: While it helps with blood flow, it may not make sex feel more pleasurable, and some users on HRT report that erections feel different than they did before transition.

: Some individuals prefer Cialis (tadalafil) because it remains active in the system for up to 36 hours, providing a larger "window" of effectiveness compared to Viagra's 4-hour window. Medical Considerations Overview of feminizing hormone therapy

: Viagra is a PDE5 inhibitor that increases blood flow to the erectile tissues. It does not increase testosterone levels, so it will not interfere with the feminizing effects of HRT.

: Some trans women wish to maintain erectile function for penetrative sex with partners or to prevent tissue atrophy (shrinkage) if they are planning for future gender-affirming surgeries.