More than half of men will grapple with ED during their lives. Though the condition does affect more older men than younger men — half of the erectile dysfunction patients in the U.S. are over the age of 60 — men who suffer from ED span age groups. Five percent of men under age 40 have complete ED and can’t achieve an erection without treatment. If any of this describes you, then you’re not alone at all. ED is a common condition. One recent study estimated that roughly a third of men struggle with ED to some degree.
Thankfully, it’s also a condition that is very treatable in 2022. There are several ED treatments proven to work for most men with ED. The question becomes: what is the best ED treatment for you?
To help you decide, we’ve tested and reviewed the major providers and treatments and analyzed all of the scientific research. Here, we’ll break down all of your best options.
First, for those in a hurry, here’s a quick snapshot of our advice.
Summary of our top recommended ED treatments
- Best overall: BlueChew tadalafil
- Best if money’s no object: Hims Stendra
- Best for newbies: BlueChew free trial
- Best for flexible dosage: Roman sildenafil
- Best for convenience: BlueChew tadalafil
- Best for morning sex: Hims Stendra
- Best for men who believe Viagra is the only option for them: Hims Viagra
Our top choice in 2022: BlueChew tadalafil
BlueChew brings all of the convenience of a good telemedicine provider — you can consult with a BlueChew-affiliated doctor for free from the comfort of home and never travel to a doctor’s office or pharmacy to get your ED treatment.
And BlueChew is our Editors’ Choice for best ED treatment in 2021 for several very compelling reasons:
- BlueChew’s medications are chewable, which means no more scrambling for a glass of water to swallow a pill.
- BlueChew’s monthly tadalafil subscriptions come in several subscription levels, and all of them are considerably more affordable than competitors
- You can try it for free for a month using our INNERBODY coupon code.
- Taking tadalafil once per day, as if it were a multivitamin, is less potentially disruptive than taking sildenafil an hour before you intend to have sex. Tadalafil is taken in this easy fashion because it stays active in your body for 18-36 hours, unlike sildenafil or Stendra.
- Tadalafil poses effectively the same low risk level of mild side effects as sildenafil.
In our opinion, tadalafil beats sildenafil, which makes it the best choice for most men. But most importantly, scientific research leads to the same conclusion. In a meta-analysis of numerous studies, couples preferred tadalafil to sildenafil — and it wasn’t very close. In one study, nearly 80% of women preferred their sexual partners to use tadalafil, compared to sildenafil (15% preference). Therefore, the chances are pretty good that tadalafil will be best for you, too.
BlueChew offers tadalafil at an incredible price and in a chewable form that can take effect in as little as 20 minutes.
In studies, tadalafil is a top choice among couples -- we believe it will be best for most people. Plus, BlueChew offers our readers an exclusive opportunity to try BlueChew ED treatment for a free month! Just use the links on this page in order to access your free trial.
Current Deals: Try it for a FREE MONTH
And right now, BlueChew is where you should buy it.
Sildenafil is a solid treatment option, as well. It works reliably, and many doctors recommend it and prescribe it with great efficacy.
Ultimately, what works best for you — and what dosage you take — depends on what the consulting physician determines is suitable. They’ll base this determination on your medical background and how you tolerate the medication when you begin using it. You’ll also have some say in the dosage you use to start.
Close runner-up: Hims
Hims is a great telemedicine company where, after a free consultation with a doctor, you can access a few different ED treatments proven to be effective: sildenafil (and brand-name Viagra), tadalafil (and brand-name Cialis), and Stendra. As a company, Hims impresses us very much, and there are circumstances in which we recommend Hims above all others for ED treatment providers.
- Why you should trust us
- What is erectile dysfunction?
- Considerations when looking for an ED treatment
- What to discuss with a healthcare provider
- Prescription ED treatment options
- Tadalafil for ED
- Sildenafil and Viagra
- Stendra (avanafil)
- Natural supplements and treatments
- ED-specific supplements
- How we evaluate health services and products
At Innerbody Research, we extensively test each health service we review, including ED medication services. All told, our team has collectively spent nearly 300 hours testing and researching these companies to provide an accurate, unbiased analysis of how they stack up, free of marketing jargon and gimmicks.
Over the past two decades, Innerbody Research has helped tens of millions of readers make more informed decisions to live healthier lifestyles. We evaluate the service based on adherence to quality, the latest medical evidence and health standards, and a simple question: would we buy the product or service ourselves if it weren’t part of our job, and would we recommend it to family and friends?
Additionally, 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.
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. So, 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 won’t.
What causes ED?
There are numerous 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:
- Hypertension (high blood pressure)
- Use of alcohol, tobacco, or drugs (recreational or prescription)
- Exhaustion and sleep disorders
- Depression and anxiety
What is your budget?
