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For a man with low T, the ideal approach is to correct the deficiency (with TRT or other means) and then, if needed, add PT-141 to further boost libido/erections

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Whereas a PDE5 inhibitor, such as Viagra, has a vascular mechanism of action, PT-141 appears instead to act on the central nervous system specifically on the hypothalamus, which plays a key role in regulating erectile function.6 Further distinguishing it from the Viagra type is that it may initiate erections without visual sexual stimulation.7 To date, one of the most compelling studies on PT-141s efficacy for ED is a randomized, double-blind, and placebo-controlled trial published in the Journal of Urology in 2008, which involved 342 married men with ED who were nonresponsive to sildenafil (generic for Viagra)

But these injections are currently illegal to buy in the United States and are linked to potentially serious side effects

In its approved population, bremelanotide has been studied for improvement in desire-domain measures and reduction in distress from low desire