Weeks 1–2: the trial period
The goal in the first fortnight is not success. It is establishing whether you are taking the medication correctly, and getting past the anticipatory anxiety of the first few attempts.
- Take it with enough lead time — 30–60 minutes for sildenafil, at least 30 for tadalafil, 15–30 for avanafil.
- Relatively empty stomach for sildenafil and vardenafil.
- Genuine physical sexual stimulation. The drug amplifies arousal, it does not create it.
- Moderate alcohol at most.
- Repeat the same dose several times before concluding anything.
Weeks 3–6: adjustment
By now you should have enough data to know whether the response is good, partial or absent. This is when the dose conversation happens.
| What you are seeing | What it usually means | Next step |
|---|---|---|
| Working reliably | Correct drug, correct dose | Continue. Discuss tapering later if the cause was largely psychological. |
| Working sometimes | Often timing, food or alcohol rather than the drug | Tighten the technique for two more weeks before changing dose. |
| Partial response every time | Dose is probably too low | Ask about increasing to the maximum tolerated dose. |
| No response at all | Wrong drug, wrong dose, or an unaddressed cause | Book a review — do not simply keep trying. |
| Works but side effects are unpleasant | Wrong molecule for you | Lower dose first, then consider switching. See side effects. |
Months 2–3: consolidation
- Side effects settle. Headache and flushing commonly diminish with repeated use.
- Confidence returns. Several reliable successes directly contradict the belief that drives performance anxiety — this is the point at which the psychological layer starts to lift.
- Lifestyle change begins to register. Exercise studies typically show measurable improvement in erectile function at around three months.
- Test results should have been acted on. If your bloods showed raised glucose, low testosterone or abnormal lipids, there should be a plan for each — not just for the erection.
- Review the whole picture. This is the natural point to ask whether the underlying cause is being managed, not only the symptom.
What to record
Two lines per attempt is enough, and it makes the follow-up appointment dramatically more productive than trying to recall three months from memory.
- Date
- And roughly what time you took it.
- Dose
- Including any change since last time.
- Timing
- How long before sex.
- Food and alcohol
- Light meal, heavy meal, drinks.
- Result
- Firm enough for penetration? Maintained to completion? Rate it out of 5.
- Side effects
- What, how bad, how long.
When to go back sooner
- No response at all after eight proper attempts at the maximum tolerated dose.
- Side effects that are severe or not settling.
- Any warning sign from the safety guide — vision or hearing change, chest pain, an erection over four hours.
- New penile curvature, pain or a palpable lump.
- Test results you have not had explained to you.
- Low mood or relationship distress that treatment has not touched.
If two different molecules have failed at maximum dose after adequate trials, that is the point to ask about urology referral rather than a third tablet. See when medication fails.
FAQ
Frequently asked questions
How long before ED medication starts working?
Within the first dose if taken correctly — but judge it over four to eight attempts, since the first few are heavily affected by anticipatory anxiety.
Do side effects go away?
Headache and flushing frequently diminish over the first several doses. Persistent or severe effects usually mean the dose is too high or the molecule is wrong for you.
When will lifestyle changes show an effect?
Exercise trials typically show measurable improvement at around three months, with further gains by six. It runs on a much slower clock than medication.
Will I need to take it forever?
Not necessarily. Where the cause was largely psychological, many men taper off once confidence returns. Where it is vascular or neurological, ongoing treatment is more likely.
Sources
What this is based on
We link to primary sources — clinical guidelines, regulator publications and peer-reviewed research — wherever possible. Links open on third-party sites we do not control.
- [01]American Urological Association. Erectile Dysfunction: AUA Guideline (2018).
- [02]National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Erectile Dysfunction.
- [03]U.S. Food and Drug Administration. Drugs@FDA — approved drug products and prescribing information.