Most insurance won’t cover the costs of ED medication, and Medicare doesn’t cover the cost either. So, your available budget is an essential factor to consider. Prescription ED medications vary in price. 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.
Do you get frustrated by medication windows?
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.
Are you able to swallow pills with ease?
ED treatments don’t require taking medicine along with a meal. In fact, sometimes a heavy meal high in fats can slow down the drug’s effect. But do you have a hard time swallowing pills? Many people do. This slight additional stress can get in the way of fun times. And if there isn’t a convenient glass of water around at the height of passions, you could unintentionally ruin the mood. This is where chewable ED treatment options like those from BlueChew would come in handy.
Before you embark on an ED treatment, it’s good to talk with your healthcare provider. If you hope to use any of the 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. This is because there are so many possible causes of ED, and your erection difficulties might signal an underlying condition that requires medical attention.
Thankfully, a few of our top recommendations for the best ED treatment include complimentary consultations with a physician who can help you. Here are some topics that you might discuss during a consultation.
ED is a common health condition with many possible underlying causes. One of these potential causes happens to be low testosterone. A testosterone test can help you determine if this is what’s behind your ED. Thankfully these days, you have the option of testing your testosterone at home, with no lab order and no waiting in a medical office. We recommend you check out the high-quality at-home Testosterone Test from LetsGetChecked.
Are you diabetic?
Diabetes mellitus can cause ED. Thankfully those with diabetes-induced ED (DMED) tend to respond very well to ED treatments. If you’re prediabetic or your family has a history of diabetes, this is something you should bring up in your consultation.
Do you take nitrate drugs?
Unfortunately, people who take nitrates for cardiovascular conditions may not be suitable candidates for PDE-5 inhibitor ED treatments. They will likely have to pursue alternative ED treatments.
History of heart disease or cardiovascular problems
Consultation with the doctor will help you determine whether you can safely take ED medications.
Do you have high or low blood pressure?
Prescription ED medications can potentially lower blood pressure. If you already have low blood pressure or are being treated for high blood pressure, there is a possibility that ED treatments could lead to hypotension, which is a serious risk. The doctor will be able to advise you on safe treatment options. You may need blood pressure results to acquire a prescription for certain ED medications.
Altering lifestyle choices (if applicable)
Certain behaviors and choices can make it harder to maintain an erection for men who don’t have ED. These include sleep patterns, use of alcohol and drugs, stress management, and even lack of exercise.
Psychological factors can contribute to erectile dysfunction and make it difficult for a consulting physician to pinpoint the cause of your ED. You should still respond well to ED medications, but if you’ve exhausted possible physical causes, you may want to speak with a counselor to rule out psychological conditions.
When it comes to readily available ED medications, here are your top choices:
|Generic available?||Brand name(s)|
Believe it or not, all of these medications work by achieving the same effect. All of them are PDE-5 inhibitors, and they support or enhance the effects of nitric oxide in our bodies.
Here’s a comparison of our top choices:
|Roman sildenafil 40 mg||BlueChew sildenafil 30 mg||BlueChew tadalafil 6 mg||Hims Stendra 100 mg||Hims Viagra 40 mg|
|How fast does it work?||40-60 minutes||20-60 minutes||30-60 minutes||15 minutes||40-60 minutes|
|How long can it work?||Up to 6 hours||Up to 6 hours||18-36 hours||Up to 6 hours||Up to 6 hours|
How PDE-5 inhibitors work
Nitric oxide (NO) mediates the vasodilation (widening of blood vessels) in the penis, increasing blood flow. Let’s break that down a bit further. Nitric oxide tells specific muscles in the penis to relax. The relaxation of those muscles allows blood flow to increase to the erectile tissues of the penis, causing the penis to enlarge and grow rigid, forming an erection.
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 an erection.
Taking one of these medications should not result in an instant erection, thankfully — stimulation is still required. But when stimulation occurs, the medicine gives a helping hand to boost nitric oxide and its effects.
Are ED medications safe for me?
There are contraindications for each drug (i.e., reasons why a person should not try to 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.
All of this is why they require a prescription. Your consulting physician will determine what will be safe and effective for you 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 rare and mostly mild side effects reported.
Side effects of PDE-5 inhibitors
Side effects, when they happen, tend to be mild and commonly include some of the following:
- A sensation of flushing in the face
- Nasal congestion
- Nausea or indigestion
- Muscle pain
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 various degrees. For instance, a slightly higher percentage of people who take sildenafil (and Viagra) report unwanted vision changes, while a slightly higher percentage of tadalafil (and Cialis) users report muscle pain. All in all, most men barely notice any side effects.
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 discuss with a healthcare provider; this could indicate a potentially unsafe drop in blood pressure.
