From the Guidelines
For a 21-year-old male with erectile dysfunction and no other health issues, I would recommend starting with a PDE5 inhibitor such as sildenafil (Viagra) at a dose of 50mg taken approximately 1 hour before sexual activity, not more than once daily. This recommendation is based on the strongest and most recent evidence from the American Urological Association guideline on erectile dysfunction, which suggests that men with ED should be informed about the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated 1. The guideline also recommends titrating the dose to provide optimal efficacy, and sildenafil is a commonly used and effective option.
Before starting medication, it's essential for this young man to undergo a thorough medical evaluation to rule out underlying physical causes such as hormonal imbalances, vascular problems, or neurological issues, as ED at this young age often has psychological components like performance anxiety or stress. Lifestyle modifications should also be considered, including:
- Reducing alcohol consumption
- Quitting smoking if applicable
- Managing stress
- Improving communication with sexual partners
If sildenafil is ineffective at the initial dose, it can be adjusted to 100mg, or alternatives like tadalafil (Cialis) 10mg could be considered 1. Side effects may include headache, flushing, indigestion, and nasal congestion, which are typically mild and transient. The choice of a specific PDE-5 inhibitor can be based on individual preferences, including ease of use, cost of medication, and adverse effects profile 1. However, the most recent and highest-quality study suggests that sildenafil, tadalafil, vardenafil, and avanafil have similar efficacy in the general ED population 1.
From the FDA Drug Label
Tadalafil tablets for use as needed: • Do not take tadalafil tablets more than one time each day • Take one tadalafil tablet before you expect to have sexual activity. You may be able to have sexual activity at 30 minutes after taking tadalafil tablets and up to 36 hours after taking it.
The recommended medication for a 21-year-old male with erectile dysfunction (ED) and no other health issues is tadalafil.
- The patient should take one tadalafil tablet before expecting to have sexual activity.
- The patient may be able to have sexual activity at 30 minutes after taking tadalafil tablets and up to 36 hours after taking it.
- The patient should not take tadalafil tablets more than one time each day. 2
From the Research
Medication Options for Erectile Dysfunction
- Sildenafil is an effective oral therapy for erectile dysfunction, allowing corpus cavernosum smooth muscle to relax and potentiate erections during sexual stimulation 3.
- The recommended starting dose for sildenafil is 50mg, taken as needed, approximately 1 hour before sexual activity, with a maximum dose of 100mg once daily 3.
- For a 21-year-old male with no other health issues, sildenafil can be an appropriate treatment option, with dosages starting at 50mg and potentially increasing to 100mg if needed 3, 4.
Efficacy and Safety of Sildenafil
- Sildenafil has been shown to be effective in improving erections and allowing successful penetrative sexual intercourse in men with erectile dysfunction of various causes 3, 5.
- Common adverse events associated with sildenafil are transient and mild or moderate, including headache, flushing, dyspepsia, nasal congestion, and abnormal vision 3.
- Sildenafil has a satisfactory efficacy-safety profile in all patient categories, including those with mild to moderate erectile dysfunction 5.
Alternative Treatment Options
- Other phosphodiesterase type 5 inhibitors, such as vardenafil and tadalafil, are also available and may be effective for treating erectile dysfunction 5, 6.
- Tadalafil once daily has been shown to improve erectile function in men with mild to mild-moderate impairments in erectile function following as-needed PDE5 inhibitor treatment 6.
- Apomorphine SL, a dopamine D1- and D2-receptor agonist, is another oral agent that may be effective for treating mild to moderate erectile dysfunction 5.