diet rich in vegetables, fruits, whole grains, lean protein, and healthy fats supports vascular health and hormone production, while excessive alcohol consumption can worsen both low testosterone and erectile dysfunction [1]. Smoking is a major risk factor for ED due to its damaging effects on blood vessels, and quitting smoking can lead to significant improvements in erectile function [1]. Managing stress, getting adequate sleep, and addressing mental health concerns such as anxiety or depression are equally important, as psychological factors often interact with physical causes of ED [1].

If you have underlying health conditions such as diabetes, high blood pressure, or high cholesterol, working with your GP to optimise control of these conditions will support both erectile function and the effectiveness of any ED treatment [1][2]. Some medications used for other health conditions can contribute to ED; if you suspect this is the case, discuss it with your doctor rather than stopping any prescribed medicine on your own. A holistic approach that combines appropriate medication, lifestyle changes, and management of underlying health issues offers the best chance of restoring satisfying sexual function.

When to See Your GP About Erectile Dysfunction

If you are experiencing erectile dysfunction for the first time, or if your symptoms have recently worsened, it is important to see your GP for a proper assessment [1][2]. ED can be an early warning sign of cardiovascular disease, diabetes, or other serious health conditions, so it should not be ignored or self-treated without medical input. Your GP will take a medical history, perform a physical examination, and arrange blood tests to check for underlying causes such as diabetes, low testosterone, high cholesterol, or thyroid problems [2]. They can also review your current medications to identify any that might be contributing to ED and discuss treatment options, including lifestyle changes, psychological support, or prescription medications like tadalafil. Early assessment and treatment of underlying conditions can improve both your sexual health and your long-term overall health.