Here’s Why You Shouldn’t Use ED Meds as a Pre-Workout

The trending pump-up practice can lead to cramping, dizziness, and more.

Medically Reviewed by Joshua Calvert, M.D.

Published: July 30, 2024 | Updated: August 13, 2024

Whether you get your sports news from ESPN, online forums, or eavesdropping at the gym, you’ve probably heard some talk about using ED meds as pre-workout. Former NFL star Chad Ochocinco told fans on X in 2020 that he took half a Viagra before every game. Within the past year, Reddit bodybuilder threads have been going berserk over the possible crossover.But is there any benefit to taking erectile dysfunction medications such as tadalafil (Cialis) and sildenafil (Viagra) ahead of training? And perhaps even more important, is it safe to pop these pills right before a vigorous workout?

About the Experts

Anthony A Mitchell M.D, a urologist who specializes in men’s sexual health with Central Texas Urology in Waco, Texas.Gowri Reddy Rocco M.D. M.S., a doctor who’s double-board certified in Family Medicine and Regenerative Anti-Aging Medication.Jake Harcoff C.S.C.S., a certified strength and conditioning coach and the head coach and owner of the training hub AIM Athletic.

ED Medications vs Pre-workout Supplements

There are a surprising number of similarities between the two, but the intended use for each is vastly different.

Pre-workout supplements

Pre is an over-the-counter supplement commonly sold as a powder that you shake into water and drink about 30 minutes before exercise. (You can also buy pre-workout gummies and capsules). The supplement can help enhance athletic performance and increase energy levels, explains certified strength and conditioning coach Jake Harcoff, C.S.C.S.Pre-workout supplements usually include caffeine (for energy), creatine (for strength), beta-alanine (for muscle endurance), L-citrulline and/or L-arginine (for increased blood flow), and occasionally also vitamins and minerals (for general health), he says.How long a pre-workout lasts depends on the formula and how much you take. On average, the effects last from one to three hours.

Erectile dysfunction medication

ED medications are FDA-approved pills that help you get and keep an erection when you’re turned on, says urologist and sexual health specialist Anthony A. Mitchell M.D. You take them 30 minutes to two hours before sex. They work by relaxing muscles in the blood vessels, which boosts blood flow to the penis.Most erectile dysfunction medications stay in your system anywhere from three to 48 hours after you take them, with Viagra (or sildenafil) falling on the lower end of that range, and Cialis (tadalafil) landing on the higher end (1, 2).These meds don’t just stop working after the grand finale. If you become aroused again while the meds are still in your body, you can reap the benefits for a second or third time.

The Link Between ED Meds and Pre-workout

From their ingredients list to their intended use, ED medications and pre-workout supplements are two very different products. However, both support blood flow—just in different ways.Most pre-workout supplements contain L-citrulline or L-arginine (and sometimes both), which are branched-chain amino acids (BCAA) that support blood flow, Harcoff explains. When consuming either, an enzyme called nitric oxide synthase (NOS) breaks down these amino acids into a gas called nitric oxide (NO). He adds that NO gas relaxes the smooth muscle cells in the blood vessels, which results in greater blood flow throughout the body.Athletically, this heightened blood flow can improve performance because blood carries oxygen and other key nutrients to muscles that enable them to contract. Visually, the boost in blood can create the appearance of a sick pump, says Harcoff.Erectile dysfunction medications also improve blood flow to muscles—but not in the same way. ED meds support blood flow by inhibiting an enzyme in blood vessel walls called phosphodiesterase 5 (PDE5), explains physician Gowri Rocco, M.D.She explains: To get an erection, you need to be sexually aroused. When you get turned on, your parasympathetic nervous system does too, leading to a release of NO, and a rush of blood to your penis (3). NO it increases the production of the molecule cyclic GMP, which relaxes the smooth muscle in blood vessels and ultimately increases blood flow to your member by 20 to 40 times (4).PDE5 can hinder cyclic GMP’s ability to work properly, which is where ED meds can help (5). These meds bind to the PDE5 enzyme so your body can reap the full downstream effects of cyclic GMP.

Can You Take Tadalafil as a Pre-workout Supplement?

