What's the Best ED Treatment in 2023?

At Innerbody Research, we extensively test each health service we review, including ED medication services, whenever possible. All told, our team has collectively spent over 1100 hours researching erectile dysfunction, its potential treatments, and the companies offering them.

Our team has considered over 100 clinical studies related to erectile dysfunction and its treatments. We’ve heard from men who rely on them and women whose partners require them. To get as clear a picture of the market landscape as possible, we’ve completed the consultation and ordering process for all of the top online ED medication providers. We’ve spoken with primary care physicians and urologists. And, like all health-related content on this website, this guide was thoroughly vetted by one or more members of our Medical Review Board for accuracy. We’ll continue to monitor developments among these providers and in the broader landscape of ED treatment.

Over the past two decades, Innerbody Research has helped tens of millions of people make more informed decisions about staying healthy and living healthier lifestyles.

Each of the treatments we cover in this guide will work for most men with ED. Some men may need higher doses than others, and it might take some time to arrive at the dose that maximizes efficacy while maintaining a low risk of side effects.

We focus here on what most men would need to consider before investing in medication for erectile dysfunction. When you look at what these pills offer and how you need to take them, dose timing becomes an important factor. It’s less a matter of better or worse and more a matter of preference, but there is one type that’s likely to please more users than others, and research supports this position. Combined with cost, safety, and medication format, we have a set of fundamental factors that form our overall value assessment of each medication type.

While sildenafil is often the least expensive option, our evaluation led us to prefer tadalafil over other medication types. Its available doses are similarly flexible to sildenafil’s, but the dose timing — taking it as needed and having it work for up to 36 hours — is preferable for many men who’d rather not try to predict precisely when sex will happen. There are some caveats, and one medicine might work better for you than another. Both are highly effective, but tadalafil is likely a solid place for most men to start.

Winner: Tadalafil

Some ED treatments are effective within a specific time window after you swallow a pill and require a short wait before they become effective. Others give you more leeway to forget about timing altogether. Are you somebody who will be irritated by a certain amount of planning for sex? For some people, this can be a mood-killer, while other men don’t mind, especially those who don’t like the idea of taking a daily pill for occasional sex.

Ultimately, we prefer tadalafil for dose timing because you can take a daily dose to ensure you’re ready at any time or take one pill within 24-36 hours of any anticipated intercourse. So, if you don’t want to take a daily pill but have a date at night, you can take tadalafil sometime that day and see reliable effects well into the next day. And since tadalafil is active in the system well within an hour, you can still use it in cases of spontaneous sex and not have to wait too long for it to kick in.

Here’s a quick visual comparison of ED medication dose timing:

And if this sounds like the right path to try first, BlueChew is the best way to try it out. As long as you’re a suitable candidate to try PDE-5 inhibitors like tadalafil and sildenafil, you can get several doses for free from BlueChew to see how well they work for you; you only pay the few dollars for shipping.

Winner: Sildenafil

Most insurance, including government insurance like Medicare, won’t cover the costs of ED medication, so it’s essential to consider your available budget. Prescription ED medications vary in price, and in most cases, sildenafil is available at the lowest cost per pill. To provide the best price for the most effective treatment, many companies have various billing cycles, shipping quantities, and dosages you can mix and match.

Let’s visualize how much you might pay for the lowest available doses on telemedicine platforms with the best prices:

This is why BlueChew sildenafil is our top choice for men for whom budget is a huge factor. BlueChew offers the lowest price for the most affordable prescription ED medication available today. For budget-conscious, try BlueChew first. Then, if you find that you can’t achieve proper dosage via BlueChew’s plans, head to Hims to take advantage of the next-lowest prices and greater dosage flexibility.

Five-way tie

Any medication designed to affect male sexual anatomy is going to be met with extreme caution, and rightly so. Beyond the psychological importance most men place on their genitalia, there is the practical use for reproduction and waste elimination to consider. We take all of these issues seriously when considering ED treatments.

Most studies show that PDE-5 inhibitors (the class of medications that includes sildenafil, tadalafil, and others) are safe for most healthy men. The men who are most at risk for severe adverse effects are those on medications that affect blood pressure.⁵ PDE-5 inhibitors act as vasodilators, effectively lowering blood pressure by increasing nitric oxide production. If your blood pressure is already lowered due to an ailment or medication, adding a PDE-5 inhibitor can prove fatal.

