Over-the-Counter ED Alternatives to Viagra: Are They Safe?

According to a survey the Handbook Team conducted in 2023, more than two-thirds of men with erectile dysfunction (ED) feel ashamed about it and wait months before seeking medical help. It’s understandable that you may feel nervous discussing your sexual health, but avoiding your doctor only delays the start of safe, effective, and long-term treatment. You can’t get powerful pills like Viagra or Cialis over the counter (OTC), so it’s best to team up with your doctor and try proven medications to start feeling better about your sex life. 

It can be tough to ignore the allure of OTC ED pills when they’re readily accessible and claim to boost performance, stamina, libido, or size, but it’s important to remember that none of these statements are vetted by the FDA. In fact, the FDA has found dangerous hidden ingredients in some OTC erectile dysfunction pills, including over 25 Rhino products, a common brand of male sexual enhancement drugs. Men from a focus group we hosted also reported intolerable side effects from so-called gas station pills (which are male enhancement pills purchased from gas stations).

Our recommended ED treatment platform

There’s some evidence that dietary supplements can support erectile function, typically by increasing testosterone. However, their success may depend on the root cause of your ED, and many aren’t safe for individuals with high blood pressure, diabetes, and other health concerns that commonly overlap ED. That’s why it’s critical to get your doctor’s approval before taking any OTC supplements for ED—even herbal ones.

Below, we’ll give you the pros and cons of some popular ED supplements, explain which OTC ED treatment options are considered safe and effective, and talk you through the difference between in-person and online ED care to help you make an informed decision.

The HelpGuide Handbook for OTC ED treatments

If you only learn five things about OTC ED pills, here’s what you need to know:

OTC ED Treatments

Viagra, Cialis, Levitra, and Stendra are not available over the counter.

OTC ED pills, including dietary supplements, are not as effective or safe for long-term use as prescription pills.

Vacuum erectile devices and Eroxon Stimgel are effective OTC ED treatments.

Making lifestyle changes can improve ED without medication.

The best way to treat erectile dysfunction is by visiting your doctor.

Can you get over-the-counter Viagra?

No, Viagra (sildenafil) is not available over-the-counter in the United States. Viagra requires a prescription because it’s dangerous when taken with certain medications (like blood pressure meds or nitrates) or by people with certain medical conditions (like heart disease). 

You may see misleading online advertisements from companies claiming to sell OTC Viagra. In reality, these are just telehealth platforms that allow you to request a Viagra prescription from an online provider. Although this process is simpler than visiting your doctor in person, it doesn’t make Viagra an OTC drug. We recommend you avoid these sites and pursue more reputable telehealth platforms, like Hims, so you can ensure the medication you receive is the right solution for your needs.

Top erectile dysfunction prescription treatments

Pills known as PDE5 inhibitors are the first course of treatment most doctors prescribe for people with ED. These include:

• Viagra (sildenafil).
• Cialis (tadalafil).
• Levitra (vardenafil).
• Stendra (avanafil).

If these medications don’t work or produce intolerable side effects, your doctor may prescribe penile injections or urethral suppositories. You may also need testosterone therapy or surgery. 

To learn more, read our full guide to erectile dysfunction diagnosis and treatment.

Compare prescription ED treatments

*Cost per pill varies based on prescription strength and quantity

Get an erectile dysfunction prescription online

Sometimes it’s easier to discuss ED with a telehealth provider. Online platforms like Hims allow you to request an erectile dysfunction prescription and have it discreetly shipped to your door every month. 

To get started, you need to fill out a health survey, indicate your preferred medication (usually Viagra, Cialis, or their generic counterparts), upload a photo ID, and supply your payment information. A doctor then reviews your information, schedules a phone or video consultation if needed (or required by law), and either approves, modifies, or rejects your prescription request.

Although convenient, these online platforms typically charge premium prices for ED medications. Talking to your regular doctor and bringing the prescription to your preferred pharmacy can save you money in the long run.

The Handbook Team has reviewed online ED medication platforms’ policies, prices, and customer service features to help you choose one that meets your needs. Here are some of the best options:

• Hims.
• Sesame.
• Roman.
• Motivated.
• BlueChew.

OTC erectile dysfunction supplements

This section on herbal supplements for ED has also been medically reviewed by Vanessa Ling, a licensed naturopathic doctor, certified nutrition specialist, and HelpGuide Handbook writer. 

