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Key facts at a glance
- Aerobic exercise
- +2.8 points on the erectile function score versus controls, pooled from 11 randomized trialsKhera et al. 2023 · PubMed
- Lifestyle timeline
- The weight-loss trial followed participants for 2 years; it does not establish a quick fix.Esposito 2004 · PubMed
- Pelvic floor evidence
- The trial used physiotherapist teaching and biofeedback, with a crossover design.Dorey 2005 · PubMed
- PDE5 tablets
- Tadalafil needs sexual stimulation to workCialis (tadalafil) label · DailyMed
- Compounded status
- The Mendoxa compounded tablet is not FDA-approvedFDA compounding Q&A
What makes an erection harder or softer
Firmness depends on blood flow, nerves, hormones and mood working together. NIDDK lists heart and blood vessel disease, diabetes, nerve damage, hormone issues and anxiety or stress among ED causes, plus lifestyle factors such as low physical activity, heavy alcohol use and smoking.
A persistent change deserves an assessment. NIDDK says ED may be a symptom of another health problem. Our erectile dysfunction guide covers the wider assessment; nitric oxide and ED explains the erection signal.
This page focuses on firmness. If the problem is losing an erection partway through, read can’t stay hard; for food and remedy ideas, see home remedies for ED.
Lifestyle steps ranked by evidence
Aerobic exercise has the broadest randomized evidence in this table. Weight loss with activity and supervised pelvic floor training also have randomized trial support; smoking, sleep and alcohol findings need more caution. IIEF is the International Index of Erectile Function questionnaire: a higher score reflects better reported function, not a measured percentage increase in hardness.
| Step · evidence type · year | What the study found | Limits |
|---|---|---|
| Aerobic exercise · meta-analysis of 11 randomized trials · 2023 | Erectile function score +2.8 points versus controls (95% CI 1.7–3.9); larger benefit with lower starting scores. Khera et al. | Programs and participants varied; this average does not predict your result. |
| Weight loss plus activity · randomized trial · 2004 | Over 2 years, IIEF rose from 13.9 to 17 in the lifestyle group, with controls stable; 17 of 55 versus 3 of 55 reached a score of 22 or higher. Esposito et al. | 110 men with obesity and ED; diet and activity changed together, so the trial cannot isolate weight loss alone. |
| Pelvic floor training · randomized trial · 2005 | Physiotherapist-taught exercises with biofeedback beat lifestyle advice alone at 3 months; at 6 months, 40% regained normal function, 35.5% improved and 24.5% did not. Dorey et al. | 55 men; controls could cross over to training after 3 months. The 6-month percentages are not a randomized treatment-versus-control comparison. |
| Quitting smoking · prospective study · 2004 | After 1 year, ED improved in at least 25% of 118 quitters and in none of 163 continuing smokers. Pourmand et al. | Not randomized; older men and those with advanced ED improved less. |
| Sleep apnea treatment · uncontrolled pre/post study · 2024 | Erectile function scores improved significantly after 3 months of CPAP in 87 men with obstructive sleep apnea. Kim et al. | No control group; the abstract gives no numerical score change. Treating diagnosed sleep apnea is different from simply sleeping longer. |
| Alcohol · observational meta-analysis · 2021 | Across 46 studies (216,461 participants), regular alcohol consumption was associated with ED odds ratio 0.89 (95% CI 0.81–0.97); the analysis found a J-shaped relationship. Li et al. | Association does not show that drinking improves erections. NIDDK advises limiting or stopping alcohol for ED. |
Sources: Khera 2023; Esposito 2004; Dorey 2005; Pourmand 2004; Kim 2024; Li 2021. Accessed Oct 24, 2026. This ranking describes study designs, not a head-to-head comparison of treatments.
Choose your next step for stronger erections
Choose the situation that sounds like yours. You can start lifestyle changes and seek an assessment at the same time; the studies do not establish a waiting period before asking for care.
