TABLE OF CONTENTS

Are sexual function medications available?

Sexual function medications are available to Plume members who receive Estrogen+ medications, such as estradiol, progesterone, spironolactone, and others. When starting estrogen and/or testosterone blockers, people’s estrogen levels generally go up. As estrogen levels go up, your androgen and testosterone (“T”) levels drop. This drop can cause a change to the structure of the erectile tissue in your genital area. It can also affect the amount of blood that gets to the tissue. Both these changes can decrease the ability for erectile tissue to function as it did prior to starting hormones. Your desire to retain erectile function (or not) is an individual decision. For some people, this change is a very welcome effect of GAHT, while for others it can be an undesired effect. (Of course, having erections is only one aspect of sexual function, and there are many ways to have intimacy and express your sexuality.) 


There are two main options that we offer for erectile function medications: sildenafil (Viagra) and tadalafil (Cialis). They are both equally effective, but some folks do better with one over the other. These medications both work the same way. They help increase blood flow to erectile tissue when you are feeling sexually stimulated. With this increased blood flow to the area, there is an increased chance of erections when you’re aroused. The main difference between the two is that with tadalafil, you have the option to take it daily or as needed; sildenafil is only taken as needed.


Sildenafil (Viagra)

Sildenafil, which is the generic name for Viagra, is a pill that you take 30 minutes to four hours before sexual activity. We usually start with a dose of a 50 mg tablet and increase to 100 mg tablets later if you are not having the desired effect.


Tadalafil (Cialis)

Tadalafil, which is the generic name for Cialis, is a pill that can be taken as needed for sexual activity. It is similar to sildenafil (Viagra), and should be taken at least two hours before sexual activity. People usually start at 10 mg per dose and can be increased to 20 mg per dose, as needed. Tadalafil can also be taken daily at a lower dose regardless of the frequency of sexual activity, usually starting at 2.5 mg per day and can increase to 5 mg per day, if needed.


Are there any possible risks?

Prior to starting tadalafil or sildenafil, we will ask you to provide us with a blood pressure reading that has been taken in the last 3 months . If another provider has taken your blood pressure, send a message in Spruce with the reading (e.g. 120/80) and date the reading was taken. Or, you can check your blood pressure with a home cuff or with a cuff in a pharmacy. Take a picture of the reading and send it to us with the date the blood pressure was taken.

It is important to be aware that sildenafil and tadalafil can suddenly drop your blood pressure. They both can interact with other heart medications such as nitrates and blood pressure medications. It is always important to tell your other providers outside of Plume that you are taking these medications, and always tell your Plume provider if you start any other new medications outside of Plume.

Sildenafil and tadalafil should not be taken with nitrates (such as nitroglycerin, isosorbide, Imdur®, Nitro-Bid®, Nitro-Dur®, Nitrol® ointment, Nitrolingual® spray, Nitrostat®, and Transderm Nitro®), or some illegal street drugs called “poppers” (such as amyl nitrate, butyl nitrate, or nitrite). Do not take sildenafil or tadalafil if you also use Riociguat (Adempas®). Sildenafil and tadalafil can rarely cause an erection that lasts longer than four hours, which is called priapism. If this happens, you need to go to an emergency room immediately.

Anybody taking sildenafil or tadalafil who is 50 years or older (or at any age with a known history of kidney disease) needs to have their kidney function checked before being prescribed these medications because the dosing can change, depending on your kidney function. If you are age 50 and over or have known kidney disease and you have not had your kidney function checked in the last three months, we will need to do a blood test to check your kidney function. If you have had your kidney function checked in the last three months outside of Plume, you can send the report to us in the Spruce app.

How do I decide which one is right for me?

Both sildenafil and tadalafil have the potential to work equally well, so picking which one to start with is based more on your preferences. The following questions might help point you in the right direction. If you feel like you are not experiencing the desired effect with one, we can always switch to the other, assuming there aren’t any medical reasons which would prevent us from doing so.

  • How many times a week do you find that the decrease in erectile function affects the quality of your sex life? If it is more than 2-3 times per week, then you might want to consider daily tadalafil for convenience, so you don’t have to remember to take a pill every time you plan to be sexually active
  • Do your sexual encounters happen with more planning? If so, you could probably go with either medication.
  • Do your sexual encounters happen with less planning involved? In that case, sildenafil (which can be taken as close as 30 minutes before sexual activity) might be your best option. Tadalafil needs to be taken at least two hours before activity to have the optimal effect

Certain health conditions can also influence which one is best for you. For example, if you have significant kidney disease, then your provider might avoid prescribing the daily tadalafil pill. Your provider will make sure to provide any individual guidance along these lines with you and answer any questions you have about their suggestions. Message your provider in Spruce or ask at an appointment if you’d like to learn more about what is best for you.


Where can I get my medication?

You have two options to obtain your medication. We can deliver it to your door in discreet packaging through our mail-order service, or you can pick it up from your local pharmacy. 


How much does it cost?

Through our mail order system, we will send you a supply of 30 tablets of Sildenafil for $18.50 or 30 tablets of Tadalafil for $14-17 (depending on your dose). This cost includes shipping and handling. Review our full mail-order pharmacy price list here. If you are using your local pharmacy, you might be able to get a discount on your medication if they accept GoodRx coupons. 

How do I get refills?

If this medicine is working for you, let us know when you have five tablets left and we will ship a new supply. Please be aware it can take up to 7-14 days for delivery in some cases, but your delivery will usually arrive within 5-7 business days.