Although the American Urological Association (AUA) also hasn’t approved any supplements to treat ED, scientists have studied quite a few herbs and amino acids to see if they can improve ED symptoms. In 2023, researchers from the University of Padova summarized the findings of studies exploring the relationship between supplements and ED. They concluded only eight dietary supplements improve erectile dysfunction:

• Yohimbe (Corynanthe johimbe or Pausinystalia johimbe).
• Ashwagandha (Withania somnifera).
• Tongkat ali (Eurycoma longifolia).
• Asian ginseng (Panax ginseng).
• Puncture vine (Tribulus terrestris).
• Saffron (Crocus sativus).
• Maritime pine (Pinus pinaster).
• L-arginine.

Below, we’ll also discuss Vitamin D based on a recommendation from a member of our medical review board.

Warning

Some of these supplements are associated with serious adverse effects and aren’t safe to take long-term. In some cases, overdoses can cause death. Your health status and current medications could increase the risks associated with these supplements. Talk to your doctor before starting any dietary supplement.

Wesley Yip, a urologist and assistant professor at City of Hope in Duarte, California, says most urologists don’t recommend OTC supplements for ED. “They are typically unregulated, and we never really know what goes into the products,” he says. “There’s anecdotal evidence behind a lot of them, but their safety and efficacy have not been thoroughly vetted.” 

To give you an idea of what’s out there and the risks involved, we’ve summarized the pros and cons of the supplements believed to be most effective for ED. But you should always consult your doctor before taking them. We realize some people may be looking into OTC erectile dysfunction treatments because they don’t feel comfortable talking to their doctor about sexual health. In that case, consider calling a local pharmacy or using a telehealth service to double-check whether the supplement is safe for you. 

It’s also important to exercise caution when combining supplements because some have similar side effects that may build on each other. A medical professional can check for any dangerous interactions. If they say it’s okay for you to take the supplement, ask for advice on sourcing a quality product. For starters, look for brands with certifications like cGMP, NSF, or USP. 

According to our survey

According to our survey of 360 men with ED, 35 percent tried treating their symptoms with supplements before being diagnosed by a provider.

Yohimbe (Corynanthe johimbe or Pausinystalia johimbe)

Warning

Yohimbe may cause heart attacks, seizures, and other serious adverse reactions.

The evergreen yohimbe tree grows in central and western Africa, where its fibrous bark has traditionally been used to treat low male libido. The Western world evaluated yohimbine—one of the plant’s main compounds—as a potential treatment for ED as early as 1987 when one study declared it as effective as sex therapy and marriage counseling in treating ED. Another 1987 study concluded that yohimbine had only “modest effectiveness” on ED. 

Yohimbe bark and its extracted compounds have been known to cause adverse side effects, including rapid heartbeat, anxiety, headaches, gastrointestinal distress, hypertension, allergic reactions, dizziness, heart attacks, and seizures. However, some studies suggest that yohimbine is generally well-tolerated and that adverse effects are rare. Proper dosing may lower the risk of side effects.

Unfortunately, it can be difficult to get the proper dose of yohimbine through an OTC supplement. In 2015, scientists tested the actual content of yohimbe supplements against their labeled ingredients and found alarming disparities, with some supplements containing 147 percent more yohimbine than advertised. This may explain why an analysis of the California Poison Control System found an increase in calls related to herbal yohimbine between 2000–2006.

Yohimbine shouldn’t be taken by people with cardiac disorders, high or low blood pressure, kidney or liver disease, mood disorders, ulcers, or glaucoma. 

Ashwagandha (Withania somnifera)

Warning

In rare cases, ashwagandha has been linked to liver failure.

Native to India and Southeast Asia, the ashwagandha shrub is also called Indian ginseng or winter cherry. It has a variety of uses in traditional Ayurvedic medicine, including as an aphrodisiac. It’s also believed to have stress-reducing and brain-enhancing effects, and contemporary studies support these claims. 

One study found ashwagandha root extract increased testosterone levels in men, which implies it could be useful in treating ED caused by low testosterone. However, no follow-up studies have confirmed this.  

Another study investigated whether ashwagandha could improve ED caused by psychological factors like anxiety, depression, and stress. No difference was found between the people who received the placebo and those who received ashwagandha. This doesn’t rule out ashwagandha as a supportive herb for ED with physical causes, though. 

Ashwagandha has been linked to liver disease in a small number of people after being taken in unknown quantities for two to 12 weeks. It should not be taken with benzodiazepine, barbituates, or anticonvulsants or by people with hyperthyroidism or hormone-sensitive prostate cancer. Most people tolerate ashwagandha well for about three months. Common side effects include gastrointestinal upset, nausea, and drowsiness.

Tongkat ali (Eurycoma longifolia)

Warning

Tongkat ali is not recommended for people with diabetes; heart, kidney, or liver disease; sleep apnea; or hormone-sensitive prostate cancer.