- No planning needed — you take a pill once a day
- Can be taken with or without food
- Can also be taken only as needed
- Proven among the most effective ED treatments
- Tends to be preferred by men and their partners, compared to sildenafil
- More affordable than medications like Stendra
- Far more affordable than brand-name equivalents
- Costs a little more than sildenafil
- Risk of mild side effects is slightly higher than Stendra
Often known by the common brand name Cialis, tadalafil is a PDE-5 inhibitor that you 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’s 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. In our opinion, tadalafil is the better value, however:
- In studies, men and their partners prefer tadalafil to sildenafil.
- Tadalafil has superior psychological outcomes to sildenafil, providing more sexual confidence.
- The larger window for sexual activity (18-36 hours, compared to 4-6 hours with sildenafil) for many people justifies the slightly higher expense.
Tadalafil from our top choice, BlueChew, is considerably more affordable than the brands like Cialis that rely on it as their active ingredient. You save money by buying tadalafil from BlueChew compared to buying Cialis from any source. Additionally, the chewable format of BlueChew’s tadalafil allows it to take effect slightly faster than standard pills because some of the medication begins entering your bloodstream from your mouth as you chew.
With BlueChew, you save on a per-month subscription for tadalafil as compared to Hims and other telemedicine providers. Right now, you can try a free month of BlueChew tadalafil. We are not sure how long this opportunity will last.
To learn more about the company and their services, visit our BlueChew reviews.
- The most economical major treatment
- Has been the subject of the most studies
- High rate of effectiveness
- Allows easy flexibility in dosage
- The window of effectiveness requires a bit of planning
- Loses efficacy when you take it with meals
- In studies, mild side effects like headache are more common than with other treatments like Stendra
Have you ever woken up in the morning and been unsure whether you’ll be having sex that day? Chances are, you have. This is one reason why some men and their partners prefer sildenafil and other ED medications instead of tadalafil. With just a little bit of preparation (making sure you have sildenafil at the ready), you can use a dose of sildenafil once it’s clear that the fun is indeed about to start.
You’ll need to take this medication 30-60 minutes before sex. If you try BlueChew (a chewable form of sildenafil), you’ll discover whether you are one of the many men who find that the chewable form takes effect much quicker, which would mean you only have to take it a half hour in advance. Now is a great time to try it because BlueChew lets our readers enjoy a free month of treatment to see if it works for you.
Viagra vs. sildenafil
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.
Preference for Viagra isn’t just a sugar-pill thing, either; there are differences in dosage to consider. Viagra commonly comes in 25mg, 50mg, and 100mg doses, with a typical dose of 50mg prescribed at the outset for men under 65. Sildenafil, meanwhile, comes in a broader range of options, including 20, 30, 35, 60, 80, and 100 mg. So, it’s the same active ingredient (sildenafil), which acts in the same way in the male body. But you may experience different levels of efficacy and side effects depending on the dosage.
Before you conclude that brand-name Viagra is superior for that reason, though, consider how much more leeway sildenafil’s strength gives you and your doctor to dial in the best dosage for you. You’ve got more control over it, and of course, the best dosage of any prescription medication will be the smallest dosage that produces the desired effects. Smaller dosage means less cost to you and less risk of side effects. And sildenafil is already much cheaper than Viagra.
Our winner here: for most men, it’s sildenafil. Sildenafil is far more economical and allows for better tailoring of dosage. We recommend BlueChew’s chewable sildenafil. There’s no easier, more convenient way for the uninitiated to explore this option than by starting a free trial month, and it’s a particularly great choice if you want either 30 or 45mg doses.
When your free trial ends, you’ll find that BlueChew’s sildenafil comes in different, competitively priced prescription levels. Managing your subscription is easy. And chewable, in our opinion, is preferable to a pill you need to swallow with liquid.
However, there are also several situations in which you might want to opt for Roman instead.
- Roman 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.
- Roman 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 Roman for hair loss treatment, then it couldn’t be more convenient to use them for ED treatment, as well.
- Roman offers classic, brand-name Viagra for men who want it. BlueChew doesn’t offer classic Viagra.
Visit our Roman reviews to learn more.
- Starts working in just 15 minutes
- Lasts for around six hours (longer than sildenafil)
- Per-dose cost via Hims is cheaper than Viagra or Cialis
- Less risk of side effects, according to studies
- Can take it with or without meals
- Alcohol won’t reduce efficacy
- Not as affordable as sildenafil or tadalafil
- Subject to fewer studies than sildenafil or tadalafil
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. These men also understandably want that drug to take effect as quickly as possible and with the lowest chance of side effects.
