Nothing works for my ED: what to try next

If standard erectile dysfunction (ED) medications like Viagra or Cialis aren’t working for you, this frustrating experience is more common than you might realize. Research shows that 30%–40% of men don’t respond well to oral ED medications, including sildenafil and tadalafil ​​(the active ingredients in Viagra and Cialis, respectively). But that doesn’t mean you’re out of options. Here’s why medications sometimes fail and what alternatives can help.

Before exploring alternatives, it's helpful to understand common reasons why ED medications stop working (or never work in the first place) for some people. Often, simple adjustments can make oral medications effective again.

1. You’re not taking it correctly 

Some ED medications are very sensitive to how and when they’re taken, and even small timing mistakes can make a big difference.

Viagra (sildenafil) should be taken 30 minutes to 4 hours before sex. It can be taken with or without food, but a full meal — especially one that’s high in fat — can delay and weaken its effects. 

Cialis (tadalafil), on the other hand, can be taken with or without food and remains active much longer, offering a wider window for intimacy — up to 36 hours in many cases. It can be prescribed as a once-daily dose or as needed. 

It’s important to know that ED pills do not cause automatic erections. Sexual stimulation is still required for them to work; the medication simply increases blood flow when arousal is already present.

Timing matters

• Sildenafil: Peaks within 60 minutes on average when taken on an empty stomach; lasts about 4 hours.

• Tadalafil: Can be taken with or without food; begins working within 30 minutes and peaks within 2 hours on average; lasts up to 36 hours.

• Vardenafil (Levitra): Similar timing to sildenafil and should usually be taken about 1 hour before sex, with or without food.

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2. Food and alcohol are interfering

A big, fatty meal can slow sildenafil’s absorption into your system, which can make it seem like “nothing’s happening.” In studies, taking sildenafil with a high-fat meal delayed its effects by about an hour.  

Grapefruit and grapefruit juice can also interfere with how your body processes certain ED meds — including tadalafil and sildenafil — altering how effective they are and increasing the risk or severity of side effects.

Alcohol adds another wrinkle. Even moderate drinking can make erections harder to achieve (sometimes called “whiskey dick”) by disrupting nerve signals and decreasing blood flow — the same processes ED pills are trying to support. So if alcohol is involved, the medication may simply not have much to work with. Bottom line: it’s best to limit alcohol with tadalafil and other ED meds.

3. You’re not sexually aroused

ED medications require sexual arousal to work. They enhance blood flow, but they don’t increase desire or switch arousal on by themselves.

Performance anxiety can quietly shut that whole process down. Worrying about whether the medication will work (especially after a letdown) makes it harder to relax in the moment, which can block arousal before it even starts. 

Relationship tension, stress, burnout, or mood changes can have the same effect. In fact, research shows that anxiety and psychological stress can reduce the effectiveness of oral ED medications.

4. Your dosage is too low

When starting ED treatment, most men are placed on a conservative dose to minimize side effects. For many people, that dose simply isn’t strong enough to be fully effective.

It’s very common to need a higher dose or small adjustments before you find what works best for your body. This trial-and-error phase is normal and expected, not a sign that treatment is failing. Studies show that dose optimization leads to significantly better outcomes for men who didn’t respond initially.

Your provider can guide you through safe dose increases or timing changes to improve results. Some people may need a lower dosage due to kidney or liver problems or because of certain drug interactions, so always check with your prescriber before making changes. 

5. Underlying health conditions are the real issue

Certain health conditions can interfere with erections in ways that pills alone can't always overcome, including: 

Nerve damage

Erections require smooth communication between the brain and the nerves that signal the penis. Conditions like diabetes, pelvic surgery, or long-term nerve injury can interrupt those signals, making it harder for ED meds to do their job. Even when blood flow is improved, the message that starts the erection may not be getting through.

Hormonal imbalances

Low testosterone can reduce libido and make erections more difficult to achieve, even with medication. If testosterone levels are low, ED pills may be ineffective or have inconsistent results until the hormone imbalance is addressed. A blood test can check your levels to determine whether testosterone is playing a role.

Vascular issues

Heart disease, high blood pressure, and smoking can all damage blood vessels, including those supplying the penis. Since ED medications rely on healthy blood flow, circulation problems can blunt their impact. In some cases, treating the underlying vascular issue improves both overall health and sexual function.

6. You haven’t given it enough time

ED medication often works better after you’ve used it a few times. The first attempt can feel high-pressure, and anxiety alone can make it harder to notice the full effects. But once you become familiar with how the medication feels in your body — and you’re not wondering whether it will “kick in” — it often works more reliably. 

Some providers even recommend trying the medication for masturbation first, so you can get comfortable in a low-stress setting.

If you've addressed the common issues above and oral medications still aren't effective, several proven alternatives can help restore erectile function. These treatments work in different ways, and many are successful even for men who don’t respond to ED pills.