- You are inactive: make aerobic exercise your first lifestyle focus. The randomized-trial review supports this approach, without promising a result.
- You have extra weight to lose: discuss a sustainable diet-and-activity approach, as tested in the Esposito trial.
- You want to try pelvic floor work: ask about supervised training with biofeedback, the approach used in the Dorey trial.
- You smoke or have diagnosed sleep apnea: discuss smoking cessation or your sleep-apnea treatment with your clinician (smoking study; CPAP study).
- Stress is part of the problem: NIDDK includes counseling among ED options; read performance anxiety and ED.
- Softness keeps happening or you want to discuss prescription care: use an online visit to review your symptoms, health history and current medicines.
For a specific product you are considering, read supplements for ED. For a non-drug option, see vacuum erection devices; NIDDK explains how they pull blood into the penis.
When lifestyle isn’t enough: how ED tablets work
PDE5 inhibitors support the body’s own erection signal; they do not create arousal. The Viagra (sildenafil) label describes nitric oxide release during sexual stimulation and PDE5 inhibition that slows the breakdown of cGMP. The Cialis (tadalafil) label says sexual stimulation is required.
| Label detail | Viagra (sildenafil) label | Cialis (tadalafil) label |
|---|---|---|
| When to take | About 1 hour before sex; permitted timing is 30 minutes to 4 hours before (Viagra (sildenafil) label) | As needed: at least 30 minutes before sex; a separate once-daily option does not depend on timing sex (Cialis (tadalafil) label) |
| What the window means | The 30-minute to 4-hour instruction is a dosing window, does not establish an exact duration of effect (Viagra (sildenafil) label) | Improved erectile function versus placebo up to 36 hours after dosing; this does not mean a continuous erection (Cialis (tadalafil) label) |
| Food | A high-fat meal may make it take longer to start working (Viagra (sildenafil) label) | May be taken without regard to food (Cialis (tadalafil) label) |
| Maximum frequency | Once per day (Viagra (sildenafil) label) | Once per day in most patients (Cialis (tadalafil) label) |
Sources: Viagra (sildenafil) label; Cialis (tadalafil) label. Accessed Oct 24, 2026. These are instructions for separate approved oral products; they do not establish the timing of Mendoxa’s compounded tablet.
Use sildenafil vs tadalafil to prepare questions about timing, and ED medications compared for the wider discussion. Prescription required.
What each path includes
Match the path to what you want to change. These paths can run together; none of them can promise a result.
| Path | What it includes | Boundary |
|---|---|---|
| Lifestyle steps | Exercise, weight, smoking, alcohol and sleep changes from the evidence table (NIDDK) | Benefits in studies took weeks to years and were not universal |
| Pelvic floor physical therapy | Supervised pelvic floor exercises, as in the Dorey trial | The cited trial was small and included crossover |
| Clinical ED assessment | Review of causes such as blood vessel disease, diabetes, hormones and medicines (NIDDK) | Ask whether any part of your assessment needs in-person care |
| Standalone ED prescription | Sildenafil or tadalafil if appropriate (Viagra (sildenafil) label; Cialis (tadalafil) label) | Prescription required; both need sexual stimulation and are contraindicated with nitrates (sildenafil label; tadalafil label) |
| Mendoxa 3-in-1 visit | Online review by Independent licensed providers of whether the compounded tablet fits | Compounded drugs are not FDA-approved |
Sources: NIDDK treatment; NIDDK causes; Dorey 2005; Viagra (sildenafil) label; Cialis (tadalafil) label; FDA compounding Q&A; Mendoxa care information. Accessed Oct 24, 2026.
Prepare for the visit: note when softness started, whether it happens every time, what you have tried and every medicine you take. Ask what the provider recommends for your situation and why. For expectations about recovery, read can ED be reversed?
