Alcohol and Erectile Dysfunction: 7 Facts Men Should Know

Alcohol and erectile dysfunction are linked in two different ways. A single night of heavy drinking can temporarily make it hard to get or keep an erection, which is common and usually harmless. Long-term heavy drinking, by contrast, is tied to lasting erection problems through lower testosterone, nerve and blood vessel damage, liver disease and mood problems. The encouraging part is that erections often improve when men cut back or stop. This guide focuses on alcohol specifically; for the full list of other triggers, see our overview of erectile dysfunction causes and our erectile dysfunction treatment page.

Source: NHS — Erection problems (erectile dysfunction); Cleveland Clinic — Erectile Dysfunction (ED)

How alcohol affects erections

An erection depends on three systems working together: the brain and nerves that send arousal signals, the blood vessels that fill the penis, and hormones such as testosterone that support sexual desire. Alcohol can interfere with each of them, which is why the link between alcohol and erectile dysfunction ranges from a one-off “off night” to a long-term problem.

In the short term, alcohol and erectile dysfunction are linked because alcohol acts as a depressant on the central nervous system. Researchers studying men with alcohol dependence describe this depressant effect, along with changes in the brain chemicals GABA and glutamate, as a likely reason that drinking dulls the sexual response. The NHS states plainly that drinking too much alcohol can make getting an erection more difficult.

Source: PMC — Arackal & Benegal, Indian J Psychiatry 2007; PMC — Prabhakaran et al., Indian J Psychiatry 2018; NHS — How and when to take sildenafil

Over months and years, heavy drinking adds slower, structural damage that ties alcohol and erectile dysfunction together more firmly. Cleveland Clinic notes that alcohol and other substances can severely damage blood vessels, which may lead to permanent erectile dysfunction. Long-term heavy use has also been linked to a possibly reversible nerve damage (neuropathy), reduced testosterone production and liver disease, all of which can weaken erections.

Source: Cleveland Clinic — Erectile Dysfunction (ED); PMC — Emanuele & Emanuele, Alcohol’s Effects on Male Reproduction

There is also a psychological side to alcohol and erectile dysfunction. Some men drink to calm performance anxiety, and alcohol may ease anxiety and inhibitions at first. But researchers note that persistent, chronic use is known to cause sexual dysfunction, and anxiety, depression and relationship strain can add to the problem. If worry about performance is a big part of your experience, our guide to psychological erectile dysfunction explains how that cycle works and how it is treated.

Source: PMC — Prabhakaran et al., Indian J Psychiatry 2018

Short-term vs long-term effects of alcohol on erectile dysfunction

When looking at alcohol and erectile dysfunction, it helps to separate what happens on a single night from what builds up over years of heavy drinking. The two patterns have different causes, different outlooks and different next steps.

Sources: NHS — Erection problems (erectile dysfunction); CDC — About Alcohol Use; PubMed — Karunakaran et al., J Addict Dis 2024

The European Association of Urology (EAU) lists “excessive alcohol intake” among the drug-related causes of ED in its guidelines. That is why, when assessing alcohol and erectile dysfunction, a urologist will ask about drinking habits when assessing erection problems, alongside smoking, exercise, medicines and chronic conditions.

Source: EAU Guidelines — Management of erectile dysfunction

What research shows about drinking levels and ED

Population studies on alcohol and erectile dysfunction have produced a result that surprises many people. A 2007 meta-analysis of 11 cross-sectional studies found that regular drinkers had slightly lower odds of ED than non-drinkers (odds ratio 0.79). A 2018 dose-response meta-analysis of 24 studies with about 154,000 men found that light-to-moderate drinking (fewer than 21 drinks a week) was associated with lower odds of ED (odds ratio 0.71), while regular and high consumption showed no significant link either way.

Sources: PubMed — Cheng et al., Int J Impot Res 2007; PubMed — Wang et al., Int J Impot Res 2018

These numbers on alcohol and erectile dysfunction do not mean alcohol protects erections. Cross-sectional studies capture a single point in time, so they show association, not cause and effect. In the 2007 analysis, the two long-term cohort studies found no significant effect of alcohol on ED, the result lost significance in some sensitivity analyses, and the authors concluded that more research is needed to know whether alcohol is protective or simply unrelated.

On alcohol and erectile dysfunction, public health agencies are clear on the bigger picture. The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) says harms may be associated with any amount of drinking and that the level of harm rises as the amount consumed increases. In practice, no doctor recommends starting to drink to prevent erectile dysfunction.

