It's both, but there is a very real effect from PT 141 that is unlike what you get from viagra or cialis. The way I've explained it to people, viagra and cialis give you the ability when you're in the middle of stimulation, whereas PT 141 does that but also brings you back to your teen years where you randomly get a hard on for no reason. Just sitting there watching TV hard on, walking through the grocery store with your wife hard on, etc. Thinking about banging your wife/girlfriend hard on? Yes, certainly and by far. The quality of erection with PT 141 is also superior to using viagra or cialis. For a really good time, take a viagra or cialis and also do a shot of pt141, they don't interact with each other in a negative way, your wife/girlfriend will be exceptionally happy, and very tired. Another thing you could add in to the mix, but do your own research, is cabergoline. Caber is a dopamne agonist and it decreases prolactin levels, and prolactin level is related to how long of a refractory period you have after an orgasm. After orgasm your prolactin levels spike very significantly which is a big part of the reason you have a refractory period at all. Using cabergoline to reduce prolactin levels thus decreases refractory period, thus you can be back at it sooner than you would otherwise. As it is also a dopamine agonist cabergoline can affect mood in a positive way which can ALSO affect how you're feeling about yourself and sex in general. BUT. . . if you do this you're messing with hormone levels and that's not something to take lightly.