Insider Tip: Doctors require a recent blood pressure reading to prescribe any PDE-5-inhibiting ED medication. This can pose a hurdle for some, potentially negating the cost- and time-saving benefits telemedicine offers. But you can get a blood pressure reading elsewhere if needed. Devices for at-home use cost as little as $20, and pharmacy chains like CVS often have free heart health programs or open-access machines that can measure it for you.

Most studies comparing oral medications for erectile dysfunction come to the conclusion that there are no meaningful differences in their respective safety profiles. Some men develop visual color processing issues when they take PDE-5 inhibitors that also act to inhibit PDE-6 — a common but usually benign collateral effect. For these men, vardenafil (which acts on PDE-5 without affecting PDE-6) would be preferable to sildenafil. Tadalafil is also less associated with visual disturbances than sildenafil.

Common but typically mild side effects associated with popular ED medications include:

• Headache
• Flushing
• Backache
• Dyspepsia
• Nasal congestion

Access to these ED medications requires a prescription, which means you’ll have the opportunity to talk with a physician along the way. Take that time to ask your doctor about any of these issues during your consultation.

Winner: BlueChew (by a hair)

You deserve a high degree of discretion when acquiring medication for erectile dysfunction, especially considering the stigmas around ED and the shame you may feel about the issue. All of the companies we’ve included here provide significant protections and stringent practices for the safeguarding of medical data. They all abide by HIPAA regulations, or else they would lose their right to offer prescription medications.

So, when it comes to comparing these companies to one another on the basis of privacy, the only two parameters left are their online tracking practices and medication delivery systems. All of these companies use cookies and web beacons to track your browsing habits on their site. The data shouldn’t link to you directly, but it will connect with your IP address and possibly information about your device. We want to see these companies make it as easy as possible to opt out of their tracking systems.

There are options for restricting the sale of your information on each of the top sites we cover here, but BlueChew has the easiest interface. You don’t have to send an email or make a phone call. When you’re logged into your account, you can click “Do Not Sell My Information” at the bottom of almost any page and quickly submit an automated request to opt out.

For the actual delivery, none of these companies ship their products in boxes that show what’s inside. Some Hims and Roman deliveries will have Hims or Roman in the return address, but those companies’ product lineups are large enough that no one could deduce the box’s contents.

BlueChew gets the edge here because of the way their pills are packaged. Since they’re individually wrapped tablets, their packaging is rather flat; it doesn’t look like it would contain medicine, and there’s no audible rattling of pills in a bottle.

Winner: Chewable tadalafil

Another way to think of medication format is, essentially, “convenience.”

When Viagra hit the market in 1998, it quickly became known as the “little blue pill,” a coy way for men to gain some distance from any potential stigma associated with ED at the time. It wasn’t hard in those days to imagine the “little” or the “blue” aspects of Viagra evolving as generic sildenafil and competitive medications came out. But recently, it seems the industry is paying closer attention to the “pill” aspect of erectile dysfunction treatment.

Sildenafil, tadalafil, Stendra, and vardenafil are typically delivered in pill form, but pills aren’t always the most convenient format. Many people have trouble swallowing pills, and — particularly in the case of pills you take just before intercourse — finding a drink to wash those pills down can be an annoyance. BlueChew and Rugiet work around this issue by providing chewable tablets and dissolving lozenges, respectively.

There is some evidence that chewable and dissolvable delivery methods can accelerate the time to action since the medication can absorb through oral membranes and into the bloodstream without having to pass through the digestive tract. However, it may only be the difference of a few minutes. These methods are ultimately more about maximizing convenience than anything else.

BlueChew’s chewable tadalafil gets our endorsement here because the company’s tablets are a bit more convenient than Rugiet’s lozenges, which need to be kept at or below room temperature to stay solid.

It’s worth noting that the “chewables” arena just got a little more crowded, as Hims recently developed its own chewable tablets for tadalafil, vardenafil, and a combination of sildenafil and tadalafil. Hims does offer a prescription for daily-use chewable tadalafil, but it’s only available at a 6mg dose at this time; many men interested in daily tadalafil should start at a 2.5mg dose. So, if you take the 6mg Hims tadalafil chewables daily and experience side effects, there’s no way to titrate down from there. Also, the pricing of its chewable tadalafil is higher at this time than BlueChew’s. Right now, comparing Hims daily chewable tadalafil to BlueChew’s same-dosage plan with 28 pills per month, your cost per dose is 12% higher with Hims than with BlueChew.

