Do ED Pills Actually Work?

This paper analyzed multiple systematic reviews of randomized controlled trials, covering tens of thousands of men with erectile dysfunction of varying causes. Across reviews, the finding was consistent: PDE5 inhibitors like sildenafil (Viagra) and tadalafil (Cialis) clearly improved erectile function compared with placebo, regardless of age or underlying cause. Men taking these medications were more likely to achieve erections firm enough for intercourse and reported higher satisfaction. Importantly, benefits were seen across different formulations rather than one single “miracle” drug.

Among available options, sildenafil, tadalafil, vardenafil, and avanafil all showed meaningful benefit, with no strong evidence that one was universally superior. Differences are mainly related to onset time and duration, not effectiveness. Side effects—such as headache and flushing—were common but generally mild and predictable.

Why this matters: This confirms that ED medications work—but also reminds us they treat symptoms, not root causes. They’re effective tools, not shortcuts, and should be part of a broader, individualized approach to men’s health rather than the entire solution.

What This Study Found About Menopause, HRT, and Brain Health

In a landmark study of nearly 125,000 women from the UK Biobank, researchers discovered that menopause is linked to shrinkage in key brain regions responsible for memory and emotional regulation, specifically the hippocampus and anterior cingulate cortex.

While HRT is often prescribed to ease menopausal symptoms like depression and anxiety, this study suggests it may not fully address the underlying mental health challenges women face. In fact, women on HRT reported higher levels of anxiety and depression than those not taking it, but this means they were prescribed it because they were struggling, not that HRT caused the problems.

Think of it this way—women struggling with mood symptoms saw their doctor, got prescribed HRT, but the medication didn't resolve those underlying issues

What you can do: If you're navigating menopause, don't rely on HRT alone for mental health support. Consider combining it with therapy, sleep optimization, and regular check-ins with your doctor about mood changes. The research highlights an urgent need for more comprehensive treatment approaches, not just HRT.

This week, someone asked me, “I hear rumors that peanuts and cashews have some kind of negative effects on erections, orgasms, or something for men. I love these nuts and don't want to give them up unnecessarily. What's the story?”. There’s no good evidence that peanuts or cashews harm erections, orgasms, or male sexual health. In fact, they contain healthy fats, magnesium, arginine, and antioxidants that support blood vessel function, which is important for erections. The only real concern is overdoing heavily salted or processed nuts, which can affect blood pressure or cause weight gain if eaten in excess. If you enjoy them and feel good eating them, there’s no reason to give them up, unless you have a specific allergy or reason to avoid them. They may even benefit your overall sexual health!

I love hearing from you, so if there’s a question you’ve been wanting to ask, just let me know. Who knows? Your question might be the one I dive into next!

I want to share a book from my friend and colleague that I think many of you will find really valuable: The Forever Strong PLAYBOOK, which just released this week.

This book flips everything you’ve been told about weight loss and aging on its head. Instead of focusing on the scale or fearing fat, it explains why muscle is the true foundation of long-term health—supporting your metabolism, energy, how you age, and even protection against disease. It’s grounded in real science but written in a way that’s practical and easy to apply, with clear guidance on how to eat, train, move, and recover. This isn’t another short-term diet—it’s a complete, sustainable approach to health.

You can learn more about the book or get your copy here:

👉 https://drgabriellelyon.com/playbook/

In this episode, I talked about how to keep your pelvic floor healthy—and why it matters for good sex, peeing, pooping, and even your back. "The pelvic floor is essentially a bowl of muscles that sits in your pelvis… it helps with sex, it helps with urination, it helps with bowel movements, and it helps sort of stabilize things when you walk and when you move."

Here are the quick takeaways:

Remember, these simple habits can help you avoid a lot of trouble later. Take care of yourself—because you are worth it! If you want more easy tips, check out the full episode.

Last week, I broke down why getting testosterone replacement therapy is so tough and what you should really know if you’re thinking about it. I covered the FDA panel’s recent discussion and made it feel super clear. "This is not an enhancement. This is restoration of health and dignity."

A few really simple takeaways:

Worth a listen if you want the real talk! So listen on Apple Podcasts, Spotify, or here and see why people are commenting, “Started TRT at 53. Life changing!!!”

Think all condoms are the same for anal sex? Check out my new Substack: Condoms for Anal Sex: What You Need to Know for Safer Sex.

In this article, I explain why anal sex carries a much higher STI risk, what the FDA’s first-ever approval of a condom for anal sex really means, and how the right condom fit and lubricant choices can dramatically improve safety and comfort.