What NPR found. Tadalafil is one of the most commonly prescribed erectile dysfunction drugs. Online clinics and prominent longevity figures now market it well past that indication, as something that protects the cardiovascular system and the brain and improves athletic performance. Dr. Jenell Decker, a medical director at one of the clinics NPR spoke to, said she considered the data strong enough to offer it to men and women over 40.
The study everyone is pointing at. Jehle and colleagues published an analysis in the American Journal of Medicine in 2025 using the TriNetX records database. They looked at men aged 40 and over who were prescribed tadalafil or sildenafil after an erectile dysfunction diagnosis, or tadalafil after a lower urinary tract symptom diagnosis, between 2004 and 2021. After propensity matching on demographics and eight pre-existing conditions, the erectile dysfunction cohort held 509,788 men and the urinary symptom cohort 1,075,908.
The numbers are large, and they are associations. Among men with erectile dysfunction, tadalafil was associated with a relative risk of 0.66 for all-cause mortality, 0.73 for myocardial infarction, 0.66 for stroke and 0.68 for dementia. Sildenafil showed a smaller association across the same outcomes. Those are the figures driving the marketing.
Every man in that analysis had a diagnosis and a prescription. Nobody in it was a healthy 45-year-old buying tadalafil from a website for longevity. An association measured in men being treated for erectile dysfunction or urinary symptoms is a statement about those men. Carrying it over to a different population, at a different dose, for a different reason, is an assumption rather than a finding.
Propensity matching is not randomisation. It balances the variables the researchers measured. It cannot balance the ones they did not, and men who seek out and fill an ED prescription differ from men who do not in ways that records do not capture. A randomised trial is what settles that question, and none has been run for this purpose. Dr. Steve Nissen, chief academic officer of the Cleveland Clinic Heart, Vascular and Thoracic Institute, put the caution plainly to NPR: "Absence of evidence of harms doesn't mean there isn't harm."
The risk being marketed is one you can already measure. The pitch is cardiovascular and metabolic protection. Those risks have markers that sit on ordinary panels and respond to change: LDL cholesterol and ApoB, triglycerides, HbA1c, fasting insulin, hs-CRP, blood pressure. Knowing where yours sit is the part that holds whatever anyone decides about a drug, because it gives you a baseline and something to re-test against.
The cardiovascular risk this drug is marketed against shows up on a panel you can already order. See how to read a lipid panel for what those numbers mean, and what hs-CRP measures for the inflammation side of the same picture.