Physician-led · Confidential · Est. 2009
ReviewsThe marketplace
Most men meet this condition through an advertisement rather than a physician. These are clinical assessments of the products in those advertisements — what is in them, what the evidence supports, and what the twenty-minute questionnaire cannot see.
Read this first
We are a competitor of the companies reviewed on this page. That is a conflict of interest and you should read everything here with it in mind. What we can offer against it: every factual claim is drawn from the company's own published material and linked, every clinical criticism applies equally to us where it applies, and no assessment on this page is for sale — the one company we carry advertising for, CoreAge Rx, is graded at our lowest tier in its own review, and those placements are labelled wherever they appear.
Looking for a shortlist?
These same reviews, cut by what you are actually deciding — the best overall, the cheapest per dose, what needs no prescription, and which services let you use your own pharmacy.
01Method
The same four questions applied to every product, including the unglamorous option we rate highest.
The molecule, the dose, and whether the finished product is FDA-approved or compounded. Compounded is not a slur — it is a specific regulatory status, and you are entitled to know which one you are buying.
Whether the thing being sold is the thing that was studied. A well-evidenced molecule in a novel combination or format is not automatically a well-evidenced product.
Whether the process could plausibly identify a contraindication or an underlying cause. A questionnaire cannot measure blood pressure, and erectile dysfunction is frequently the first symptom of vascular disease.
Total cost on the recurring plan rather than the introductory offer, compared against the same molecule from a retail pharmacy.
What the verdicts mean
Graded against approved dosing envelopes rather than opinion. Every verdict below should follow from this ladder.
02The reviews
Grouped by what each one actually is, because an approved generic and a compounded four-drug combination are not competitors in the same category and should not be read side by side as though they were.
02Benchmark
What the approved molecule costs when nobody has built a business model around it. Every price below should be read against this one.
Retail pharmacy
The default against which every product below should be measured.
The benchmark nobody advertises, because there is no subscription attached to it. An FDA-approved molecule, from a regular pharmacy, usually for less than the compounded alternatives.
03Over the counter
Exactly one product in the United States is authorised for over-the-counter sale to treat erectile dysfunction. Everything else sold without a prescription is a supplement, and we cover that separately.
Futura Medical
Genuinely non-prescription, genuinely authorised, and usable by men who cannot take PDE5 inhibitors.
The only product authorised for over-the-counter sale to treat erectile dysfunction in the United States — and it contains no drug at all, which turns out to be the most useful thing about it.
04At-home device
Devices sold direct to consumers for erectile dysfunction. These are not medicines, so they are graded on evidence and on whether their regulatory claims survive a look at the FDA's own databases.
Launch Medical
No clearance on record, no trial of this device, and the wrong kind of wave for the evidence it cites.
A nine-hundred-dollar home device sold on a regulatory status we could not find in the FDA’s own databases, borrowing evidence generated by machines it is not one of.
Encore (sold via Mayo Clinic Store)
Drug-free, mechanically effective, and usable by the men who cannot take any of the tablets.
The least fashionable thing in this entire market, bought once for the price of a month of most subscriptions, and the option with the longest regulatory paper trail behind it.
05Approved generic, prescribed online
The approved drug at licensed doses, obtained remotely. These differ mainly in what the consultation actually consists of and what you end up paying for the tablet.
PlushCare
A real consultation with a real physician, and it takes insurance.
A live video consultation with a board-certified physician, billed through insurance if you have it, with the prescription sent to whichever pharmacy you already use. The closest thing on this page to an actual medical appointment.
Walgreens
Approved generic at genuine retail pricing, behind a one-off visit fee.
A national pharmacy chain prescribing the approved generic through an online visit, then dispensing it at ordinary retail prices. The medication cost here is the number the rest of this page should be measured against.
Lemonaid Health
The only service here that tells you to know your blood pressure first.
Approved generic tadalafil prescribed after an online assessment and a message from a clinician. Notable for one line of instruction the rest of this market omits.
Approved generic, two pricing models, one async questionnaire.