Safety checks before ED medication
- Sildenafil and tadalafil are contraindicated with organic nitrates or riociguat (Viagra (sildenafil) label; Cialis (tadalafil) label).
- An erection lasting more than 4 hours needs immediate medical care (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Stop and seek care for sudden vision loss or sudden decrease or loss of hearing (Viagra (sildenafil) label; Cialis (tadalafil) label).
- Common adverse effects include headache and flushing with sildenafil, and headache, indigestion and back pain with tadalafil (Viagra (sildenafil) label; Cialis (tadalafil) label).
- The APOKYN (apomorphine) label contraindicates use with 5HT3 antagonists such as ondansetron and warns about nausea and fainting.
Do not add another ED medicine to an existing treatment on your own: the Viagra (sildenafil) label and Cialis (tadalafil) label advise against combining with other PDE5 inhibitors. See ED medication and nitrates for more detail.
Could Mendoxa ED care fit you?
Online ED visit · Prescription required · Independent licensed providers · Not available in California
If you want treatment for softer erections now
Start with an online assessment of your symptoms. Share your health history, current medicines and the lifestyle steps you have tried. Independent licensed providers decide whether treatment is appropriate. Prescription required. Mendoxa ED care explains the process.
Mendoxa offers a compounded rapid-dissolve tablet containing sildenafil, tadalafil and apomorphine. It is not FDA-approved. The Viagra (sildenafil) label, Cialis (tadalafil) label and APOKYN (apomorphine) label concern separate products; they do not establish the safety or effectiveness of this combination.
Read about the compounded combination ED tablet or visit the Mendoxa home page, then use the online visit to discuss suitability. Costs below apply if prescribed.
Mendoxa ED plans and prices
The Mendoxa ED tablet is a compounded rapid-dissolve tablet with sildenafil (the active ingredient in Viagra), tadalafil (the active ingredient in Cialis) and apomorphine (APOKYN label). It dissolves under the tongue. A licensed clinician decides if it fits you and selects the strength. Compounded medicines are not FDA-approved.
| Tablets per month | 1-month total | Per tablet (1 month) | 3-month total | Per tablet (3 months) |
|---|---|---|---|---|
| 6 tablets / month | $129 | $21.50 | $329 | $18.28 |
| 10 tablets / month | $149 | $14.90 | $379 | $12.63 |
| 20 tablets / month | $179 | $8.95 | $449 | $7.48 |
The 3-month total covers three months at the monthly tablet quantity shown.
If prescribed · Cancel anytime · Available in 49 states (not California). Prices from the Mendoxa intake at try.mendoxa.co/f/ed on Oct 24, 2026. The intake always shows the current price.
The science behind firmer erections: nitric oxide and erections. If you lose it midway: can't stay hard and losing an erection during sex.
What the evidence says about diet: foods for stronger erections.
Training that has trial data behind it: Kegel and cardio exercises for ED.
Averages from stopwatch studies and when to worry: how long an erection should last.
Related reading: how to stay hard after you finish, beet juice and ED.
FAQ
Can you get harder erections naturally?
Lifestyle changes can help some men. The aerobic-exercise review and diet-and-activity trial found improvements in erectile function, but neither promises a personal result. Start with the decision guide above; if you are searching for how to stay hard longer naturally, that guide addresses losing firmness during sex.
Do Kegels make erections harder?
Supervised pelvic floor training helped in the Dorey trial. It included physiotherapist teaching and biofeedback, so it does not establish the same benefit for unguided Kegels. The six-month results also included controls who crossed over to training.
How long does it take for exercise to improve erections?
The studies do not give a dependable deadline for you. The Esposito diet-and-activity trial followed men for 2 years; the pelvic floor trial found a treatment-versus-control difference at 3 months. Persistent softness is a reason to discuss care while making changes.
Does alcohol make erections softer?
Survey data show a J-shaped pattern rather than a simple rule (Li et al.), and NIDDK advises limiting or stopping alcohol. The Cialis (tadalafil) label warns that 5 or more units with tadalafil can increase dizziness and headache. See ED and alcohol.
