Why aren’t more people taking/ talking about Cialis?

[Gman86]

Good video going over its benefits. It’s not only a longevity drug, but can be used as a an ai, BP med, cardiovascular med, prostate med, preworkout supplement, all while giving better EQ. Seems like every male should be at least taking a low dose of this stuff, whether ur member works or not

 

[Guided_by_Voices]

Good video going over its benefits. It’s not only a longevity drug, but can be used as a an ai, BP med, cardiovascular med, prostate med, preworkout supplement, all while giving better EQ. Seems like every male should be at least taking a low dose of this stuff, whether ur member works or not

In general, people seem to be drawn toward things that seem exotic rather than the basic fundamentals.

 

[Nelson Vergel]

Because some of us can't tolerate side effects like back ache, sinus congestion, headaches, heartburn, and others that do not dissipate after 2 weeks even at 5 mg per day.

Thread 'How to Manage Tadalafil-Induced Back Pain (Cialis Side Effect)'

May 17, 2026

Curated by Nelson Vergel | ExcelMale.com | Updated June 2025

Key Takeaways • Back pain affects roughly 6-15% of men on tadalafil, primarily due to PDE11 enzyme inhibition and paraspinal fluid shifts - it is not a sign of kidney or spinal damage. • Switching from on-demand high doses (10-20 mg) to daily low doses (2.5-5 mg) reduces back pain incidence from 10-15% to 1-3%. • Morning dosing (chronotherapy) is the single easiest adjustment - keeping peak drug levels in waking hours prevents the...

• Nelson Vergel
• Cialis Back Pain Tadalafil Back Pain Tadalafil Side Effects
• Replies: 1
• Forum: When TRT Is Not Enough (ED, Libido, & More)

 

[Vince]

I'm a big fan of Viagra/ Cialis. When I first started using I did have reflex and lower back pain. Slowly over time my lower back pain improved and also my acid reflux issue improved. I no longer have acid reflux and at times I still have some back issues but it may not be from the Viagra/ Cialis.

 

[Gman86]

In general, people seem to be drawn toward things that seem exotic rather than the basic fundamentals.

That’s probably pretty accurate actually

I just always consider it an ED drug only. Had absolutely no clue it had all these other benefits until very recently

 

[FunkOdyssey]

Because some of us can't tolerate side effects like back ache, sinus congestion, headaches, heartburn, and others that do not dissipate after 2 weeks even at 5 mg per day.

This, and also the apparent cardiovascular and all-cause mortality benefits in observational studies are hugely confounded by healthy user / selection bias. In randomized trials, you see no trend towards mortality benefit (just the opposite in fact).

 

[Gman86]

This, and also the apparent cardiovascular and all-cause mortality benefits in observational studies are hugely confounded by healthy user / selection bias. In randomized trials, you see no trend towards mortality benefit (just the opposite in fact).

So ur saying in the randomized trials cialis actually decreased overall cardiovascular health/ and made overall mortality risk worse? Or at least the latter?

 

[Vince]

While RCTs showed it was perfectly safe, massive observational studies (tracking hundreds of thousands of men in real-world databases) actually associated Cialis with a significantly lower risk of cardiovascular death and overall mortality (with some studies showing up to a 44% to 55% reduction in risk).

 

[Gman86]

While RCTs showed it was perfectly safe, massive observational studies (tracking hundreds of thousands of men in real-world databases) actually associated Cialis with a significantly lower risk of cardiovascular death and overall mortality (with some studies showing up to a 44% to 55% reduction in risk).

Ya as far as I know, it improves endothelial function and reduces markers of vascular damage. As well as possibly repairing endothelial cells

 

[Vince]

You can read more about these findings in the Potential Beneficial Impacts of Tadalafil on Cardiovascular Diseases review.

 

[FunkOdyssey]

So ur saying in the randomized trials cialis actually decreased overall cardiovascular health/ and made overall mortality risk worse? Or at least the latter?

Yes, that's what it looks like. When you randomize patients to PDE5i versus no PDE5i in clinical trials, you eliminate all sources of bias and the mortality benefits disappear. Instead, you get results like these:

Randomized trial/population	PDE5 inhibitor	Main result	Mortality/safety signal
RELAX — HFpEF (n=216)	Sildenafil	No improvement in peak VO₂, 6MWD, clinical status, LV remodeling or pulmonary pressure	3/113 deaths sildenafil vs 0/103 placebo; serious AEs 22% vs 16%. Not powered for mortality. (JAMA Network)
SilHF — HFrEF + pulmonary hypertension (n=69)	Sildenafil	No improvement in symptoms, QoL, pulmonary pressure or walking distance	4/45 deaths sildenafil vs 0/24 placebo; SAEs 33% vs 21%. Mortality difference nonsignificant, P=.30. (Wiley Online Library)
PASSION — HFpEF + combined post/precapillary PH (n=125)	Tadalafil	No benefit on HF hospitalization/death composite	9/62 deaths tadalafil vs 2/63 placebo, HR 5.10 (1.10–23.69). Trial stopped early for drug-supply reasons, so this is a concerning but imprecise safety signal. (PubMed)
SIOVAC — persistent PH after corrected valvular disease (n=200)	Sildenafil	Significantly worse clinical outcomes	Worsened composite score: 33 sildenafil vs 14 placebo; survival free from HF admission worse, HR 2.0. Harm was primarily increased HF events rather than a clear mortality effect. (PubMed Central (PMC))
SIDAMI — post-MI diastolic dysfunction (n=70)	Sildenafil	Failed primary endpoint: no reduction in filling pressure; some favorable hemodynamic secondary measures	Too short/small to assess MI, stroke or mortality. (PubMed)
Diabetic cardiomyopathy (n=59)	Sildenafil	Improved MRI measures of LV strain/torsion/remodeling	Surrogate-endpoint study; not an outcomes trial. (PubMed)