Right now, BlueChew remains the only source of chewable sildenafil on its own.

ED is the term used to describe the condition of being unable to get or keep an erection long enough to engage in satisfying sexual activity. It encompasses a few circumstances:

• You can get an erection but can’t maintain it for a long enough period of time.
• You can get semi-erect but not fully firm.
• An erection just won’t happen at all.
• Erections sometimes happen, but sometimes they won’t.

ED prevalence is much greater than you might think. Various studies indicate that anywhere from one-third to one-half of all men deal with ED at some point.⁶ And incidences of ED increase steadily with age.

There are numerous potential causes of ED. Though it occurs more frequently as men age, this isn’t a condition that’s a natural part of the aging process; erectile dysfunction isn’t something that men or their partners should just accept. And it’s not at all something that should be a source of shame or embarrassment. ED is a common condition, and many roads may lead to it, including:

• Hypertension (high blood pressure)
• Obesity
• Diabetes
• Stress
• Use of alcohol, tobacco, or drugs (recreational or prescription)
• Exhaustion and sleep disorders
• Depression and anxiety

It would be wise to speak with your doctor to rule out any of these potential causes before taking a prescription for ED, as each of those listed ailments can have far-reaching consequences beyond sexual health. Dealing with the greater issue should alleviate most (if not all) ED symptoms, but if it doesn’t, you can still reach for an ED prescription.

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It’s always a good idea to talk with a healthcare provider before you embark on an ED treatment journey. If you hope to use any prescription ED treatments, you’ll have to get the prescription from a doctor who will review your medical history and current health to determine if one of these medicines is suitable for you.

But even if a prescription treatment isn’t the best course of action, it’s still wise to consult with a healthcare provider. Because there are many possible causes of ED, your erection difficulties might signal an underlying condition that requires medical attention.

Thankfully, our top recommendations for the best ED treatment include complimentary consultations with a physician who can help you. This is an incredible value for anyone without insurance, for whom a simple doctor’s visit might be prohibitively expensive. Here are some topics that you might discuss during a consultation.

When it comes to readily available ED medications, you have several options to consider. Believe it or not, all of these medications work by achieving the same effect: they are all PDE-5 inhibitors, supporting or enhancing the effects of nitric oxide in our bodies. However, they each have specific onset times and durations that may make one a better option for your lifestyle than another.

Here’s a comparison of our top choices:

Nitric oxide (NO) mediates vasodilation (widening of blood vessels) in the penis, increasing blood flow. PDE-5 inhibitors promote the release of nitric oxide, causing improved blood flow and helping the muscles in the penis to relax, causing the penis to enlarge and grow rigid, forming an erection.¹⁰

Meanwhile, PDE-5 (phosphodiesterase-5) is a chemical that the body releases to signal that it’s time for the erection to end. PDE-5 inhibitors slow the activity of PDE-5, allowing the NO activity to continue, bringing forth a sustained erection.

Taking one of these medications should not result in an instant erection — stimulation is still required. But when stimulation occurs, the medicine gives a helping hand to boost nitric oxide and its effects.

When we break down your top choices for ED medication, we find it useful to refer only to the names of the active ingredients (i.e., sildenafil, tadalafil, etc.) as opposed to their brand names. Unless you’re going through your insurance company, there’s almost never a good reason to buy branded ED medication — generic options are therapeutically identical.

We always recommend that people start with generics, so let’s look at which medications are available in generic form:

To make matters more confusing, telemedicine providers will sometimes use original brand names when selling generics that are not “authorized generics” because it makes it easier for their customers to understand what they’re choosing. Others sell branded pills, authorized generics, and regular generics without doing enough work to explain the differences to their customers.

Sildenafil and Viagra present the most complex situation in this regard, and we’ll break that down a little later. If you’re confused by all of this, make sure to ask your doctor which one would be right for you.

Every ED drug has contraindications (i.e., reasons why a person should not use it). Men with certain liver, kidney, or cardiovascular conditions may not be able to take ED medications safely. Men taking nitrates and alpha-blockers to treat hypertension may need to find other ways to treat their ED. Other health conditions could make PDE-5 medications unsafe for men as well.