Tongkat ali is also known as longjack or Eurycoma longifolia. Native to Southeast Asia, it’s been dubbed “home-grown Viagra” in Malaysia thanks to its effect on erectile dysfunction. That nickname isn’t far from the truth—scientists detected a compound in tongkat ali that’s structurally similar to sildenafil, the active ingredient in Viagra. 

Studies have also demonstrated tongkat ali’s effect on other aspects of male sexual health, such as testosterone levels, sperm motility, and semen volume.   

Side effects of E. longifolia aren’t well-documented but may include insomnia, irritability, restlessness, headache, mild fever, or a rash. Taking tongkat ali with other immune-suppressing medications or supplements increases the risk of infection. Like other supplements that can increase testosterone, tongkat ali shouldn’t be taken by men with hormone-sensitive prostate cancer. You also shouldn’t take it if you have diabetes, heart disease, kidney disease, or sleep apnea.

Asian ginseng (Panax ginseng)

Warning

Asian ginseng should not be used with several types of medications, including those that treat high blood pressure, diabetes, and depression.

Panax ginseng is found in the Korean peninsula and China, earning it the common names Asian ginseng and Korean red ginseng. In Traditional Chinese Medicine, Asian ginseng is considered a cure-all. It’s also been identified as an adaptogen thanks to its ability to regulate the body’s response to stress. 

Several studies show Asian ginseng has a slight to significant effect on erectile dysfunction, libido, and premature ejaculation. Symptoms can improve after taking this supplement for just four weeks.  

Side effects of Asian ginseng include insomnia, headache, anxiety, euphoria, poor appetite, gastrointestinal issues, high or low blood pressure, breast pain, and increased heart rate. Taking Asian ginseng with food is recommended to avoid a sudden change in blood sugar. 

You shouldn’t take Asian ginseng if you also take these medications:

• ACE inhibitors (a type of blood pressure medication).
• Insulin and other diabetes medications.
• Calcium channel blockers (a type of heart and blood pressure medication).
• Immune-suppressing drugs.
• Stimulants, including ADHD medications and caffeine.
• MAOIs (a type of antidepressant).
• Blood-thinners.
• Morphine.
• Diuretics.
• Medications metabolized by the liver.

Puncture vine (Tribulus terrestris)

Warning

Long-term use of T. terrestris can cause liver and kidney problems.

Tribulus terrestris—also known as caltrop, gokshura, or puncture vine—is a small yellow-flowered plant found in dry climates throughout the world. Puncture vine has long been used in traditional medicine as an aphrodisiac, fertility booster, and a tonic for sexual dysfunction in men and women. 

Studies show mixed results on the usefulness of T. terrestris for treating ED. Some evidence suggests puncture vine increases testosterone production through a compound called protodioscin, allowing it to improve ED caused by low testosterone. Other studies have found no difference between Tribulus and a placebo, and others suggest puncture vine supplements decrease testosterone production in men with sufficient testosterone levels.

If you believe your ED is caused by low testosterone and you hope to replicate the positive results of some studies, scientists recommend finding a supplement that uses Bulgarian Tribulus leaf extracts. Varieties from elsewhere in the world may not be as potent, and the leaves contain more protodioscin than the roots or fruits. 
Tribulus is believed to be well-tolerated when taken for about 12 weeks. Long-term use of this herbal supplement can cause liver problems. It can also cause gastrointestinal side effects and shouldn’t be taken with diuretics, high blood pressure medications, or anticoagulants. People with diabetes should also avoid taking T. terrestris supplements due to its effect on blood sugar. 

Saffron (Crocus sativus)

Warning

Saffron is poisonous or fatal in high doses.

The red “threads” of the saffron crocus, or Crocus sativus, are a popular culinary spice that also shows promise as a treatment for ED. A 2009 study found that saffron supplements increased the rigidity of nighttime erections in as little as 10 days. Another study found that saffron effectively treated ED caused by fluoxetine (Prozac). More recent studies have also shown that saffron may be able to treat ED. 

These positive results may have to do with saffron’s ability to support the cardiovascular and nervous systems, which must be healthy for men to get and maintain an erection. Research shows that saffron can also help people manage depression and anxiety, which can also contribute to ED.

Some people are allergic to saffron. Taking too much can be poisonous, with fatal results at extremely high doses. When taken in smaller amounts, side effects can include dizziness, drowsiness, nausea, headache, appetite changes, dry mouth, and anxiety. Like many other herbs on this list, saffron shouldn’t be taken by people with heart conditions or low blood pressure. It can also cause euphoria in people with mood disorders. 