These trials weren't powered to find a significant effect on mortality, but the numbers seem to be going in the wrong direction. Certainly, this is not the pattern you would expect to see if PDE5 inhibition actually produced substantial cardiovascular and overall mortality benefits.

Also, when PDE5i users were compared to alprostadil users, the PDE5 mortality benefit shrank from the 30-33% from the observational studies to 12% (PubMed). Even this study doesn't completely eliminate healthy user bias though: within the larger group of men seeking treatment for ED (healthy users), you have more healthy users (for whom PDE5i is effective) and less healthy users (men who have to resort to alprostadil because of more advanced atherosclerosis, worse endothelial function, etc).

It seems plausible that PDE5 inhibition would have some minor benefit on CVD outcomes, from at least the modest BP reduction if nothing else, but there's no good quality randomized evidence to support that currently, and the observational studies are hopelessly confounded.

 

[Gman86]

Yes, that's what it looks like. When you randomize patients to PDE5i versus no PDE5i in clinical trials, you eliminate all sources of bias and the mortality benefits disappear. Instead, you get results like these:

Randomized trial/population	PDE5 inhibitor	Main result	Mortality/safety signal
RELAX — HFpEF (n=216)	Sildenafil	No improvement in peak VO₂, 6MWD, clinical status, LV remodeling or pulmonary pressure	3/113 deaths sildenafil vs 0/103 placebo; serious AEs 22% vs 16%. Not powered for mortality. (JAMA Network)
SilHF — HFrEF + pulmonary hypertension (n=69)	Sildenafil	No improvement in symptoms, QoL, pulmonary pressure or walking distance	4/45 deaths sildenafil vs 0/24 placebo; SAEs 33% vs 21%. Mortality difference nonsignificant, P=.30. (Wiley Online Library)
PASSION — HFpEF + combined post/precapillary PH (n=125)	Tadalafil	No benefit on HF hospitalization/death composite	9/62 deaths tadalafil vs 2/63 placebo, HR 5.10 (1.10–23.69). Trial stopped early for drug-supply reasons, so this is a concerning but imprecise safety signal. (PubMed)
SIOVAC — persistent PH after corrected valvular disease (n=200)	Sildenafil	Significantly worse clinical outcomes	Worsened composite score: 33 sildenafil vs 14 placebo; survival free from HF admission worse, HR 2.0. Harm was primarily increased HF events rather than a clear mortality effect. (PubMed Central (PMC))
SIDAMI — post-MI diastolic dysfunction (n=70)	Sildenafil	Failed primary endpoint: no reduction in filling pressure; some favorable hemodynamic secondary measures	Too short/small to assess MI, stroke or mortality. (PubMed)
Diabetic cardiomyopathy (n=59)	Sildenafil	Improved MRI measures of LV strain/torsion/remodeling	Surrogate-endpoint study; not an outcomes trial. (PubMed)

These trials weren't powered to find a significant effect on mortality, but the numbers seem to be going in the wrong direction. Certainly, this is not the pattern you would expect to see if PDE5 inhibition actually produced substantial cardiovascular and overall mortality benefits.

Also, when PDE5i users were compared to alprostadil users, the PDE5 mortality benefit shrank from the 30-33% from the observational studies to 12% (PubMed). Even this study doesn't completely eliminate healthy user bias though: within the larger group of men seeking treatment for ED (healthy users), you have more healthy users (for whom PDE5i is effective) and less healthy users (men who have to resort to alprostadil because of more advanced atherosclerosis, worse endothelial function, etc).

It seems plausible that PDE5 inhibition would have some minor benefit on CVD outcomes, from at least the modest BP reduction if nothing else, but there's no good quality randomized evidence to support that currently, and the observational studies are hopelessly confounded.

Very interesting. And very logical. I was thinking that a good amount of the cardiovascular benefits have to do with the reduction in blood pressure alone.

I can’t really think of any reasons why cialis would worsen cardiovascular health, and/ or overall mortality. So between not being able to figure out a mechanism of action by which cialis could worsen cardiovascular function/ overall mortality, and knowing that a decrease in BP, from cialis, could improve cardiovascular function (assuming BP doesn’t get too low after the reduction) my gut is telling me at worst, cialis is neutral, when it comes to it’s effects on cardiovascular function/ overall mortality risk, or it has some positive benefits on both