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This guide, like all medical-related content on this website, was thoroughly vetted by one or more members of our Medical Review Board for medical accuracy. Additionally, we extensively test, experience and order from each medical service we review. We try our best to give you unbiased, marketing-jargon-free descriptions of all the at-home health services evaluated based on the latest scientific evidence and medical standards.

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’re able to get an erection, but unable to 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.

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 also it’s not at all something that should be a source of shame or embarrassment. This is a common condition, and there are many roads that may lead to it:

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

Before you embark on an ED treatment, it’s good to talk with your healthcare provider. Of course, if you hope to use any of the prescription ED treatments, you’ll have to get a prescription from a doctor, which means the doctor 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 smart 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 best ED treatment include complimentary consultations with a physician who can help you. Here are some topics that you might discuss during a consultation.

When it comes to readily available ED medications, here are your top choices:

• Sildenafil (brand example: Viagra, available in generic form)
• Tadalafil (generic available, brand ex: Cialis, Adcirca)
• Avanafil (Stendra)

Believe it or not, all of these medications work by achieving the same effect. All of them are classified as “PDE-5 inhibitors” and they support or enhance the effects of nitric oxide in our bodies.

Here’s a comparison of our top choices.

So what does nitric oxide do? It mediates the vasodilation (widening of blood vessels) in the penis, increasing blood flow. Nitric oxide (NO) basically tells certain 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 the erection.

PDE-5 (phosphodiesterase-5) is a chemical that the body releases in order 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 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, resulting in an erection.

There are contraindications for each of the drugs (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. There are other health conditions that could make PDE-5 medications unsafe for men.

All of this is why they require a prescription. Your consulting physician will be able to 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 very safe for most men, with only very mild side effects sometimes reported.

Side effects, when they happen, 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 basic mechanism to treat ED, research confirms that these different PDE-5 inhibitors tend to produce the mild side effects to different 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.

Often known by the common brand name Cialis, tadalafil is a PDE-5 inhibitor that can be taken once per day in order to provide 18-36 hours of effectiveness. This significantly reduces the kind of planning typically involved in using other treatments like sildenafil.

Side effects with tadalafil are about as common as with sildenafil and in general 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:

• Men and their partners, in studies, prefer tadalafil to sildenafil.
• Tadalafil in studies tends to bring more pronounced psychological benefit to men, providing more sexual confidence than sildenafil.
• In a way, paying a little more for tadalafil makes sense because your window for sex is up to 18 hours per dose, compared to closer to 4-6 hours with sildenafil.

Tadalafil from our top choice, BlueChew, is considerably more affordable than the brands like Cialis that rely on it as their active ingredient. You definitely 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. But best of all, 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 its services, visit our BlueChew reviews.

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 prior to sex. If you try BlueChew (a chewable form of sildenafil), you’ll find out 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 is letting our readers enjoy a free month of treatment to see if it works for you.

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?

For some men who are familiar with Viagra, having used it before successfully, they just 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 years old. Sildenafil, meanwhile, comes in 20mg strength per pill. So it’s the same active ingredient (sildenafil), which obviously acts in the same way in the male body, but a sildenafil pill may be significantly less strong than the Viagra pill a man has used in the past.

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, much cheaper than Viagra.

Our winner here: for most men, it’s sildenafil. Sildenafil is far more economical and allows for easier tailoring of dosage. And there’s no easier, more convenient way for the uninitiated to explore this option than by starting a free trial month of sildenafil with BlueChew.

• When your free trial ends, you’ll find that BlueChew’s sildenafil comes in different subscription levels that are priced competitively.
• BlueChew’s sildenafil is chewable, which allows it to take effect often considerably faster than standard pill-form sildenafil (as quickly as a half hour rather than an hour).

However, there are also several great reasons to opt for Hims instead. Hims is a fantastic company that impresses our testers across the board. Among the reasons for choosing Hims for sildenafil:

• 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 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 couldn’t be more convenient to use Hims for ED treatment as well.
• Hims offers classic, brand-name Viagra for all of the men who want it. BlueChew doesn’t offer classic Viagra.

Visit our Hims ED review to learn more, or for a complete picture of the company, check out our full Hims review.

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 possible change of side effects.

Avanafil (brand-name Stendra) is the newest medication in the landscape of ED treatments. It is more micro-targeted to inhibit specifically the PDE-5 enzyme that relates 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 allows Stendra to make the common, mild side effects less common.

• About 1 in 10 men using the 200mg Stendra (highest dosage) report headaches, according to FDA data. Meanwhile, close to 3 in 10 men using the maximum dosage of Viagra report headache.
• Only about 4 in 100 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 is acting to help you.

This 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 other men find its effects wear off in closer to 18 hours. If you are in the latter camp, then Stendra will be better for your morning rituals because you can take a dose as you’re waking up and then be ready for fun in only 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 $175 per month. If you can afford the cost, this may be the best choice for you.

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 6 hours, which is basically on par with sildenafil/Viagra.

Prescription ED medications are a very effective and safe way for most men to treat ED. However, not all men want to take a 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 effective treatment for mild or moderate ED using a natural supplement. As with any medication or supplement, it’s very important 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 is an amino acid and something we naturally have within our bodies. Under normal circumstances, it plays a role in the production of nitric oxide, which in turn plays a key 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. In the study, men were given L-arginine for one month; nothing really 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 fully restored. A third month, using this same combination, found that over 92% of the men were having what they considered normal erections.

L-arginine supplementation is possibly unsafe for men with blood pressure problems or men who have had 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. The studies leave a fair bit to be desired in their methodologies and size, however. 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 (dehydroepiandrosterone) is a hormone that our body’s adrenal glands normally 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 the erectile dysfunction in 30% of the subjects was connected to a deficiency of DHEA. The results of this study suggest that possibly a third of men with diabetes-related ED could treat their ED using DHEA.

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 have five areas that we use for our evaluations, including:

Quality: How well does the company deliver its core service(s) and/or product(s) to the customer? Is the quality of the product or service high enough that we would recommend it to loved ones without hesitation? If not, why not?

User-friendly: How intuitive and user-friendly is the service? Does the device/program/app/website achieve a good degree of user-friendliness for its customers?

Value: Are you getting your money’s worth? Are there any hidden costs or charges? Does the company offer discounts?

Privacy: If health data is stored, will your data be stored securely? Are payments secure?

Customer support: Particularly in situations where ‘one size fits all’ doesn’t make sense, how well does the company help to make the service or product ideal for you?