WHAT TO TRY FIRST
The American College of Physicians recommends PDE-5 inhibitors - drugs like sildenafil (Viagra) - as first-choice treatment.
There are not enough “head-to-head” trials to know which PDE-5 drugs are most effective or safer. Higher doses may work better but have more side effects.
Choose a drug based on ease of use, cost and personal preference.
WHAT ELSE TO TRY
The American Urological Association lists a variety of treatment options for patients who do not respond to PDE-5 drugs. The following options - from the least invasive/lowest side effects to most invasive/most side effects - should be considered in a step-wise fashion:
The American College of Physicians. Hormonal testing and pharmacologic treatment of erectile dysfunction. Published July 2009.
The American Urological Association. The Management of Erectile Dysfunction. Published 2005, reviewed 2011.