Sold under the brand name Cialis, tadalafil is a popular prescription ED pill that temporarily increases blood flow to the penis.Taking a low dose of tadalafil about an hour before a workout is generally considered safe, Rocco says. For context, when tadalafil is used for erectile support, the usual dose is 10-20 mg taken 30 to 60 minutes before sex (6).The research on whether tadalafil can improve exercise performance is promising, though very limited. One small-scale study published in 2005 in the British Journal of Clinical Pharmacology found that taking 10 mg of tadalafil before a running test resulted in lower resting and exercise systolic blood pressure, compared to placebo (7). Another small 2017 study on men with diabetes and mild ED found that 5 mg of tadalafil daily for two months increased lean muscle mass (8).Keep in mind that both studies were small, and the latter consisted of a very specific group of study subjects.

Sildenafil as a Pre-workout Supplement

Sold under the brand names Viagra, Aronix, Liberize, and Nipatra, sildenafil is another ED medication that inhibits PDE5 (9, 10). Most people with erectile dysfunction take 50 mg (11).Despite Ochocinco’s stamp of approval for sildenafil, there’s little proof it enhances athletic performance. The most promising research comes from a 2013 study published in Clinical and Translational Science, which found that a daily 25 mg dose helped reduce muscle fatigue and support muscle protein synthesis (muscle growth) (12). But the study included only 11 men—far too few to make broad claims. Researchers behind another review, in BMJ Open Sport & Exercise Medicine, explored the effects of sildenafil on 210 subjects and concluded that taking the drug ahead of exercise did not improve exercise performance (13).

Side Effects of Using ED Meds as Pre-workout

The side effects of ED medication are the same, whether you use them as intended or off-label as a pre-workout.Since ED medications work by directing blood flow to the penis, that means less blood flow to other parts of the body, which can lead to digestive issues such as cramping, says Rocco. The sudden change in blood flow from the medication can also cause headache and dizziness, she says. “Actually, these side effects are fairly common—more than you might think for how little they’re talked about,” Mitchell adds.And while these side effects are annoying during sex, they can be downright dangerous when you’re exercising. Getting lightheaded in the middle of a heavy back squat or weight chin-up, for example, could lead to much more serious injuries than the same happening while you’re doing it missionary style on a mattress.“Some people may experience visual disturbances, such as a blue tint or increased light sensitivity,” Rocco says, which can be unsafe whether you’re on the treadmill or under the barbell rack (14).

Wait, Can Pre-workout Cause Erectile Dysfunction?

Probably not. “Pre-workout supplements are generally considered safe for healthy adults,” says Rocco (15). To date, there is no direct evidence linking pre-workout supplements to erectile dysfunction, she adds. That said, common pre-workout ingredients like caffeine may make it more difficult to get hard.In particular, the caffeine in most pre-workout supplements could interfere with users’ sleep patterns, and thus indirectly affect sexual performance,” Rocco explains (16). One review in Frontiers in Public Health found that participants with poor sleep quality had a nearly 60 percent higher prevalence of mild ED compared to those with good sleep quality (17). This is likely because lack of sleep can cause testosterone levels to nosedive and cortisol levels to spike—both of which can contribute to erectile dysfunction.If you do take pre-workouts, Rocco suggests using them as directed and discontinuing use if they tamper with your sleep or stress levels (18, 19).

So, Should You Use ED Meds as Pre-workout?

Ultimately, there isn’t enough research to support the widespread use of ED medications as a pre-workout, especially given that the potential downsides of using ED medication for this off-label are severe, Mitchell says. The good news is that there are safer, science-backed alternatives for increasing blood flow and supporting muscle repair and recovery, Harcoff adds. “Supplements like citrulline malate, betaine, and arginine are known nitric oxide enhancers that can effectively promote blood flow to muscles without the potential risks associated with medications intended for erectile dysfunction,” he explains. Whether you choose a prescription medication (like ED meds) or an over-the-counter supplement ahead of exercise, Rocco says it’s always best to get the green light from a healthcare provider first.

The Bottom Line

While there are similarities between erectile dysfunction medications and pre-workout supplements, they are not interchangeable. Taking ED meds before exercise can make you feel lightheaded and dizzy, which can be dangerous when you’re pumping iron on the bench. Before a sweat sesh, opt for a pre-workout supplement—specifically one that is third-party tested and certified.

About the author

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies.

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