These potential complications are why you need a prescription for ED medication. Your consulting physician will determine what will be safe and effective based on your medical history and any current medications that you use. Thankfully, PDE-5 medications for ED are prescribed very widely, and the healthcare community considers them safe for most men, with side effects rarely reported.

When side effects happen, they tend to be mild and commonly include some of the following:

• Headache
• A sensation of flushing in the face
• Nasal congestion
• Nausea or indigestion
• Muscle pain
• Dizziness

Though they rely on the same primary mechanism to treat ED, research confirms that these different PDE-5 inhibitors tend to produce side effects to varying degrees. For instance, a slightly higher percentage of people who take sildenafil (and Viagra) report flushing and headaches,¹¹ while a slightly higher percentage of tadalafil (and Cialis) users report muscle pain.¹² All in all, most men barely notice any side effects, if at all.

Any of the PDE-5 inhibitors can also cause your blood pressure to drop (though Stendra is less likely to cause this to happen). You might think that’s a good thing, but blood pressure that gets too low is also dangerous. If you get dizzy from taking any of these medications, you should share this observation with a healthcare provider; it could indicate a potentially unsafe drop in blood pressure.

One rare but noteworthy side effect of many PDE-5 inhibitors is a change in visual color processing. This occurs when a PDE-5 inhibitor collaterally inhibits PDE-6. If you’re one of the very few men to experience this phenomenon, you should ask your doctor about vardenafil, which does not have any collateral effect on PDE-6.

Often known by the common brand name Cialis, tadalafil is a PDE-5 inhibitor that you can take once per day to provide 18-36 hours of effectiveness. This significantly reduces the planning typically involved in using other treatments like sildenafil. That said, some users only take tadalafil as needed, and those dosages can sometimes be different. You and your doctor will decide what dosage and schedule are right for you.

Side effects with tadalafil are about as common as with sildenafil and are similarly mild. Dose for dose, tadalafil is also a little bit more expensive than sildenafil. However, we believe tadalafil is the better value, mainly because:

• In studies, men and their partners prefer tadalafil to sildenafil.
• Tadalafil has superior psychological outcomes to sildenafil, providing more sexual confidence.¹³
• The larger window for sexual activity (18-36 hours, compared to 4-6 hours with sildenafil) for many people justifies the slightly higher expense.

Branded Cialis and generic tadalafil are available in the same dose increments across most platforms, with 2.5mg, 5mg, 10mg, and 20mg being the most common. Daily doses typically start at 2.5mg, while as-needed doses typically start at 5mg.

BlueChew and Rugiet differ from the norm, with BlueChew offering 6mg and 9mg doses and Rugiet offering 14mg and 22mg doses (possibly blended with sildenafil and apomorphine). We’ll get a little more into Rugiet’s offering in the “Apomorphine” section below. Ultimately, you’ll decide with the prescribing doctor which dose and schedule are best for your lifestyle.

Here’s a quick visual reference to let you know what kinds of branded and generic tadalafil our top choices carry:

Tadalafil from our top choice provider, BlueChew, is considerably more affordable than branded Cialis, which relies on tadalafil as its active ingredient. BlueChew also has prices that are on par with or better than their competitors selling generic tadalafil. Additionally, the chewable format of BlueChew’s tablets allows you to take them without water, so you have one less obstacle to deal with. Hims recently developed chewable tadalafil, as well, but it’s much more expensive than the offering from BlueChew. And right now, BlueChew is offering our readers a free month of tadalafil as a way to test their service; all you pay is a small shipping fee. As far as we know, no other platform offers such a low-cost way to try the medication.

Insider Tip: If you’re willing to take on some hassle and you know your goal is to take as-needed tadalafil at a dosage no stronger than 5mg, then tadalafil from Hims could conceivably be your most economical option. That’s because you could request daily tadalafil on a quarterly billing cycle, which brings the cost per dose below $3 (slightly less money than the $3.21/dose cost of BlueChew’s 6mg chewable doses). You could then temporarily cancel your Hims subscription until you make your way through that stock of 90 doses and reinstate it whenever you need more. Canceling and restarting through Hims carries no financial penalty, but there’s also the value of your own time to consider; resubscribing would be a nuisance. And lastly, doses lower than 5mg would be considered on the low side for as-needed tadalafil. But if they work for you, then all the better.

