If you struggle to get or maintain an erection, it’s easy to think it’s an isolated problem that only affects your sex life. In reality, erectile dysfunction (ED) is often caused by psychological factors and poor physical health, and is associated with an increased risk of heart attack, anxiety, and depression in men, among other concerns. ED is a common problem that affects men of all ages, including half of all men age 50 and older, but it can be tough to acknowledge due to various cultural and social factors.
Fortunately, FDA-approved erectile dysfunction medications are increasingly accessible and affordable thanks to the introduction of generic drugs and the rise of telehealth. High costs and the fear of an awkward conversation should no longer get in the way of treating ED and improving your mental and sexual health. But that creates another question: Where should you buy ED medication online?
We found more than two dozen websites where you can get prescription ED medications like Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil). These platforms charge wildly different fees, have inconsistent age and state requirements, and aren’t necessarily thorough when screening for contraindications and comorbidities.
Men in their 40s who have ED have almost a ten-times higher risk of having a major heart attack or stroke in the next decade. So [ED] should initiate a medical evaluation. The disadvantage [of online ED platforms] is they’re getting no medical or psychological evaluation.
Michael Werner, urologist and medical director at Maze Men’s Sexual and Reproductive Health
To help people understand the benefits of ED treatment and the best options available to them, we’ve made it our job to study, test, and review online erectile dysfunction medication platforms. Let us show you exactly how we do it.
Why HelpGuide cares about sexual wellness
Four out of 10 men in their 40s experience erectile dysfunction (ED), and it becomes more common with age. That means a staggering number of men don’t feel satisfied with their ability to perform sexually. We know this can lead to performance anxiety, less intimacy, tension in a partnered relationship, low self-esteem, depression, increased stress, and even increased absenteeism at work.
“All of these things have been described in patients that I’ve seen and treated with erectile dysfunction,” says urologist Fenwa Milhouse. “Feeling less of a man, feeling less worthy, feeling less like an individual and the person they once were.”
If that sounds like you, there’s nothing to be ashamed about. And you’re certainly not alone. We, the Handbook Team, want to shed light on this topic, help you feel comfortable addressing it, and encourage you to seek help for this highly treatable issue. Ignoring erectile dysfunction means ignoring the impact on your physical and mental health—and the ED may only get worse.
The relationship between these mental health conditions and ED can be cyclical. ED can be a source of considerable anxiety and stress for individuals, leading to a self-perpetuating cycle where the fear of experiencing ED again exacerbates the problem.
Rhiannon John, certified sexologist
Fortunately, there’s good news. Oral medications for ED, such as Viagra (sildenafil) and Cialis (tadalafil), are now available in generic forms, making erectile dysfunction treatment far more affordable than it was even five or six years ago. The recent popularity of online telehealth platforms also means you can request a prescription for ED medication without visiting a doctor or pharmacy in person. This is a solution for people who may feel embarrassed discussing their sexual health with a doctor or collecting this prescription at the pharmacy, and it’s also safer than turning to “gas station” remedies. These are unregulated supplements often found in dispensers inside the bathrooms of gas stations, and they have been known to contain hidden ingredients.
But not all of these platforms use the same screening process, charge the same prices, or let you directly message your provider. We don’t want you to feel frustrated and hampered by low-quality platforms or misled by false information all over the internet. We want to make it easy to feel like yourself again.
Who are we?
The Handbook Team is a group of medical reviewers, writers, editors, designers, and fact-checkers who have spent years perfecting the art of testing and reviewing health products.
We mystery-shopped more than 25 online ED medication platforms, interviewed more than 20 urologists, sexologists, pharmacists, and psychologists, read dozens of academic journal articles, ran a focus group, and surveyed 360 real people about their experiences with erectile dysfunction. We got really comfortable with this topic and encourage you to do the same by reading our guides and reviews.
What goes into our review process?
Professional insights
We know it’s not easy to talk about erectile dysfunction, so we asked the tough questions for you. We interviewed experts in the fields of urology, pharmacology, sexology, psychology, and general medicine to learn what causes erectile dysfunction, how it’s treated, and how it affects your physical and mental health.
One thing I always like to recommend is that they do whatever they can to get their diabetes, blood pressure, or weight under control to try to treat the underlying causes of ED. Certain medications could also cause ED, like hypertensive medication.
Alexander Sankin, urologist at Montefiore Medical Center
Our questions also focused on PDE5 inhibitors—a class of oral medications commonly used to treat erectile dysfunction. We asked whether people better tolerate Viagra or Cialis, whether the generic versions of these drugs are just as effective, and why it may not be safe for some people to take PDE5 inhibitors at all.
For occasional use, most individuals initiate treatment with sildenafil (Viagra). In the case of regular or daily use, tadalafil (Cialis) may be a more suitable option. Tadalafil has been shown to last longer than other ED medications and is especially helpful for men who don’t respond to as-needed medications.
Monica Amin, pharmacist at Marley Drug
We also asked for experts’ honest opinions about whether it’s safe to get an ED prescription online. Their answers helped us refine our review criteria and place extra emphasis on screening questions, patient education, and affordability when reviewing online ED medication platforms.
A lot of men are so anxious about coming [to the physician], but they’re spending a fortune on mail-order services. If they were to compare milligram per milligram what they’re paying, they’d be totally shocked.
Michael Werner, urologist and medical director at Maze Men’s Sexual and Reproductive Health
After video conferencing with multiple urologists, we had one key takeaway: It’s okay to talk about erectile dysfunction. Urologists are completely at ease talking about how penises work, and they don’t mind your questions. Sure, it may be awkward to say the first few words—we stuttered a few times, too—but the embarrassment decreases with every conversation.
