Just to clarify my position, I haven’t taken any PDE5i myself and have no interest in using it in the future, so I’m looking at this purely from an objective perspective.
There’s actually an interesting paradox here: hearing loss is linked to an increased risk of AD, yet some studies show that PDE5i might actually reduce AD risk. Looking at all the medical databases currently available, I believe hearing loss is a low-probability event that can be effectively managed and prevented with regular hearing tests.
Subjective tinnitus was not “nocebo”. It was so loud that I had trouble falling asleep towards the end (when I was at 0.4mg). Stopped completely about 48h after my last dose. Rechallenge - same thing.
Tinnitus or cochlear stress is not something a hearing test would pick up. Conventional hearing tests are not very sensitive.
It is a pity I do not tolerate PDE5is as they are amazing drugs. But subtle progressive hearing damage from these drugs is probably more common than most people think - that does not make it common but still something to pay attention to.
A friend who has been taking 2.5mg for 2 years has an audiogram that is 10 years his senior. Sure, could be many other things. Also Bryan Johnsons hearing got more shitty in the last 4 years. Sure, could be other things. Reddit anecdotes of people getting tinnitus from PDE5 inhibitors
BJ’s hearing actually got better overall! The black dots are from 2022, while the red dots and black X’s are from 2025. So his right ear hearing improved significantly, while his left ear only showed a slight decline.
Overall, significant visual disturbances linked to tadalafil affect a very small fraction of users—large pharmacovigilance databases estimate the incidence rate of reported visual disturbances at approximately 0.02% .
Alabama Department of Senior Services (.gov)
Minor Visual Changes: Temporary side effects such as blurred vision, increased sensitivity to light, or a slight blue/green tinge to vision are recognized side effects of PDE5 inhibitors. While older drugs like sildenafil (Viagra) saw these minor changes in up to 10% of users at high doses, they are significantly less common with tadalafil.
PMC - NIH
NAION (Sudden Vision Loss): Non-arteritic anterior ischemic optic neuropathy (NAION) is a severe condition that causes sudden, painless vision loss in one or both eyes. It is extremely rare. The background rate for NAION in the general population over age 50 is roughly 0.002% to 0.01% (1 in 50,000 to 1 in 10,000 people). While it is listed as a serious warning for all PDE5 inhibitors, it is not yet fully clear if the medication directly increases this risk above the natural background rate for older men.
PMC - NIH
Tinnitus and Hearing Problems
Hearing-related side effects are slightly more common than visual ones, but they still affect a very small minority of patients.
Tinnitus: In clinical trials, tinnitus (ringing in the ears) is classified as an “uncommon” side effect, occurring in 0.1% to 1% (1 in 1,000 to 1 in 100) of users.
Sudden Hearing Loss: Cases of sudden decrease or loss of hearing (sometimes accompanied by dizziness and tinnitus) have been reported. Large database tracking estimates the rate of serious auditory symptoms at roughly 0.03% .
PrescriberPoint+ 1
Important Safety Note: If you experience sudden vision loss, a sudden decrease in hearing, or severe ringing in the ears while taking tadalafil, the FDA strictly advises that you stop taking the medication immediately and seek prompt medical attention.
PMC - NIH Does the tinnitus disappear on stopping tadalafil?
In most cases, yes. If tadalafil is the direct cause of the tinnitus, the ringing typically resolves on its own once the medication is stopped and fully clears from the body.
However, there are two important factors regarding how and when it resolves:
The “Washout” Period: Tadalafil is sometimes called the “weekend pill” because it has a very long half-life (about 17.5 hours). It can take 3 to 4 days for the medication to completely leave your bloodstream. Because of this, the tinnitus may not disappear the exact day you stop taking the pill; instead, it should gradually fade over a few days.