Most people can’t predict with complete certainty whether or not they’ll have sex on any given day. Even if you’re accustomed to daily intercourse, your partner could get sick, you could strike out at the club, or your in-laws could pay you a surprise visit. For that reason, some men prefer not to take a daily tablet of Cialis or tadalafil when the prospect of sex is not guaranteed. This is even truer for men who’ve experienced some mild side effects from frequent or daily tadalafil use.

On the flip side, sildenafil and Viagra (as well as a specific regimen of Cialis and tadalafil) offer you the choice to take them as needed. So, if you want to spend all day in bed playing video games, you don’t have to worry about missing a daily pill. And if you know that sex is on the horizon, you can take these meds accordingly.

You’ll need to take this medication 30-60 minutes before sex. Some men report that BlueChew’s chewable sildenafil and Rugiet’s lozenges kick in faster, but this is not guaranteed.

Viagra’s active ingredient is sildenafil, but you might not know it from looking around at your ED options. Why would Viagra be so much more expensive than sildenafil (the active ingredient in Viagra)? Why does anyone opt for the more expensive Viagra if both have the same ingredient?

Some men familiar with Viagra, having used it before successfully, want to stick with what works. They trust it, and the brain is the largest and most important sex organ after all; psychology can be a potent tool in combating ED.

But a complete understanding of your options requires a little knowledge about the differences between Viagra, generic Viagra, and generic sildenafil.

Sildenafil is also the active ingredient in Revatio, a drug designed to treat pulmonary arterial hypertension. The drugs are identical in almost every way — they’re even both made by Pfizer. But Revatio is made only in 20mg tablets.

Many providers that stock generic sildenafil for erectile dysfunction prefer these 20mg tablets because they allow for more dose flexibility from a single stockpile of pills. A doctor can prescribe 20mg, 40mg, 60mg, or 100mg, and the patient simply takes the corresponding number of 20mg pills. Both branded and generic Viagra come in 25mg tablets, 50mg tablets, and 100mg tablets. If the most common dose is 50mg, then those 100mg doses are going to sit on the shelf, gradually approaching their expiration date and causing providers to lose money.

Like tadalafil, sildenafil doses can vary to greater degrees, especially as delivery mechanisms change. BlueChew’s chewable tablets come in 30mg and 45mg doses, and Hims chewable sildenafil is only available in combination with tadalafil. In these combinations, the sildenafil dose is always 10mg, while the tadalafil dose ranges from 8mg-18mg. Rugiet’s combination pills include sildenafil doses of 40mg, 60mg, 80mg, or 110mg.

Here’s a quick visual reference detailing which versions of sildenafil our top choices offer:

Our recommendation here, for most men, is generic sildenafil. Sildenafil is far more economical and allows for better dosage tailoring.

Specifically, we recommend BlueChew’s chewable sildenafil; BlueChew’s dosages allow for good flexibility. However, there are also a few situations in which you might want to opt for Hims instead.

• Hims sildenafil is available in a wider number of doses, making it our top choice for men who find they need to fine-tune their dosage of sildenafil for the best effect.
• Hims telemedical support is fantastic for men who are dealing with ED alongside efforts to treat premature ejaculation.
• If you’re one of the many men who already use Hims for hair loss treatment, then it could be convenient to use them for ED treatment as well.
• Hims offers classic, brand-name Viagra or an authorized generic for men who want it. BlueChew doesn’t offer classic Viagra or the authorized generic.

Hims is the only company we recommend that sells an authorized generic Viagra. Interestingly, Roman lists their options as “Branded Viagra” and “Generic Viagra.” That second option is actually generic sildenafil — it is not an authorized generic made by Pfizer. Roman lists their sildenafil this way because they believe it makes it easier for potential patients to understand that the two drugs are practically identical. Visit our Roman reviews to learn more.

While it isn’t the most widely available option from telemedicine providers, vardenafil is an important option for the few men who might not have success taking sildenafil but still want an effective medicine they can take on demand 30-60 minutes before sex. Studies show that vardenafil behaves the same way in the body as sildenafil, with one known exception.