Literature reviews
The internet is full of misinformation about sexual health, so it’s important to get facts and statistics from reputable sources. But it’s not always easy to access or understand academic studies, especially when you’re short on time. Our reviews and articles offer an easy alternative—accurate summaries of scientific literature, well-documented statistics, and insights about erectile dysfunction from physical and mental health perspectives. Medical experts review all our pieces to make sure we have correctly interpreted each study.
To date, the Handbook Team has read more than two dozen academic studies in journals like the International Journal of Impotence Research, The Urologic Clinics of North America, Sexual Medicine, and Research and Reports in Urology to provide meaningful context for our reviews and prepare for expert interviews.
Surveys
We surveyed 360 men age 35 and older who have used an online ED medication platform. We wanted to learn why they chose a telehealth provider and what policies or features they looked for when signing up. By understanding real people’s motivations and concerns, we can focus on what matters most in our reviews.
We also wanted to hear about the mental health impacts of erectile dysfunction from people who have experienced it first-hand. The majority of respondents reported feeling ashamed of their sexual dysfunction before being treated and hesitant to talk to their primary care provider about it.
However, an incredible 76 percent said their self-esteem improved after treatment.
These survey results underscore the importance of de-stigmatizing erectile dysfunction and its treatment. One conversation with a health care provider could significantly improve your quality of life, and online platforms make that conversation less intimidating. By reviewing these platforms, we hope to make it even easier for people to find a comfortable and safe way to seek ED treatment.
Focus groups
To hear candid reactions from men who have gotten ED medication online, we conducted a focus group with seven participants. These men echoed the feelings of shame and stigma reported by our survey respondents and confirmed that treating their ED improved their confidence and relationships.
It was one of the hardest conversations. It was very awkward to get it going. And then, once we finished, I thought I should have done that a long time ago. What was I waiting for?
Focus group participant on talking to his doctor about ED
It wasn’t just about how I was feeling. It was also about how my wife was feeling because she’d start thinking, ‘I don’t turn you on anymore,’ or, ‘What’s the problem?’ And then I’d be sort of embarrassed to be like, ‘Well, it’s not you, it’s me.’
Focus group participant
Several focus group participants said they initially tried unregulated supplements that gave them unwanted side effects like headaches, a runny nose, or an erection that lasted too long. They turned to online platforms to find safe, regulated pills for ED while still prioritizing convenience.
Their journeys helped us understand the motivations and experiences of our readers, and their insights provide critical evidence in support of our message: You are not alone in experiencing erectile dysfunction and its mental health effects, and it’s okay to acknowledge and treat it.
Mystery shopping
After learning how physicians diagnose and treat erectile dysfunction and discovering what men want from telehealth providers, we mystery-shopped popular online platforms to compare features and prices.
We identified 26 websites that sell ED medication. We noted whether pricing information was available without signing up for an account, and then we completed each platform’s questionnaire. We looked for questions that aligned with the American Urological Association guidelines for diagnosing erectile dysfunction and would help a provider recommend a specific ED medication.
We valued brands with a transparent and education-centric approach, such as those that immediately tell you whether an oral ED medication may be unsafe due to your health history.
Here are some other things we noted while mystery shopping:
- Generic and name-brand medication availability.
- Membership or consultation fees.
- Delivery time and price.
- Live consultation availability.
- Insurance acceptance.
- State availability.
The five most important things to know about erectile dysfunction prescription platforms
Physicians read your health questionnaire before approving prescriptions.
Generic and name-brand ED medications are available.
ED prescriptions may cost more through online providers compared to pharmacies.
Video consultations are often available but not usually required.
State laws may prohibit the use of online ED platforms.
Bottom line
It can be hard to talk about erectile dysfunction due to a fear of shame or embarrassment, but sometimes we fear what we don’t understand. Our goal is to build up your confidence through education and encourage you to seek a safe, effective ED treatment to improve your mental health. We settle for nothing less than expert opinions and first-person experiences to make sure you get accurate, trustworthy information in our reviews.
- American Heart Association News. (11 June, 2018). Erectile Dysfunction May Be Warning Sign for More Serious Health Problems. American Heart Association. Link
- Burnett, A.L., Nehra, A., Breau, R.H., et al. (2018). Erectile Dysfunction: AUA Guideline. Journal of Urology, 200(633). Link
- Ciaccio, V. and Giacomo, D.D. (2022). Psychological Factors Related to Impotence as a Sexual Dysfunction in Young Men: A Literature Scan for Noteworthy Research Frameworks. Clinics and Practice, 12(4), 501–512. Link
- Elterman, D.S., Bhattacharyya, S.K., Mafilios, M., Woodward, E., Nitschelm, K., and Burnett, A.L. (2022). The Quality of Life and Economic Burden of Erectile Dysfunction. Research and Reports in Urology, 13(), 79-86. Link
- Feldman, H.A., Goldstein, I., Hatzichristou, D.G., Krane, R.J., and McKinlay, J.B. (1994). Impotence and Its Medical and Psychosocial Correlates: Results of the Massachusetts Male Aging Study. The Journal of Urology, 151(1), 54-61. Link
- Fode, M., Nolsøe, A.B., Jacobsen, F.M., Russo, G.I., Østergren, P.B., Jensen, C.F.S., Albersen, M., Capogrosso, P., and Sønksen, J. (2020). Quality of Information in YouTube Videos on Erectile Dysfunction. Sexual Medicine, 8(3), 408-413. Link
- U.S. Food and Drug Administration. Platinum 69000 Rhino 69 Contains Hidden Drug Ingredient. (5 May, 2023). Link