1. Vacuum erection devices (penis pumps)

How they work

A vacuum erection device (VED) uses a tube placed over the penis to create negative pressure. This pulls blood into the penis and helps it swell. A small tension ring placed at the base of the penis helps keep the blood in place once the tube is removed. The ring should be removed within 30 minutes.

Effectiveness

VEDs are drug-free and work for most men who try them. They can also be a good option for men who can’t take oral ED medications due to health conditions or side effects.

Things to keep in mind

Some men notice mild bruising or discomfort if too much pressure is used, and the erection may feel cooler or firmer at the base due to the ring. But with proper use, these devices are safe and offer consistent results.

2. Penile injections

How they work

Penile injections deliver medication (such as alprostadil) directly into the erectile tissue. Alprostadil works by relaxing the smooth muscles and widening the arteries inside the penis. This allows the erectile tissue to fill with blood, typically within 5–20 minutes. As the tissue expands, blood gets trapped inside the penis then dissipates within an hour.

This method bypasses many of the pathways oral medications rely on, which is why it often works when pills don’t.

What to expect

The idea of an injection into the shaft of the penis can sound intimidating. But rest assured the needle is very small, and your healthcare provider will train you in the office before you try it alone. 

Effectiveness

Penile injections are one of the most reliable ED treatments, with success rates from 50%–94% depending on the type of medication — significantly higher than oral medications. They work even for men with severe ED or underlying health conditions. 

3. Testosterone replacement therapy (TRT)

How it works

If ED is tied to low testosterone, restoring levels through injections, gels, patches, or other forms of testosterone replacement therapy can improve libido and sexual function. TRT won’t fix ED on its own unless low testosterone is the primary issue, but it can meaningfully support other treatments.

Effectiveness

When low testosterone is the cause, TRT can improve desire, energy, and responsiveness to standard ED therapies. Many men use TRT alongside oral medications or other treatments to get better results.

4. Shockwave therapy

How it works

Shockwave therapy uses low-intensity sound waves applied to the penis to stimulate blood vessel growth and improve circulation. It’s non-invasive and done in a healthcare provider’s office.

Effectiveness

This treatment is still considered emerging, but early studies show it may help some men, particularly those with blood-flow-related ED. It typically takes several sessions, and results may happen gradually over one to two months.

5. Penile implants

Penile implants are a surgical option reserved for men who have tried other treatments without success. They offer the highest long-term satisfaction rates of any ED therapy.

Semi-rigid implants

These devices are bendable rods placed inside the penis. You position the penis manually for sex and bend it downward when not in use. This option is simple, durable, and ideal for men who prefer a straightforward solution.

Inflatable implants

Inflatable implants are more popular because they allow a more natural-looking erection. A surgeon places a small pump in the scrotum. When squeezed, it fills cylinders in the penis with fluid. After sex, the pump returns the penis to a soft state.

What to expect

Implants require surgery and a recovery period of several weeks. Once healed, they provide reliable, on-demand erections and do not affect sensation or orgasm. Because the procedure is irreversible (the natural erectile tissue is replaced), implants are usually only considered after you’ve tried other treatments.

When you’re frustrated with ED medication, it’s tempting to try every supplement or “natural cure” you see online. But these products are unregulated and often unsafe. In fact, the United States Food and Drug Administration (FDA) has repeatedly found that over-the-counter “sexual enhancement” supplements contain undisclosed prescription drugs, including sildenafil or tadalafil, which can lead to dangerous side effects or interactions.

It’s also important to avoid using testosterone without proper testing. Testosterone replacement therapy should only be used if a healthcare provider confirms a true deficiency; taking it unnecessarily can cause more harm than good. When exploring alternatives, stick to treatments backed by research and medical guidance.

Next steps: getting the help you need  

If ED medication hasn’t been working for you, the most important thing you can do is talk with a qualified healthcare provider — ideally a urologist or men’s health specialist who can help pinpoint what’s going on. ED is common, but it’s also a medical condition with many possible causes, and getting the right diagnosis is key to finding the right solution.

A professional evaluation can uncover factors you may not realize are playing a role, including hormonal changes, circulation issues, or early signs of conditions like diabetes or heart disease. Addressing these underlying issues can improve your overall health and your sexual function.

If you’re ready to take the next step, you can start with Ro’s ED assessment to connect with a licensed provider and get personalized guidance. With the right support, most men find a treatment plan that truly works for them.

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If ED medication hasn’t worked the way you hoped, it doesn’t mean you’re out of solutions — it simply means there’s more to explore. With the right adjustments and support, most men find a treatment approach that truly works for them.

Here are the key takeaways:

• ED meds can fail for several common, fixable reasons, including timing, dosing, food, alcohol, or lack of arousal.

• Health conditions like diabetes, vascular issues, and low testosterone can also make ED meds less effective.

• A wide range of proven alternatives exists, from pumps and injections to hormone therapy, shockwave therapy, and implants.

• Avoid unregulated supplements and use testosterone therapy only if a deficiency is confirmed.

• The best next step is connecting with a trained provider who can pinpoint what's going on and guide you toward the right treatment plan.