Cialis in Bodybuilding
A Comprehensive Medical and Performance Perspective
By Dr. Alexander Reynolds, MD, CSCS – Sports Medicine Specialist & Performance Consultant
Introduction
As a sports medicine physician and performance consultant working with elite bodybuilders, I am frequently asked about the use of prescription medications in the context of training, recovery, and competition preparation. One of the most commonly inquired-about drugs is Tadalafil, better known by its brand name Cialis. While Cialis is FDA-approved for the treatment of erectile dysfunction (ED) and benign prostatic hyperplasia (BPH), its off-label use among bodybuilders has grown significantly over the past decade.
It is important to emphasize that I do not advocate or endorse the misuse of prescription medications. However, my responsibility as a physician is to provide accurate, evidence-based information so that athletes can make informed decisions—especially when they are already exposed to or considering such compounds.
This article provides a comprehensive overview of Cialis: its history, pharmacology, potential benefits, risks, and its role—real and perceived—in the world of professional bodybuilding. We’ll also examine how it may interact with anabolic cycles, training regimens, and nutritional strategies.
The History and Development of Cialis
Cialis (tadalafil) was developed by Lilly ICOS LLC, a joint venture between Eli Lilly and Company and ICOS Corporation. It was first approved by the U.S. Food and Drug Administration (FDA) in 2003 for the treatment of erectile dysfunction. Unlike sildenafil (Viagra), which has a shorter half-life (~4 hours), tadalafil’s extended duration of action—up to 36 hours—earned it the nickname “the weekend pill.”
Tadalafil is a phosphodiesterase type 5 (PDE5) inhibitor, meaning it enhances the effects of nitric oxide (NO), a natural chemical your body produces that relaxes smooth muscles in the blood vessels of the penis, increasing blood flow and facilitating erections in response to sexual stimulation.
Over time, research has revealed that PDE5 inhibition affects more than just penile tissue. These broader physiological effects—particularly on vascular function, oxygen delivery, and muscle perfusion—have led to interest in tadalafil’s potential performance-enhancing and recovery-supporting roles in athletic populations, especially bodybuilders.
Positive Effects of Cialis on the Body
While Cialis is not a performance-enhancing drug in the traditional sense (like anabolic steroids or stimulants), several of its physiological actions are of interest to bodybuilders:
1. Enhanced Blood Flow and Muscle Pumps
One of the most sought-after effects by bodybuilders is the “pump”—the temporary engorgement of muscle tissue with blood during training. Tadalafil promotes vasodilation via increased nitric oxide signaling, leading to improved microcirculation. This can result in:
More pronounced muscle fullness and vascularity during workouts
Enhanced nutrient delivery to working muscles
Improved waste product (e.g., lactate) clearance
While the pump is largely aesthetic, some athletes report that better perfusion contributes to a more productive training session and reduced perceived fatigue.
2. Improved Recovery via Vascular Support
During intense training, muscle tissue undergoes microtrauma. Efficient delivery of oxygen and nutrients is critical for repair and hypertrophy. Tadalafil may support recovery by:
Increasing capillary density and perfusion in skeletal muscle
Reducing exercise-induced ischemia (oxygen shortage)
Supporting mitochondrial biogenesis through NO-mediated pathways
A 2015 study in The Journal of Physiology found that PDE5 inhibitors improved exercise capacity in healthy individuals by enhancing oxygen utilization and endothelial function.
3. Potential Anti-Fibrotic Effects
Some preclinical studies suggest that tadalafil may reduce fibrosis in cardiac and skeletal muscle tissue. In bodybuilders using anabolic-androgenic steroids (AAS), especially long-term or at high doses, cardiac fibrosis and pulmonary hypertension are serious concerns. While not a treatment, tadalafil’s ability to modulate fibrotic pathways via cGMP signaling has led to experimental use in mitigating steroid-induced organ stress.
4. Pulmonary and Cardiovascular Support
Bodybuilders, particularly those using compounds like trenbolone or high-dose testosterone, often report symptoms of exercise-induced pulmonary hypertension or shortness of breath. Tadalafil is FDA-approved for pulmonary arterial hypertension (PAH) under the brand name Adcirca (same active ingredient, different dosing). By relaxing pulmonary vasculature, it may reduce right ventricular strain during intense exertion.