A very rare side effect of sildenafil is an alteration in color perception due to the drug’s inhibition of PDE-6 in addition to PDE-5.¹⁴ Vardenafil is somewhat more selective in this regard, having no known effect on PDE-6 and, thus, no known effect on color perception. And while vardenafil is less thoroughly researched than sildenafil, there are still numerous studies looking at thousands of users over nearly two decades, so its safety and efficacy are without question.¹⁵

For a while, BlueChew was the only provider among our top picks to offer vardenafil, but Hims included it in its recent development of chewable mint tablets. From BlueChew, you can get vardenafil in 8mg doses with monthly deliveries of four, eight, 15, or 30 tablets. Hims vardenafil has a little more dose flexibility, offering 12mg and 18mg doses, but you’d be out of luck if those doses are too high for your needs. And BlueChew’s prices are still better than Hims for vardenafil. A limited-time BlueChew free trial is also available for Innerbody readers that gets you four free tablets of vardenafil, so you can see how it works for you.

You can find out more about BlueChew’s vardenafil and other treatments by reading our complete BlueChew reviews.

Many men prefer to take an ED medication only when they need it rather than at the start of a day when they may or may not have sex. Understandably, these men also want that drug to take effect as quickly as possible and with the lowest chance of side effects.

Avanafil (brand-name Stendra) is a newer medication in the landscape of ED treatments. While other ED medications like sildenafil affect enzymes like PDE-1 and PDE-6 alongside PDE-5, Stendra is more micro-targeted to inhibit the specific PDE-5 enzyme related to a man’s ability to get and keep an erection. This increases Stendra’s efficacy while reducing its side effect profile. Here are some other benefits of Stendra:

• According to FDA data, close to 3 in 10 men using the maximum dosage of Viagra report headaches. By contrast, about 1 in 10 men using the 200mg Stendra (highest dosage) report headaches.
• Only about 4% of men using 200mg Stendra experience flushing of the face, compared to 18% of men using the maximum dosage of sildenafil.
• Heartburn, muscle and back pain, congestion, and vision changes are all less likely with Stendra.

Stendra also acts quicker in the body than others — some studies showed efficacy in as little as 15 minutes.¹⁶

This speed makes Stendra a great treatment choice for men who don’t always know when they’ll want to have sex and are happy to take something shortly beforehand. If this describes you, then we recommend Hims Stendra.

Stendra is also our top choice for couples who enjoy morning sex. Tadalafil taken in the morning can sometimes require about an hour before it is fully effective. This experience with tadalafil varies — some men find tadalafil to be effective for a full 36 hours (which would make the prior morning’s dose still effective), while others find its effects wear off in closer to 18 hours. If you are in the latter camp, Stendra will be better for your morning rituals because you can take a dose as you wake up and then be ready for fun in as little as 15 minutes.

However, Stendra will cost you significantly more than sildenafil or tadalafil. Hims — our top choice for convenient access to Stendra — offers a monthly subscription for four 100mg Stendra tablets at $116 per month, billed quarterly. If you can afford the cost, this may be the best choice for you. If not, then we’d suggest you explore daily tadalafil.

There are three standard dosage options for Stendra:

• 50mg
• 100mg
• 200mg

Both the 100mg and 200mg dosages take effect in about 15 minutes, which is even faster than BlueChew’s chewable sildenafil. It lasts about six hours, which is basically on par with sildenafil (and Viagra).

Apomorphine has been used since the 19th century as everything from a sedative to an aid in kicking heroin addiction, and it’s currently FDA-approved for treating Parkinson’s disease. However, multiple studies indicate its potential as a treatment for ED.¹⁷ The name can be a source of confusion since most people outside the medical professions would likely hear the “morphine” in apomorphine and assume opioid properties. But apomorphine doesn’t bind to opioid receptors and is non-addicting.

For Parkinson’s patients, apomorphine is delivered via subcutaneous injection at doses often higher than those used in erectile dysfunction treatment. Studies into its use for Parkinson’s often revealed intense nausea as a side effect, to the point that doctors would often have to prescribe an antiemetic to deal with nausea and vomiting. ED patients taking apomorphine as a sublingual film — or in the case of Rugiet, a lozenge — may also experience some nausea, but this appears to decline with regular use.¹⁸

Apomorphine appeared on target to become a viable alternative to Viagra in 2000, but the manufacturers behind its two branded forms intended for ED patients pulled it from FDA consideration despite what appeared to be a sure path to approval. They cited the need for further study, particularly into the drug’s interaction with nitrates and its potential to cause fainting in less than 0.2% of trial participants. Today, apomorphine remains FDA-approved for Parkinson’s disease but is only prescribed for ED treatment as an off-label use.