Maritime pine (Pinus pinaster)

Native to Mediterranean Europe, Pinus pinaster is a tree commonly known as maritime or cluster pine. Its bark contains a compound called pycnogenol, which has been shown to improve erectile function with relatively few side effects. Some people report gastrointestinal discomfort, nausea, dizziness, or headache when taking pycnogenol.

Whereas other herbal supplements can raise blood sugar levels, P. pinaster extracts do not, making them a potentially safer choice for people with diabetes. However, this supplement may interact with some diabetes medications, so don’t start taking it without talking to your doctor. 

People with autoimmune and bleeding disorders shouldn’t take maritime pine supplements. Immune-suppressing drugs and anticoagulants may also interact with P. pinaster. 

L-arginine

Warning

L-arginine supplements can induce asthma attacks and herpes outbreaks in some people.

L-arginine is an amino acid that allows the body to produce nitric oxide, a critical chemical for erectile health. During arousal, the nitric oxide is released in the penis, causing blood vessels to relax and widen. An erection occurs as more blood flows through the vessels. 

Without sufficient L-arginine, the body can’t create enough nitric oxide to dilate the blood vessels in the penis. So, perhaps it’s no surprise that some studies show L-arginine supplements improve erectile function in people with mild to moderate ED. 

However, other studies suggest that L-arginine supplements work no better than a placebo.  

It may be necessary to take this supplement in high doses and for relatively long periods of time to see improvements in ED symptoms, which could explain why research gives contradictory results.

L-arginine is generally safe for most people, but you should consult your doctor before taking it if you take blood pressure medication; have allergies, asthma, or a history of cold sores or genital herpes; or have recently had a heart attack. Side effects of L-arginine supplements can include nausea, gastrointestinal discomfort, headache, gout, an allergic response, or an asthma attack.

Vitamin D

Warning

Too much vitamin D can cause kidney stones and dehydration.

Vitamin D is a hormone that’s produced by the body whenever our skin comes in contact with the sun’s UV rays. We also consume a small amount of Vitamin D in fatty fish and fortified processed foods. Vitamin D aids in the development of an erection by helping to stimulate the production of nitric oxide, the compound responsible for relaxing blood vessels in the penis so that blood can flow in. 

Studies have found that people with vitamin D deficiency are more likely to experience erectile dysfunction, and it may be linked to low testosterone and male infertility too. Jonathan L. Davila, a urologist at Northwell Health in Staten Island, New York, routinely checks vitamin D levels in patients with ED. “In doing this, I have found the incidence of vitamin D deficiency to be quite common in most patients with ED and/or testosterone deficiency,” he says. 

While a prescription is required for a form of the vitamin called D2, Davila says he also routinely recommends an OTC vitamin D3 supplement for people with a deficiency. Too much vitamin D in your bloodstream can cause side effects like kidney stones, dehydration, nausea, vomiting, and confusion, so monitoring your levels through routine blood work is important. 

Other non-prescription erectile dysfunction treatments

Most erectile dysfunction treatments require you to tell a doctor or therapist about your sexual health. Below, we’ve listed the few ED treatment options you can pursue without a prescription and without talking about your sex life—though we encourage you to do so.

Lifestyle changes

Vascular disease is the leading cause of ED. An erection’s hardness depends on how much blood flows into the penis and stays there. Leaky or weak blood vessels create erectile dysfunction. 

Fortunately, the vascular system can heal through a commitment to lifestyle changes. We’ll share some tips below, but developing a personalized game plan with your doctor is smart.  

Quit smoking

Smoking cigarettes makes you 1.5 to two times more likely to develop ED. According to several studies, kicking the habit improves ED symptoms within six to 12 months for 25–54 percent of smokers. Nicotine damages blood vessels, so quitting smoking gives them a chance to heal. 

Read our guide on how to quit smoking.

Eat a heart-healthy diet

Foods high in cholesterol and saturated fatty acids can damage blood vessels by sticking to the interior walls, effectively narrowing the vessels and reducing the amount of blood that can flow through them. Too much salt can raise blood pressure, and a sugar-laden diet can lead to chronic inflammation in the heart and blood vessels.  

Therefore, a heart-healthy diet emphasizes foods low in cholesterol, saturated fats, salt, and sugar. These include fresh fruits, vegetables, legumes, whole grains, nuts, olive oil, fish, and skinless poultry. Researchers have identified the Mediterranean diet as particularly good for erectile dysfunction because it incorporates many of these ingredients, allowing the vascular system to heal. 

Exercise

Physical activity has been shown to improve erectile dysfunction in multiple ways: improving cardiovascular health, decreasing stress and symptoms of depression and anxiety, improving body image, and increasing testosterone production. 