Sources: PubMed — Cheng et al., Int J Impot Res 2007; NIAAA — Drinking Levels and Patterns Defined

Heavy drinking: alcohol and erectile dysfunction over time

The link between alcohol and erectile dysfunction is much clearer in men who drink heavily over long periods. Studies of men treated for alcohol dependence consistently find high rates of sexual problems, although the exact numbers vary with the population and the questionnaire used.

• NIMHANS, India (2007): among 100 men with alcohol dependence who drank an average of about 20 standard drinks a day, 72% had at least one sexual dysfunction and 33.3% reported erectile dysfunction. The amount drunk per day was the strongest predictor.
• Kerala, India (2018): among 84 men in de-addiction treatment, 36.9% had sexual dysfunction and 25% had ED. Problems were linked to the daily amount, the duration and the severity of dependence.
• Kerala, India (2024): among 203 men with alcohol use disorder, 68.5% had ED on the IIEF-5 questionnaire. ED was associated with age, diabetes, high blood pressure, and the duration and severity of drinking.

Sources: PMC — Arackal & Benegal, Indian J Psychiatry 2007; PMC — Prabhakaran et al., Indian J Psychiatry 2018; PubMed — Karunakaran et al., J Addict Dis 2024

These studies of alcohol and erectile dysfunction have limits: they were small, hospital-based and mostly lacked a non-drinking comparison group. Still, they point the same way. The more and the longer a man drinks heavily, the more likely he is to have erection problems, and other sexual problems such as premature ejaculation and low desire often appear alongside them.

Heavy drinking also damages the organs that erections depend on. The CDC links excessive alcohol use to high blood pressure, heart disease, stroke, liver disease, depression and anxiety. Each of these is itself a recognized risk factor for ED, which widens the link between alcohol and erectile dysfunction. Because ED can be the first symptom of heart disease, persistent erection problems in a heavy drinker deserve a proper medical check, not just a pill. Our article on erectile dysfunction and heart disease explains this warning sign in detail.

Sources: CDC — About Alcohol Use; Cleveland Clinic — Erectile Dysfunction (ED)

Alcohol, testosterone and sex hormones

Hormones are another link between alcohol and erectile dysfunction. Testosterone supports sexual desire and helps the erection system work properly. Alcohol affects every level of the hormone chain that controls it: the hypothalamus, the pituitary gland and the testicles themselves.

A 2024 meta-analysis in the journal Andrology pooled 21 studies (30 trials, 10,199 men). Alcohol consumption was associated with significantly lower total testosterone, lower free testosterone and higher estradiol (an estrogen). These changes were seen in healthy men exposed to chronic drinking, not after a single drinking session, which supports the idea that the hormonal side of alcohol and erectile dysfunction builds up over time.

Source: PubMed — Santi et al., Andrology 2024

An NIAAA-published review explains the mechanism. Alcohol can harm the Leydig cells in the testicles that produce testosterone, and alcohol abuse can shrink the testicles. Alcohol may also speed up the conversion of testosterone into estrogen, which may explain the raised estrogen levels and breast enlargement seen in some heavy drinkers. The review notes that these hormonal changes can result in impotence and infertility.

Source: PMC — Emanuele & Emanuele, Alcohol’s Effects on Male Reproduction

If you drink heavily and also notice low sex drive, tiredness or loss of muscle, a morning blood test can check your hormone levels. Our guide to low testosterone covers the symptoms, testing and treatment options.

Can you drink alcohol with ED pills?

Men worried about alcohol and erectile dysfunction often ask whether a drink or two will interfere with sildenafil (Viagra) or tadalafil (Cialis). The prescribing information gives a clear answer: modest amounts are usually tolerated, but heavy drinking adds risk and also works against the medicine.

Sildenafil (Viagra)

In a study in healthy volunteers, sildenafil 50 mg did not increase the blood-pressure-lowering effect of alcohol given at 0.5 g/kg, a dose that produced blood alcohol levels of about 0.08%. The largest drop in systolic blood pressure was -18.5 mmHg with the combination versus -17.4 mmHg with alcohol alone. However, the NHS advises avoiding drinking too much while taking sildenafil, because alcohol itself makes getting an erection more difficult.

Sources: DailyMed — VIAGRA (sildenafil citrate) prescribing information; NHS — How and when to take sildenafil

Tadalafil (Cialis)

The Cialis label explains that both alcohol and tadalafil are mild vasodilators (they widen blood vessels), so together they can lower blood pressure more. It warns that substantial drinking, for example 5 units or more, combined with Cialis can increase dizziness, headache, a faster heart rate and a fall in blood pressure on standing. In studies where men drank about 6 ounces of 80-proof vodka (0.7 g/kg) within 10 minutes, more men had clinically significant blood pressure drops on the combination than on alcohol alone. At a lower dose (0.6 g/kg), no orthostatic hypotension was seen.