The only major provider we recommend that offers apomorphine in any form is Rugiet, but they don’t stock apomorphine on its own. Instead, they combine it with tadalafil and sildenafil in a lozenge that dissolves under the tongue and may decrease the time it takes to start working. As you can imagine, combining these three medications theoretically increases the chances that they will work for you quickly and remain active in your system for a good 24-36 hours. The specific combinations available to you depend on the results of your doctor’s consultation, but here’s a look at their standard mixes:

As you can see, the obvious downside to Rugiet is its cost. If you sign up for recurring shipments of 18 doses every three months, the company will knock $70 off the cost, resulting in a monthly cost ranging from $57-$150 and a per-dose cost ranging from $9-$25.

A less apparent downside to Rugiet’s lozenges is their tendency to melt in the package at any temperature above 72 degrees Fahrenheit. That makes it ill-advised to carry them in a pants pocket for a night out and expect to be able to take one easily just before intercourse. Rugiet recommends that you keep them in the refrigerator.

To learn more about Rugiet’s offering, check out our comprehensive review of their services.

Despite the tremendous success of currently available PDE-5 inhibitors like sildenafil and tadalafil, research continues into additional treatments that could have greater efficacy, fewer side effects, or both. Some of these are additional oral medications, while others involve new medical devices applied to the penis directly.

Sildenafil and tadalafil, the active ingredients in Viagra and Cialis, remain the most reliable treatments for erectile dysfunction. Sanofi — the pharmaceutical giant that makes Cialis — is currently designing a study that would put them on track to alter Cialis’ designation from a prescription drug to an over-the-counter medication.

The most compelling new treatments being researched are acoustic wave and low-intensity shockwave therapies (LI-SWT).¹⁹ These treatments both use soundwaves, but the much faster-moving shockwaves appear to be more effective at stimulating blood flow and improving vascular performance in penile tissue.

There are currently several clinics around the country that perform LI-SWT, but no at-home device has been approved yet.

Ultimately, the safest, most effective treatments imaginable are already available. Nothing coming down the pike seems poised to challenge their supremacy in the near future. We’ll continue to stay on top of the latest research so you can rely on us as a resource for future ED treatment developments.

Prescription ED medications are safe and effective ways for most men to treat ED. However, not all men want to take prescription medication, and some men cannot take PDE-5 medicine safely.

Based on our research, we believe you may find an effective treatment for very mild cases of ED using a nutritional supplement. As with any medication or supplement, it’s imperative to discuss this with your primary care provider to make sure there’s nothing in your medical history that might make these alternative treatments unsafe for you.

Nutritional supplements don’t work anywhere near as well as prescription ED medications, based on clinical research. Research is also still less thorough for supplemental ingredients, which makes it harder to assess safety. They also typically come in only one dose, so the efficacy can be wildly different in men with disparate BMIs and metabolisms. And from a cost standpoint, supplements are often much more expensive than prescriptions, especially considering generic options.

Still, if your ED isn’t too severe, and you’re determined to avoid getting a prescription for it, these alternatives may be sufficient.

L-arginine is an amino acid we naturally have within our bodies. Under normal circumstances, it plays a role in nitric oxide production, which in turn plays a crucial role in allowing blood to rush into the penis to cause an erection.

In one study, a third of men reported that they experienced significant improvement in sexual function while using L-arginine.²⁰

A separate study of men ages 25-45 examined the effect of taking both L-arginine and pycnogenol (chemicals taken from French pine trees) together for ED treatment.²¹ Participants were given L-arginine for one month; nothing happened.

Then the men were given both L-arginine and pycnogenol for a month. After this second month, 80% of the men reported that their sexual function was mostly restored. Using this same combination for a third month, over 92% of the men had what they considered normal erections.

While promising, this study also illustrates the elusory nature of just the right combination of supplements to do what we already know prescription medications can do. It’s also worth noting that L-arginine doses in supplements like Male Extra or Semenax are significantly lower than those used in these studies. Comparatively, studies into prescription options almost always use clinically relevant and commonly prescribed doses.

Also, L-arginine supplementation may be unsafe for men with blood pressure problems or men who have had a heart attack, allergies, or asthma.

Panax ginseng (red ginseng) is sometimes called “herbal Viagra.” There have been more than a handful of studies providing evidence that Panax ginseng can help with ED. However, the studies leave a fair bit to be desired in their methodologies and size.²² The evidence thus far points to the need for more research and the alluring potential of red ginseng as an effective treatment.

