Viagra vs. TRT: What Works Better for ED?

Published: 2025-09-26

Updated: 2025-09-26

4 mins

Erectile dysfunction is one of the most common sexual health concerns in men. While the most typical treatment route for ED are PDE5 inhibitors like Viagra, there are other treatment options that may be effective as well. One of these is testosterone replacement therapy (TRT). 

While both can help with ED, they work in very different ways – and understanding which option is right for you depends on what’s behind the problem in the first place.

How Do PDE5 Inhibitors Work?

PDE5 inhibitors like Viagra, Cialis, and Levitra target a very specific part of the erection process: blood flow. Normally, when you’re sexually stimulated, the nerves in the penis release nitric oxide. This chemical triggers cGMP, which relaxes smooth muscle in the penile arteries. This process allows more blood to rush in and fill the erectile tissue, which is what happens when the penis gets hard. 

The problem is that an enzyme called PDE5 naturally breaks down cGMP. In men with ED, this breakdown often happens too quickly, making it difficult to get or maintain an erection. PDE5 inhibitors block that enzyme, so blood vessels stay relaxed longer. The end result is better blood flow to the penis and stronger, more reliable erections.

It’s important to note that these medications don’t work without sexual stimulation – you still need to be aroused to achieve an erection. They also don’t increase libido, testosterone, or fertility. Their role is to support the vascular mechanism of an erection.

In clinical practice, PDE5 inhibitors are often considered first-line therapy for ED because they are effective for most men, generally well-tolerated, and can be adjusted in dose or switched among different options if one doesn’t give the desired results.

How Does TRT Work?

Testosterone is a key hormone that affects more than just sexual function. It influences sex drive, energy levels, mood, muscle mass, bone density, and even fat distribution. When testosterone levels drop, men may notice symptoms like reduced libido, fatigue, difficulty with erections, and sometimes low mood or loss of muscle tone.

TRT works by restoring testosterone to normal levels through various methods, including gels, patches, injections, or small pellets implanted under the skin. By replenishing this hormone, TRT addresses the root cause of symptoms related to low testosterone rather than just masking them.

For sexual function, TRT can help in a few ways. First, it often increases libido, making sexual activity more appealing. It can also improve the body’s natural response to sexual stimulation, which may make erections easier to achieve, especially in men whose ED is linked to hormonal deficiency. However, it’s important to understand that TRT is not a quick “on-demand” solution like Viagra. It can take weeks to months for testosterone levels to normalize and for symptoms to noticeably improve.

Beyond sexual health, TRT can also support overall wellbeing. Many men report higher energy, improved mood, better focus, and increased muscle strength after consistent treatment. 

With the Rex MD Testosterone Program, you’ll have access to quality care from a team of licensed clinicians and testosterone replacement therapies (if clinically appropriate) or other testosterone solutions that can help you feel like yourself again.

To find out if the program is right for you, just answer some questions about your symptoms and medical history. Your provider will order lab work for you to help determine if you’re eligible for TRT or another testosterone solution available through the program.

Then, you’ll be able to schedule a virtual call with the Rex MD care team to further discuss your results, eligibility, and which treatment option would be most suitable for you, if any.

Can You Take PDE5 Inhibitors and TRT Together?

Many men wonder if it’s safe or effective to combine Viagra (or other PDE5 inhibitors) with testosterone therapy. The short answer is yes. Under medical supervision, using both can be safe and even beneficial for certain men.

Healthcare professionals may recommend combination therapy for men who have conditions associated with low testosterone levels and erectile dysfunction that doesn’t fully respond to PDE5 inhibitors alone. In this scenario, TRT may boost libido and sexual desire, while Viagra ensures erections are achievable. 

It’s important to note that combining these therapies should always be done under supervision. Your doctor will monitor hormone levels, overall health, and any potential side effects to ensure the combination is safe and effective.

How Can Rex MD Help?

Rex MD helps guys in need of some extra help in the bedroom get ED medications like Viagra and Cialis. Plus, you won’t even have to leave your house. After you answer a few questions online about your needs, a doctor may prescribe ED medication that can be sent to your home quickly and discreetly.

Get started today with Rex MD.