Source: DailyMed — CIALIS (tadalafil) prescribing information

The practical message on alcohol and erectile dysfunction pills is simple: keep drinking light on nights you plan to use an ED pill, stand up slowly if you feel lightheaded, and tell your doctor about your usual alcohol intake when ED medicine is prescribed. Never combine any ED pill with nitrate medicines for chest pain.

Source: DailyMed — CIALIS (tadalafil) prescribing information

Can alcohol and erectile dysfunction damage be reversed?

For many men, much of the damage from alcohol and erectile dysfunction is reversible. A prospective study in the Journal of Sexual Medicine followed 104 men with alcohol use disorder and ED. After 3 months of abstinence, 88.5% showed improvement in erectile function on the IIEF-5 questionnaire. Recovery was better in younger men, in men without alcoholic liver disease, and in those who had drunk for a shorter time and fewer drinks per day.

Source: PubMed — Karunakaran & Michael, J Sex Med 2022

Improvement can start early. In the 2024 study of 203 men, erectile function had already improved significantly after just one month without alcohol. Earlier researchers also described alcohol-related sexual dysfunction as largely reversible with abstinence. The authors suggest that knowing ED can improve may motivate men during alcohol treatment.

Sources: PubMed — Karunakaran et al., J Addict Dis 2024; PMC — Arackal & Benegal, Indian J Psychiatry 2007

Recovery from alcohol and erectile dysfunction is not certain for everyone. Where years of drinking have damaged blood vessels or the liver, or where diabetes or high blood pressure are also present, ED may persist. EAU guidelines recommend starting lifestyle changes before or at the same time as specific ED treatment, so cutting back on alcohol and getting effective treatment can go hand in hand.

Sources: Cleveland Clinic — Erectile Dysfunction (ED); EAU Guidelines — Management of erectile dysfunction

How much alcohol is too much for sexual health?

There is no proven “safe” number of drinks for erections, and tolerance varies between men. The most useful guide to alcohol and erectile dysfunction risk is general low-risk drinking advice, which also protects the heart, liver and hormones that erections rely on.

• UK guidance: the NHS advises men and women not to drink more than 14 units a week on a regular basis, spread over 3 or more days, with several drink-free days.
• What a unit is: one UK unit is 10 ml or 8 g of pure alcohol. A 175 ml glass of 12% wine is 2.1 units, a pint of 5.2% beer is about 3 units, and a 25 ml shot of 40% spirit is 1 unit.
• US definitions: a US standard drink contains 14 g of alcohol. NIAAA defines heavy drinking for men as 5 or more drinks on any day or 15 or more per week, and binge drinking as about 5 drinks for men within roughly 2 hours.
• No truly safe level: the NHS notes that the less you drink, the lower your risk.

Sources: NHS — Calculating alcohol units; NHS — The risks of drinking too much; NIAAA — Drinking Levels and Patterns Defined

Because a US standard drink (14 g) holds more alcohol than a UK unit (8 g), 14 UK units a week is roughly 8 US standard drinks. Alongside drinking less, the NHS suggests other steps that support erections: losing weight if you are overweight, stopping smoking, eating a balanced diet, exercising and reducing stress. Together, these changes address both alcohol and erectile dysfunction risk factors at the same time.

Sources: NHS — Calculating alcohol units; NHS — Erection problems (erectile dysfunction)

When to see a doctor

With alcohol and erectile dysfunction, an occasional problem after a heavy night does not need medical attention. Book an appointment with a doctor or urologist if any of the following apply:

• Erection problems keep happening, including on days when you have not been drinking.
• You have ED and risk factors for heart disease, such as high blood pressure, high cholesterol, diabetes or smoking, because ED can be the first symptom of heart disease.
• You notice low sex drive, shrinking testicles or breast enlargement, which can point to hormone changes from heavy drinking.
• You feel dizzy or faint after combining an ED pill with alcohol.
• You find it hard to cut down on drinking. A GP or an alcohol support service can help, and severe withdrawal symptoms need emergency care.

Sources: NHS — Erection problems (erectile dysfunction); NHS — Alcohol-use disorder; Cleveland Clinic — Erectile Dysfunction (ED)

A good assessment of alcohol and erectile dysfunction looks at the whole picture: drinking pattern, medicines, blood pressure, blood sugar, cholesterol and hormones. Our page on the erectile dysfunction test explains what these checks involve.