Panax ginseng likely will not work for everyone. There’s no contest when compared with something like sildenafil’s more than 90% success rate, so if you want a “sure-shot” treatment, this isn’t it. But if you’ve got some patience to give it a try and either want to avoid prescription medication or cannot take those medications, you might find that you’re one of the lucky men for whom this does the trick.

DHEA (dehydroepiandrosterone) is a hormone that our body’s adrenal glands typically produce. Production of DHEA naturally drops as we age, but DHEA is a precursor to the sex hormones testosterone and estrogen.

ED can often occur as a result of diabetes. Several studies on diabetics have uncovered an inverse relationship between serum DHEA levels and the incidence of ED.²³ The results of this study suggest that possibly a third of men with diabetes-related ED could treat their ED using DHEA.

The World Anti-Doping Agency and many collegiate and international competitive organizations have banned DHEA as a performance-enhancing drug. The quantities you’ll encounter in male enhancement supplements aren’t likely to help you break any home run records, but they could still show up on mandatory drug tests. You might also find that DHEA raises your cholesterol levels, so if you have high cholesterol levels already, DHEA might not be the right choice.

Ultimately, these complicating factors make DHEA an inferior choice for diabetics compared to a combination of prescription ED medication for the short term and dietary or lifestyle changes — and perhaps medication to address high blood sugar — in the long term.

Some companies tailor their supplements to target ED and increase sex drive and performance. Unfortunately, you have to shop very carefully because these can be highly sketchy products from disreputable companies. The safest first step may be to try supplements of single ingredients like the ones detailed above, but that also requires patience and a higher budget for trial and error. When it comes to broader, multi-ingredient supplementation for ED, we can recommend these few options:

Side effects with all of the supplements mentioned here tend to be mild if any occur. Most men don’t experience any, but it’s always wise to share your supplement plans with your healthcare provider before adding anything new to your regimen. Notably, men who take medications for cardiovascular problems may not be suitable candidates for ED supplements.

Most of the supplements you can use to combat ED are more expensive than generic drugs. You also have to take them every day for them to be effective, unlike certain ED meds that you can take as needed. Ultimately, the choice between a prescription ED treatment and a supplement comes down to budget and lifestyle, and the choice is yours to make.

How do I know if I have ED?

Erectile dysfunction is the recurrent inability to generate an erection strong enough to achieve penetration. If you consistently find that you can’t get hard enough for sex, you might have ED. But if you’ve only recently had this happen once or twice — especially if you can identify contributing factors in the moment, like fatigue or inebriation — you shouldn’t worry.

What causes ED?

ED can have numerous causes, and many men have multiple contributing factors to their ED. These can include cardiovascular or mental health issues, diabetes or obesity, and a reaction to certain medications. If you’re experiencing ED, a thorough conversation with a doctor can help you identify potential causes.

Can depression or anxiety cause ED?

Yes, depression or anxiety can definitely cause ED. The experience may be consistent or episodic, but there is a well-established connection between mental health and erectile performance.

Is there a cure for ED?

Technically, there is no cure for ED. If you have ED and you’re treating it with prescription medication, your ED will still be there if you stop taking those meds — except perhaps in cases where it’s the result of self-doubt, and the performance of those meds helped you restore that confidence. Because ED can often be traced back to specific causes, treating those underlying conditions can potentially eliminate it. And you can use prescription medication as a bridge while working on those issues.

Will Viagra or other ED meds give me an erection automatically?

Contrary to popular belief, Viagra — or any similar ED medication — won’t automatically give you an erection. These medications create an environment in the body where appropriate stimulation — physical or psychological — will cause an erection the same way it would in individuals without ED.

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[8] Jackson, G. (2013). Erectile dysfunction and cardiovascular disease. Arab Journal of Urology, 11(3), 212-216.

[9] Korfage, I. J., Pluijm, S., Roobol, M., Dohle, G. R., Schröder, F. H., & Essink-Bot, M. L. (2009). Erectile dysfunction and mental health in a general population of older men. The Journal of Sexual Medicine, 6(2), 505–512.

[10] Kass, D.A., Takimoto, E., Nagayama, T., Champion, H.C. (2007 July). Phosphodiesterase regulation of nitric oxide signaling. Cardiovascular Research, 75(2) 303–314.

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