The current edition of the Physical Activity Guidelines for Americans recommends that the average adult engage in at least 150 minutes of moderate aerobic exercise and two days of strength-training exercise per week. To ensure that you don’t overdo it, talk to your doctor before starting an exercise program. 

Vacuum erectile devices

Also called penis pumps, vacuum erectile devices (VEDs) are available over the counter and allow you to get an erection within minutes. After placing a tube over the penis, you squeeze a pump to pull air out of the tube. This creates a vacuum that draws blood into the penis. A ring at the base of the penis keeps the blood in place, but it should be removed within 30 minutes to avoid bruising. 

Eroxon Stimgel (MED3000)

MED3000, also called Eroxon Stimgel, is a relatively new OTC treatment for ED. A pea-sized amount of gel is applied to the head of the penis, where it stimulates nerve endings as it evaporates. It should lead to an erection within 10 minutes.  

Eroxon is safe to use with latex condoms and lubricants. Reported side effects include headache and a burning sensation on the penis. It’s safe to use without a condom and before oral sex. 

“It works by temperature changes, which dissipate pretty quickly,” says Yip, noting that, according to Eroxon’s safety data, only 0.5 percent of female partners reported a minimal burning sensation from the product. 

Talk to your doctor about erectile dysfunction medication

OTC erectile dysfunction pills and supplements promise convenience but don’t offer fast, reliable, or safe results. The best solution is to talk to your doctor about your ED symptoms. They’ll consider your other medications, health concerns, and the cause of your ED to recommend a safe treatment plan.

According to the urologists we’ve interviewed, most will recommend lifestyle changes to control ED long-term. However, they usually aren’t opposed to starting patients on a PDE5 inhibitor like Viagra or Cialis to give quick, confidence-boosting results. These pills are also considered safe to take long-term, although there’s a risk of developing psychological dependence on them. In contrast, it can take weeks for dietary supplements to improve ED, and information about long-term safety often isn’t known. 

We know it’s awkward to talk about erectile dysfunction, but it’s the best way to get help. Something that’s critical to your identity, self-esteem, and well-being isn’t working right, and you deserve an effective, safe treatment. OTC ED pills don’t meet that criteria.

From our focus group

In researching erectile dysfunction, we ran several focus groups to fully understand all the ways it can affect those experiencing symptoms and how they go about treatment. We learned many men aim to self-treat ED through over-the-counter medications that are not FDA-approved and may make promises they can’t fulfill or even have dangerous side effects.

I’d go get the Rhinos, but it seemed like I was just getting sick and [my] mouth was watering all the time.

Focus group participant

It started with the gas station things. You go to the gas station like, ‘Oh, let me see if this works.’ And then it blows your head up, and you’re like, ‘Oh, it worked, but I can’t, I’m gonna die.’

Focus group participant

HelpGuide Handbook’s erectile dysfunction testing methodology

The Handbook Team tested 26 telehealth platforms that offer prescription medication for erectile dysfunction. Our team acted as mystery shoppers to compare each platform’s screening process, navigation, cost, delivery time, and restrictions. Our testers completed the sign-up process, filled out questionnaires, clicked through all educational information, and noted available medications and dosages. 

To learn about what happens after someone submits their information to a provider, our team also surveyed 360 men who have purchased erectile dysfunction medication online. The team also held multiple focus groups with real users to get more candid responses about the effects of erectile dysfunction treatment.

To learn more about how we review ED medication platforms and treatments, read our full erectile dysfunction methodology.

Frequently asked questions

Can you get Viagra without a prescription?

No, Viagra (sildenafil) is only available with a prescription in the United States.

Can I fix my erectile dysfunction naturally at home?

You may be able to improve vascular-based erectile dysfunction by adopting a healthy diet, following a moderately intense workout schedule, and quitting cigarettes. Reducing stress, learning more about sex, and improving communication with your partner can improve ED that’s rooted in anxiety and other psychological factors. 

You should always talk to a doctor because your erectile dysfunction could be caused by a hormone imbalance or neurological damage.

Studies show that a few dietary supplements can improve ED symptoms, but these aren’t necessarily safe to use for a prolonged period. They can also be dangerous when taken in combination with certain medications or by people with certain health conditions. Despite their OTC availability, natural supplements for ED shouldn’t be taken without approval from your doctor.

Is there anything OTC that works like Viagra for ED?

Nothing OTC works like Viagra, Cialis, and other PDE5 inhibitors for ED. Instead, you can use a vacuum erectile device or MED3000 gel to get an erection within minutes once you’re ready to have sex.

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