5. Mood and Libido Support During Post-Cycle Therapy (PCT)
After discontinuing anabolic steroids, many bodybuilders experience suppressed testosterone, leading to ED, low libido, and depression. While Cialis does not restore endogenous testosterone, it can help maintain sexual function during PCT, improving psychological well-being and adherence to recovery protocols.
Negative Side Effects and Risks
Despite its benefits, Cialis is not without risks—especially when used chronically, at high doses, or in combination with other substances common in bodybuilding.
Common Side Effects:
Headache (due to vasodilation)
Facial flushing
Nasal congestion
Indigestion or acid reflux
Back pain and muscle aches (especially at higher doses)
Dizziness
These are usually mild and transient but can impair training focus or sleep quality.
Serious Risks:
Hypotension: When combined with nitrates (e.g., nitroglycerin) or recreational drugs like poppers (amyl nitrite), tadalafil can cause a dangerous drop in blood pressure. This is a life-threatening interaction.
Priapism: A prolonged, painful erection lasting more than 4 hours. Though rare, it requires emergency treatment to prevent tissue damage.
Sudden Hearing or Vision Loss: Rare cases of non-arteritic anterior ischemic optic neuropathy (NAION) have been reported. Those with pre-existing risk factors (e.g., diabetes, hypertension, small optic cups) should be cautious.
Cardiovascular Strain: In individuals with undiagnosed heart disease, increased physical exertion combined with vasodilation can increase cardiac workload.
Long-Term Use Concerns:
Tolerance Development: Some users report diminished effects over time, potentially requiring higher doses.
Endothelial Downregulation: Chronic PDE5 inhibition might theoretically reduce natural NO production, though human evidence is lacking.
Psychological Dependence: Relying on medication for sexual function can impact confidence and natural arousal pathways.
Why Is Cialis Sought After by Bodybuilders?
Bodybuilders are not typically using Cialis solely for erectile function. Its appeal lies in several performance-adjacent benefits:
Enhanced Vascularity and Aesthetics
On stage, vascularity is prized. Tadalafil’s vasodilatory effects can accentuate superficial veins, especially when combined with low body fat and proper lighting.
Training “Feel” and Pump Quality
Many report a more intense, sustained pump, which can improve mind-muscle connection and training motivation.
Recovery and Endurance Support
Improved circulation may reduce muscle soreness and speed up recovery between sets or workouts.
Mitigation of Steroid Side Effects
As mentioned, some use it to counteract pulmonary or cardiovascular strain from certain AAS, especially trenbolone or high-dose testosterone.
Use During PCT to maintain sexual function while waiting for HPTA (hypothalamic-pituitary-testicular axis) recovery.
Off-Label Use for Altitude or Air Travel
Some bodybuilders use it prophylactically during travel to reduce the risk of high-altitude pulmonary edema (HAPE), especially when flying to competitions at elevation.
Proper Usage: Dosing and Timing
Cialis is available in multiple formulations:
As-needed: 10 mg or 20 mg, taken 30–60 minutes before sexual activity.
Daily use: 2.5 mg or 5 mg, for continuous effect (approved for ED and BPH).
For bodybuilders, the low-dose daily protocol (2.5–5 mg) is most common. This maintains steady plasma levels, supports vascular tone, and avoids the peaks and troughs of on-demand dosing.
Recommended Guidelines:
Dose: 2.5–5 mg daily, preferably in the morning.
Cycle Length: 4–8 weeks, aligned with training or competition phases.
Avoid High Doses: 10–20 mg daily increases side effect risk without added benefit for performance.
Avoid Alcohol and Nitrates: Both potentiate hypotension.
Monitor Blood Pressure: Especially if using stimulants, diuretics, or AAS.
Important: Never combine Cialis with poppers (alkyl nitrites)—this combination has caused fatalities.
