If you’re one of the 30 million men in the United States experiencing erectile dysfunction (ED), you’ve probably heard of nitroglycerin gels. And you're probably wondering where to get them.
Unlike the little blue pills—which often require hours to work and have to be taken on an empty stomach—topical nitroglycerin gels and creams are rubbed directly onto the penis and begin working within minutes. “Nitro gels make sense because they’re more powerful than pills and can be applied right to where you need them to work,” says New York-based urologist Elizabeth Kavaler, MD, a Men’s Health advisor.
Nitroglycerin gels stimulate erections by dilating blood vessels, allowing for more blood to enter the penis. Nitroglycerin also releases nitric oxide, a compound that acts as a neurotransmitter that activates the nerves, helps relax the smooth muscle cells, and reduces the “outflow” of blood from the penis. In other words, the gel helps you get hard and stay hard. Nitroglycerin has been used as an active ingredient in many medications for more than a century, most often to treat high blood pressure and chest pain, but scientists have begun to study the chemical’s effectiveness for treating ED.
According to research published in the Journal of Sexual Medicine, 232 men with erectile dysfunction participated in two separate, four-week trials. In one, they used a topical gel containing 0.2 percent glyceryl trinitrate, or nitroglycerin, before sex. In the other, they used a placebo gel. In each trial, they rubbed a pea-sized amount of the gel onto the head of the penis right before sex.
Nearly 1 in 4 guys reported a significant improvement in their sexual functioning score—a number that includes measures like hardness of erections, satisfaction with sex, and amount of confidence in getting and maintaining an erection—after using the nitroglycerin gel, compared to just 14 percent of men using the placebo gel.
In addition, the nitroglycerin gel worked quickly. Seventy percent of men noticed the start of an erection within 10 minutes; 44 percent within five minutes or less. That’s a lot faster than oral ED drugs. In fact, if you’re taking Viagra or Cialis, it takes about an hour for the drugs to reach their peak effectiveness in your system to a point where you can get busy, Jacob Rajfer, MD, professor of urology at the David Geffen School of Medicine at UCLA told us previously.
Where to get nitroglycerin gel
Despite these promising results, nitroglycerin gel hasn’t yet been approved by the Food and Drug Administration to treat ED. Dr. Kavaler says more studies are needed to determine how the gels can be used safely. Nitroglycerin comes in different strengths and usually wears off within just a few minutes, which can lead to overdosing. “The last thing you want is an erection that doesn’t go away,” she says.
Still, some nitroglycerin gels are available with a prescription for medical conditions other than ED. For example, Rectiv is a topical hemorrhoid cream that’s 0.4 percent nitroglycerin (that’s twice as strong as the gels studied for erectile dysfunction). Larry Lipshultz, MD, Men’s Health advisor and a professor of urology at Baylor College of Medicine, says some doctors might be willing to prescribe it for “off label” use. But the penis is a tricky place for experimentation and Dr. Lipshultz cautions that any off-label nitroglycerin use should be strictly supervised by a doctor.
Like any med, the gels have their share of side effects. “Nitroglycerin medications can result in a sudden and serious loss of blood pressure,” says Adam B. Murphy, MD, a professor of urology at Northwestern University’s Feinberg School of Medicine. Men with heart disease or low-blood pressure shouldn’t use them. Other serious side effects include methemoglobinemia, which can lead to seizures, cyanosis, and heart arrythmias, as well as bleeding and dermatitis on the penis. And because nitroglycerin gels are applied topically, the side effects may be transferred to your partner, too. If you’re insistent on trying it, it’s wise to first grease up a toe or a finger to see how it reacts. When you move to the junkyard, start with the base, where the penis isn’t as sensitive.
Until the FDA gives nitroglycerin gels the green light, Dr. Kavaler says traditional PDE5 inhibitors, such as Viagra and Cialis, are still the best bet for combatting ED. Sildenafil, the generic version of the drug, has made ED medication more affordable while companies such as Hims and Roman offer telehealth appointments with healthcare providers and will ship the pills right to your mailbox. Suppositories, such as Muse, which are inserted into the urethra, as well as vacuum erectile devices, constriction bands, and surgical implants can be effective remedies for men with more severe erectile dysfunctions or with medical conditions that keep them from stomaching the pills.
Dr. Kavaler adds that the Covid-19 pandemic has taken its toll in the sheets (see how the disease itself can affect ED) and for younger men, erectile troubles often boil down to issues of psychology and lifestyle. “So many guys are stuck at home, eating and drinking too much, and watching porn instead of going on dates,” she says. She recommends cutting back on substances, upping the reps in the gym, and practicing visualization (without the help of the computer). Paying attention to what goes into your body—and what goes on in your head—can help keep your erection strong.