Why are my erections not as hard as they used to be?
Possible causes include blood vessel disease, diabetes, hormone issues, stress and lifestyle factors (NIDDK). A persistent change deserves assessment because ED may be a symptom of another health problem.
Do ED pills make you hard without arousal?
No. The Viagra (sildenafil) label and Cialis (tadalafil) label say sexual stimulation is needed, and both are contraindicated with nitrates. Prescription required.
Ready to see if the Mendoxa ED tablet fits you?
From $129/month if prescribed · Cancel anytime · Available in 49 states (not California)
How we wrote this
Written by the Mendoxa editorial team · Sources: DailyMed/FDA. Medical facts on this page come from the FDA-approved labels on DailyMed and Drugs@FDA; each drug name links to its label. We rechecked the retained PubMed abstracts, NIH guidance and DailyMed/FDA sources on Oct 24, 2026. We rank lifestyle evidence by study design and show the study population, outcome and limits. The studies did not compare all these steps head to head. Group results do not predict your outcome. APOKYN (apomorphine) labeling concerns a Parkinson’s disease injection, not an approved ED tablet. FAQ topics reflect search intent; a live Google People Also Ask block was not independently confirmed.
Updated Oct 24, 2026. This page is general information, not medical advice. A licensed clinician decides what fits you.
References
- DailyMed: VIAGRA (sildenafil citrate) tablet, film coated, label revised 12/2017. Accessed Oct 24, 2026.
- DailyMed: CIALIS (tadalafil) tablet, film coated, label revised 3/2026. Accessed Oct 24, 2026.
- DailyMed: APOKYN (apomorphine hydrochloride) injection, label revised 6/2022. Accessed Oct 24, 2026.
- FDA (Drugs@FDA): VIAGRA (sildenafil) prescribing information, NDA 020895. Accessed Oct 24, 2026.
- FDA (Drugs@FDA): CIALIS (tadalafil) prescribing information, NDA 021368. Accessed Oct 24, 2026.
- FDA: Compounding and the FDA, questions and answers. Accessed Oct 24, 2026.
- Khera et al. (2023): aerobic exercise, randomized-trial meta-analysis. Accessed Oct 24, 2026.
- Esposito et al. (2004): lifestyle changes in men with obesity and ED. Accessed Oct 24, 2026.
- Dorey et al. (2005): pelvic floor exercises. Accessed Oct 24, 2026.
- Pourmand et al. (2004): smoking cessation. Accessed Oct 24, 2026.
- Kim et al. (2024): CPAP in men with obstructive sleep apnea. Accessed Oct 24, 2026.
- Li et al. (2021): alcohol and ED meta-analysis. Accessed Oct 24, 2026.
- NIDDK: ED treatment. Accessed Oct 24, 2026.
- NIDDK: ED symptoms and causes. Accessed Oct 24, 2026.
- Mendoxa ED care (product, format, max 1 dose per 24 hours). Accessed Oct 24, 2026.
- Mendoxa ED intake: plan prices (term_options). Accessed Oct 24, 2026.
About Mendoxa
Mendoxa (mendoxa.co) is a US telehealth brand. Independent licensed providers (licensed clinicians in the LocumTele network) review each online visit, and prescriptions are filled by Rush Pharmacy, a licensed US pharmacy. Available in 49 states (not California).
- Prescription required. A licensed clinician reviews every visit and can say no. A prescription is not automatic.
- A compounded medicine is not an FDA-approved finished product (FDA compounding Q&A).
- Plans: 1 month or 3 months, from $129. If prescribed · Cancel anytime · Available in 49 states (not California).
Compounded medication prescribed only if a licensed U.S. clinician decides it is appropriate. Not FDA-approved as a finished product. Not available in California. This site is not for emergencies. Call 911 if you need urgent care.