Use in Bodybuilding Cycles: With or Without Other Compounds
Cialis is typically used as an adjunct, not a core performance compound. Here’s how it fits into common cycles:
1. During Bulking Phases
Often unnecessary unless using compounds that impair vascular function (e.g., trenbolone).
May help with nutrient delivery but is not a growth agent.
2. During Cutting and Pre-Contest Phases
Most beneficial period due to:
Low body fat enhancing vascularity
High training volume increasing pump demand
Use of diuretics, which can impair circulation
Can counteract diuretic-induced cramping and poor perfusion.
3. With Anabolic Steroids
Trenbolone Users: Frequently report improved breathing and reduced “tren cough” with tadalafil.
Testosterone-Only Cycles: Less need, unless ED is present.
Post-Cycle Therapy (PCT): Can be used alongside SERMs (e.g., clomiphene, tamoxifen) to support sexual function while natural testosterone recovers.
4. With Other PEDs
SARMs, Peptides, Growth Hormone: No significant interactions, but additive vasodilation may increase hypotension risk.
Stimulants (e.g., clenbuterol, ephedrine): Opposing effects on blood pressure—monitor closely.
Nutrition While Using Cialis in a Cycle
While Cialis does not directly affect metabolism, optimal nutrition enhances its vascular benefits and minimizes side effects.
Key Nutritional Strategies:
Nitric Oxide-Boosting Foods
Synergize with tadalafil by supporting endogenous NO production:
Beets, spinach, arugula (high in dietary nitrates)
Citrulline-rich foods: watermelon, cucumbers
Garlic (contains allicin, which supports endothelial function)
Hydration
Dehydration increases the risk of dizziness and muscle cramps. Aim for 1 gallon (3.8 L) of water daily, especially during cutting.
Electrolyte Balance
Critical when using diuretics or training in heat. Ensure adequate sodium, potassium, magnesium, and calcium to prevent cramping and arrhythmias.
Avoid Heavy Fatty Meals with Dosing
High-fat meals can delay tadalafil absorption. Take on an empty stomach or with light food.
Limit Alcohol
Alcohol is a vasodilator and diuretic—combining it with Cialis increases the risk of hypotension, flushing, and dehydration.
Liver Support
Though tadalafil is metabolized by the liver (CYP3A4), it is not hepatotoxic. However, bodybuilders using multiple oral compounds should consider milk thistle or NAC for liver protection.
Additional Considerations
1. Drug Testing
Cialis is not a banned substance by the World Anti-Doping Agency (WADA) or major natural bodybuilding federations. However, professional bodybuilders in tested organizations should verify with their sanctioning body.
2. Natural Alternatives
For athletes seeking pump and vascular support without prescription drugs:
L-Citrulline (6–8 g/day): Converts to arginine, boosting NO.
Beetroot Juice: Proven to enhance endurance and vasodilation.
Pycnogenol or French Maritime Pine Bark Extract: Improves endothelial function.
Agmatine Sulfate: May enhance NO and insulin sensitivity.
3. Monitoring and Medical Oversight
I strongly recommend:
Baseline blood pressure and cardiovascular screening before use
Annual echocardiograms for long-term AAS users
Avoidance in those with:
History of heart attack or stroke
Retinitis pigmentosa
Severe liver or kidney disease
4. Psychological Aspects
Relying on medication for performance or aesthetics can create dependency. Encourage athletes to assess whether they’re using Cialis for medical need or psychological comfort.
Final Thoughts: A Tool, Not a Solution
Cialis is a well-studied, generally safe medication when used appropriately. In the context of bodybuilding, it can offer meaningful supportive benefits—especially for vascular function, recovery, and quality of life during PCT. However, it is not a muscle-building agent, nor should it be viewed as a shortcut to aesthetics or performance.
As a physician, my advice is clear:
Use only under medical supervision
Avoid high doses and long-term daily use without breaks
Prioritize natural methods of enhancing circulation and recovery
Address the root causes of ED or fatigue, not just the symptoms
Bodybuilding is as much about longevity and health as it is about size and symmetry. Any compound—prescription or otherwise—should serve that greater goal.
If you’re considering Cialis as part of your regimen, consult your physician. Your heart, your hormones, and your future self will thank you.