Avanafil (brand-name Stendra) is a new medication in the landscape of ED treatments. It is more micro-targeted to inhibit the specific PDE-5 enzyme related to a man’s ability to get and keep an erection. Other ED medications like sildenafil affect additional enzymes like PDE-1 and PDE-6. This increases Stendra’s efficacy while reducing its side effect profile.
- According to FDA data, about 1 in 10 men using the 200mg Stendra (highest dosage) report headaches. Meanwhile, close to 3 in 10 men using the maximum dosage of Viagra report headaches.
- Only about 4% 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 — 15 minutes is all it typically takes before the drug acts to help you.
This speed makes Stendra a great treatment choice for men who are happy to take something shortly before sex and who don’t always know when they’ll want to have sex. If this describes you, then we recommend Hims Stendra.
Stendra is also our top choice for couples who enjoy morning sex. Why? 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.
But Stendra will cost you significantly more than sildenafil or tadalafil — that’s the tradeoff. Hims — our top choice for convenient access to Stendra — offers a monthly subscription for Stendra at $116 per month, billed quarterly. If you can afford the cost, this may be the best choice for you.
There are three standard dosage options for Stendra:
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).
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 testing and examination of studies and evidence, we believe you may find an effective treatment for mild or moderate ED using a natural 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.
L-arginine and pycnogenol
L-arginine is an amino acid and something 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.
A separate study of men ages 25-45 examined the effect of taking both L-arginine and pycnogenol together for ED treatment. Pycnogenol is the name for certain chemicals taken from a French pine tree. Men were given L-arginine for one month; nothing happened in the study.
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 fully restored. Using this same combination for a third month, over 92% of the men had what they considered normal erections.
L-arginine supplementation is possibly 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. 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. 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, a potential choice for diabetics
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. A study of type-1 and type-2 diabetics with ED found that erectile dysfunction in 30% of the subjects was connected to DHEA deficiency. The results of this study suggest that possibly a third of men with diabetes-related ED could treat their ED using DHEA.
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 three:
Extenze combines herbal extracts like horny goat weed with hormones like pregnenolone and DHEA to help block PDE-5 and boost testosterone. You can read our ExtenZe review for more information.
Male Extra is a good choice if you want to try out vitamin and mineral supplementation without hormonal intervention. It sticks to natural ingredients like pomegranate and cordyceps mushrooms. Please read our full review for more details.
Max Performer is very similar to Male Extra, but it contains many more ingredients (learn more about them at our full review of the product). This can increase the chances of Max Performer working for you, but it will decrease your ability to know which ingredients are effective. More ingredients mean more potential for side effects, as well.
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, this comes down to budget and lifestyle, and the choice is yours to make.
At Innerbody Research, we customize our evaluation criteria depending on the type and nature of the health-related service. For sexual health products and telehealth companies, we use the following for our evaluations:
How well does the company deliver their core services or products to the customer? Is the quality of the product or service high enough that we would recommend it to loved ones without hesitation? The prescription medications in this guide are highly regulated, so their quality is extremely high. That said, we found BlueChew to offer the highest quality and most user-friendly product. Their chewable tablets are both convenient and effective.
While the top three prescription ED treatment companies we’ve included here all offer good value, we want to know who has the best. At the outset, the best value can be found at BlueChew because you can’t do better than a free trial month. For those who have never tried an ED medication, you have the opportunity to make sure the medication is effective at treating your ED before you invest more money.
Over time, your best value will depend a little on the conclusions from your doctor’s consultation. They might think a 45mg dose may be just right for you, and a company like BlueChew offers precisely that. So, even if you can get a better deal on a 40mg dose elsewhere, it may not be as effective. However, different dosage needs – for instance, if you only need 20mg doses of sildenafil – or a desire to use a different medication like Stendra instead might mean a company like Roman or Hims offers better value for you.
You’ll discover your best path via the doctor’s ED consultation, which is free at all of the aforementioned three companies.
Particularly in situations where ‘one size fits all’ doesn’t make sense, how well does the company help meet your specific needs? Hims, Roman, and BlueChew rely on top-notch doctors for consultations, and they offer convenient chat features and valuable, friendly phone support. The consultation is free of charge. Additionally, there is room within each service to tailor dosage and subscription level to suit your needs. For flexible dosage, we believe men who tolerate sildenafil can find the most flexibility in Roman’s service.
Erectile dysfunction is a sensitive topic. Most men would not want anyone to know they struggle with it. Fortunately, these companies all value your privacy, and shipments do not reveal what’s inside.
BlueChew’s shipments are completely discreet; no one would ever be able to guess what’s inside of the package. We want you to know in advance that you might see “Hims” or “Roman” in a return address field on their shipments, but since these companies offer so many products from shampoo to vitamins, you don’t really have to worry about that revealing anything specific about your purchase.