Week 1: Foundations that move the needle
1) Walk + lifts
- 30–40 min brisk walking 5 days/week.
- 2 strength sessions: squats, hinges, pushes, pulls. Blood flow improves within weeks.
2) Sleep like it matters
- 7–9 hours. Same bedtime/wake time.
- If you snore or wake unrefreshed, screen for sleep apnea.
3) Remove silent saboteurs
- Alcohol: max 1 drink on nights you plan sex.
- Nicotine: start cessation plan now.
- Porn diet: reduce novelty scrolling; focus on partnered arousal.
4) Labs and meds check (with a clinician)
- Review BP, lipids, A1c, thyroid, morning total testosterone (repeat if low).
- List all meds. SSRIs, some BP pills, finasteride, antihistamines can blunt erections.
5) Mindset reset
- Performance breath: 4-second inhale, 6-second exhale, 3–5 min daily.
- Reframe session goals from “orgasm” to “curiosity and connection.”
Week 2: Precision with stimulation and timing
1) Longer runway
- Minimum 15–20 minutes of unhurried foreplay. More arousal = less effort.
- Use lube. Dry friction kills sensitivity and mood.
2) Sensation pacing
- For premature ejaculation: pause–squeeze, edging, or thicker condom.
- For ED: maintain steady arousal; avoid sudden stops.
3) Food and dose timing
- Sildenafil: best on a relatively empty stomach; high-fat meals slow onset.
- Tadalafil: food-agnostic; consider evening dosing for next-day window.
4) Start a structured log
- Record date, dose, timing, food/alcohol, arousal level, outcome, side effects.
- Data beats guesswork.
Week 3: Evidence-based treatments, used right
PDE-5 inhibitors (first-line)
- Tadalafil (generic Cialis)
- As needed: 10–20 mg, 30–60 min before sex, duration up to ~36 h.
- Daily: 2.5–5 mg for spontaneity and BPH relief.
- Sildenafil (generic Viagra)
- As needed: 25–100 mg, 30–60 min before sex, lasts ~4–6 h.
Rules that prevent disappointment
- One dose per 24 hours.
- No nitrates or riociguat.
- Limit alcohol.
- Try 4–8 attempts with correct timing before judging failure.
- Switch agent or regimen (e.g., daily tadalafil) if fit is poor.
Telehealth workflow (typical)
- 5–10 min intake + photo ID.
- Clinician review; video if needed.
- If appropriate, Rx to licensed pharmacy.
- Manage refills, address, timing online. Reputable platforms (e.g., MyfirmX) provide clear safety screens and follow-up.
Week 4: Optimize, stack, and stabilize
If response is partial
- Verify timing, food, alcohol, anxiety.
- Switch sildenafil ↔ tadalafil.
- Consider daily tadalafil 2.5–5 mg for steadier performance.
- Add pelvic-floor training (controlled Kegels) 3–4x/week.
If anxiety dominates
- Brief psychosexual coaching or CBT tools.
- Low-stakes sessions with “no-goal” rules to rebuild confidence.
If PE persists
- Behavioral work (edging) + thicker condom.
- Discuss topical anesthetic sprays or off-label SSRIs with a clinician if needed.
If libido is low
- Check sleep, stress, relationship climate.
- Reassess hormones. Treat true hypogonadism per clinical guidance.
Red flags: stop and see a clinician
- Chest pain, fainting, marked shortness of breath.
- Vision/hearing changes.
- Painful or prolonged erection (>4 hours).
- New neurologic deficits. ED can signal vascular disease. Do not ignore systemic symptoms.
Myths vs facts
- Myth: “More milligrams = better.” Fact: Standard max for most is tadalafil 20 mg or sildenafil 100 mg. Higher doses raise risk, not results.
- Myth: “PDE-5s work without arousal.” Fact: Sexual stimulation is required.
- Myth: “Alcohol boosts performance.” Fact: Alcohol undermines arousal, BP, and response.
Safe buying checklist
- Licensed prescriber + licensed pharmacy.
- Clear contraindication screening.
- Tamper-evident packaging, lot/expiry shown.
- Avoid “herbal boosters” with undisclosed drugs.
Quick FAQ
How fast should I expect improvement?
Some win in days. Most see steady gains over 2–4 weeks with training, sleep, and correct dosing.
Can I combine ED meds?
Not without clinician guidance. Do not stack PDE-5s.
What if I also have urinary symptoms?
Ask about daily tadalafil 2.5–5 mg; it can help ED and BPH.
Is porn the problem?
Excess novelty can dull arousal. Reducing intensity often helps partnered response.
Does weight loss matter?
Even 5–7% loss improves endothelial function and testosterone dynamics.
30-day checklist (printable)
- Cardio 5×/week + strength 2×/week.
- Sleep 7–9 h; screen for apnea if needed.
- Alcohol ≤1 drink on active nights; nicotine quit plan.
- Choose one PDE-5, dose correctly, log results.
- 15–20 min foreplay, lube, pacing techniques.
- Reassess in week 4; adjust dose/regimen with clinician.