If erection problems continue even after you cut back on alcohol, you can arrange a confidential consultation with our urologist-andrologist on WhatsApp. He can assess the cause and discuss the options on our erectile dysfunction treatment page.

FAQs about alcohol and erectile dysfunction

Can alcohol cause permanent erectile dysfunction?

It can. Cleveland Clinic warns that alcohol and other substances can severely damage blood vessels, which may lead to permanent ED. Many men with alcohol and erectile dysfunction improve when they stop drinking, though: in one study, 88.5% of men with alcohol use disorder showed better erections after 3 months of abstinence. Older age, liver disease and longer, heavier drinking made recovery less likely.

Sources: Cleveland Clinic — Erectile Dysfunction (ED); PubMed — Karunakaran & Michael, J Sex Med 2022

Is it normal to lose an erection after drinking?

Yes. The NHS lists drinking too much alcohol as one of the usual reasons for occasional erection problems, alongside stress and tiredness, and says this is nothing to worry about. This short-term form of alcohol and erectile dysfunction happens because alcohol slows down the nervous system, so arousal signals are weaker. If the problem keeps happening when you are sober, see a doctor, because it may signal a treatable health condition.

Source: NHS — Erection problems (erectile dysfunction)

Does moderate drinking improve erections?

Not in any proven way, based on research into alcohol and erectile dysfunction. Some cross-sectional studies found slightly lower odds of ED in light-to-moderate drinkers, but such studies cannot show cause and effect, and long-term cohort studies found no significant link. NIAAA says harms may be associated with any amount of drinking, so starting to drink to protect your erections is not recommended.

Sources: PubMed — Wang et al., Int J Impot Res 2018; NIAAA — Drinking Levels and Patterns Defined

Is it safe to take Viagra or Cialis after a few drinks?

When it comes to alcohol and erectile dysfunction pills, a small amount is generally tolerated. In a label study, sildenafil 50 mg did not add to alcohol’s blood-pressure-lowering effect at a blood alcohol level of about 0.08%. The Cialis label warns that 5 or more units of alcohol can increase dizziness and blood pressure drops on standing. Heavy drinking also weakens the erection the pill is meant to support.

Sources: DailyMed — VIAGRA (sildenafil citrate) prescribing information; DailyMed — CIALIS (tadalafil) prescribing information

How long after quitting alcohol do erections improve?

Studies of alcohol and erectile dysfunction in men with alcohol use disorder suggest improvement can begin within weeks. One study of 203 men found significant improvement after one month of abstinence, and another of 104 men found that 88.5% had improved by 3 months. Men who were younger and had no alcoholic liver disease tended to recover better. If ED persists, other causes should be checked.

Sources: PubMed — Karunakaran et al., J Addict Dis 2024; PubMed — Karunakaran & Michael, J Sex Med 2022

Does alcohol lower testosterone?

Chronic drinking appears to, which is one hormonal link between alcohol and erectile dysfunction. A 2024 meta-analysis of 21 studies with 10,199 men linked alcohol consumption to lower total and free testosterone and higher estradiol in healthy men who drank regularly over time, but not after a single drinking session. An NIAAA-published review adds that alcohol can damage the testosterone-producing Leydig cells in the testicles.

Sources: PubMed — Santi et al., Andrology 2024; PMC — Emanuele & Emanuele, Alcohol’s Effects on Male Reproduction

Does the type of drink matter, such as beer, wine or whiskey?

The studies on alcohol and erectile dysfunction measured how much alcohol men drank, not which drink they chose. What matters is the amount of pure alcohol, which depends on the strength and size of the drink. The NHS counts this in units: a pint of strong beer is about 3 units, a standard 175 ml glass of 12% wine 2.1 units, and a single spirit shot 1 unit.

Source: NHS — Calculating alcohol units

Can alcohol cause premature ejaculation or other sexual problems?

Yes. Alcohol and erectile dysfunction often come with other sexual problems. In a study of 100 men with alcohol dependence, premature ejaculation was the most common problem (37.5%), followed by low sexual desire (36%) and erectile dysfunction (33.3%). Another study of 84 men found orgasm problems in 20% and premature ejaculation in 15.5%. In both, problems were more common in men who drank more each day.

Sources: PMC — Arackal & Benegal, Indian J Psychiatry 2007; PMC — Prabhakaran et al., Indian J Psychiatry 2018