Two ways to buy the same approved generic: a flat monthly subscription covering everything, or a one-off visit fee with the medication bought separately — which, given who GoodRx is, can be very cheap indeed.
RedBox Rx
Approved generic at a competitive price; the free consult is the marketing.
Approved generic tadalafil advertised from a dollar a tablet with the consultation given away free — a pricing shape worth understanding before you read it as generosity.
The approved option from a company better known for the unapproved one.
The same company that sells Ro Sparks also sells the approved generic. If you are buying from Ro, this is the product to buy — and Ro’s own page tells you why.
Amazon Health
Requires a recent blood pressure reading, and turns men away.
The only service on this page that will not treat you without a blood pressure reading. That single requirement puts it at the top of this category.
Q Care Plus
You can choose to speak to somebody, which most of this market does not offer.
A sexual-health service offering a genuine choice of consultation format — questionnaire, on-demand video, or a scheduled appointment including evenings and weekends — and it states the nitrate contraindication plainly.
Approved generic, at roughly three times retail unless you commit for a year.
The approved generic from a company whose advertising almost entirely promotes its compounded products. As with Ro, the plain option is there — you have to go looking for it.
24hrDoc
Cheapest route to your own pharmacy — and the thinnest assessment here.
A flat consultation fee, a five-minute assessment, and the prescription sent to your own pharmacy. The speed is the selling point, and it is also the thing to think about.
WebDoctors
A disciplined formulary at the highest consultation price on this page.
FDA-approved medicines only, no compounded anything, the prescription sent to your own pharmacy, and the risks published on the page. The most expensive consultation reviewed here, and the money buys something.
Superdrug Online Doctor
Likely sound in Britain. The caveat is whether you can use it at all.
A well-established British service that surfaces in American search results. Before anything else about it matters, check whether it serves you at all — the prices are in pounds and the pharmacy counter is on a UK high street.
IBSA USA
An approved dissolving sildenafil now exists. That changes this category.
The FDA approved the first sildenafil oral film in February 2026. It dissolves on the tongue, needs no water, and — unlike every compounded sublingual reviewed on this page — it has an approval behind it.
A real video consultation at the lowest price we have found for one.
A live video visit with a licensed provider from around $34, approved generics only, and the prescription sent wherever you want it. On value, this is the strongest combination on the page.
LloydsPharmacy Online Doctor
Well run, well regulated, and unavailable to American readers.
A properly regulated British service that ranks on the first page of an American search and states in plain terms that it does not serve the United States. It also offers two treatment formats Americans cannot get at all.
Hone Health
Does the diagnostics properly; the open question is what happens after the first prescription.
Bloods before prescribing, a telehealth consultation with a physician, and fertility-preserving alternatives offered rather than hidden. Most of what we complain about in this category, this one does correctly.
ZipHealth
An approved drug at an approved dose. The caveat is the two-minute consultation.
The first product on this page that is simply the approved medicine. No compounding, no second PDE5 inhibitor, no vitamin counted as an ingredient — generic tadalafil at the doses a prescriber would actually use, bought outright rather than on a plan.
06You bring the prescription
Pharmacies and price tools that fill a prescription you already hold. There is no consultation here to criticise — and none to rely on either. Judge these on price and convenience alone.
Blink Health
A dispensing route, not a diagnosis. The caveat is purely the price.
Not a prescriber at all — a pharmacy and discount platform for a prescription you already hold. That makes it the only entry here with no consultation to criticise, and none to rely on either.
The approved drug, at the lowest price on this page, with no strings.
Not a prescriber and not a pharmacy — a free coupon you show at the counter. Paired with a prescription you already hold, it is the cheapest legitimate route to this medication that we found anywhere.
ClearSpring Pharmacy
Compounding as it is supposed to work: a prescriber decides, a pharmacy prepares.
A compounding pharmacy that will not prescribe to you — it fills what your own physician writes. Included here deliberately, because it shows what compounding looks like when it is done the way it was designed to be done.
Kare Pharmacy
Prescription-gated and properly labelled — but 115mg is above sildenafil’s ceiling.
A compounded sublingual sildenafil that will not be sold to you without a prescription, and that publishes its contraindications in full. Good practice, with one strength that sits above the approved ceiling.
07Compounded combination
Products built from the same molecules but combined, re-dosed or reformulated into something no approval covers. This is where the page gets more cautious, and where the prices are highest.
Keeps
Two PDE5 inhibitors is still a pairing without evidence — but every dose here sits inside its own envelope.
Two different PDE5 inhibitors stacked in a single tablet, plus a third drug that has never been approved for erectile dysfunction in the United States. No approved product combines two PDE5 inhibitors, and there is a reason for that.
Empower Pharmacy
The unit as dispensed holds twice the approved on-demand ceiling; the safety margin is the patient cutting it correctly.
A troche containing double the approved maximum on-demand dose of tadalafil, dispensed whole, with instructions to take half of it.
Defy Medical
Testosterone does not work on demand, and a product that implies it does is describing the wrong thing.
A controlled substance combined with an ED drug in an on-demand lozenge, with no strengths published on the product page.
BosleyRx
Sensible doses, honest disclosure, and a claim about speed its own instructions contradict.
The most defensible of the combination products we have looked at — both doses sit inside approved ceilings — and still an expensive way to buy two drugs whose combination nobody has shown helps.
CoreAge Rx
Carefully divided PDE5 dosing, and a fourth ingredient with more history behind it than this market usually offers.
Four actives in one sublingual dose, and — now that we have the dispensing pharmacy’s own literature — a formulation that turns out to be considerably more conservative than its marketing lets you establish.
Defy Medical, menMD and other compounders
A combination with real clinical pedigree — and a first dose that belongs in a clinic, not a bathroom.
The cheapest dose on this entire site, the highest response rate of anything short of surgery, and the one compounded combination here with decades of urological practice behind it. It also involves a needle, and a risk you must be able to recognise.
Hims
Two PDE5 inhibitors, compounded, in a tablet that is not absorbed any faster.
The best-known chewable in this market, and the one where independent testing produced the most useful finding on this page: you chew it, you swallow it, and it is absorbed exactly like a tablet.
The combination has no approval and no trial evidence as a combination.
A compounded sublingual combining sildenafil and tadalafil in one dose. Fast and convenient by design — and, by Ro's own disclosure, not an FDA-approved product.
RocketRx
Two PDE5 inhibitors in one tablet, one of them already at its approved ceiling.
A compounded chewable pairing 20mg of sildenafil with 20mg of tadalafil. Cheaper per dose than most of the category, and more forthcoming about side effects — but it is still two drugs of one class in a tablet, sold off a two-minute questionnaire.
Hims
Two PDE5 inhibitors again, and a vitamin counted as the third ingredient.
A compounded chewable mint pairing sildenafil and tadalafil with vitamin B12 — the cheapest per dose on this page. The third of the three is the one worth thinking about.
MaleMD
Daily dual PDE5 dosing, and vardenafil has no approved daily regimen.
A compounded daily capsule pairing vardenafil with tadalafil and a small amount of citrulline. The doses are modest — it is the word 'daily' that changes the analysis, because one of these two drugs has no daily regimen at all.
BlueChew
Four actives, two of them stacked above their approved single-dose maximums.
A compounded sublingual containing four active ingredients at once, including doses of sildenafil and tadalafil above the FDA-approved maximum for either drug on its own. This is the most pharmacologically aggressive product on this page by a wide margin.
03The thing to understand
It appears in the small print of most products in this category, usually phrased as something positive — custom, personalised, tailored to you. It is in fact a regulatory status, and it is worth knowing exactly what it means before you buy on it.
A compounded medication is prepared by a pharmacy rather than manufactured under an FDA approval. Compounding is legal, longstanding and genuinely necessary: it is how a patient who cannot swallow a tablet gets a liquid, or how someone allergic to a dye gets a version without it.
What it is not is an approved product. An FDA-approved drug has been through review of its safety, its efficacy and its manufacturing. A compounded preparation has not. That does not make it dangerous; it means a layer of verification you probably assumed was there is not there.
The molecules in most of these products are excellent. That is not the same as the products being well evidenced.
The second thing worth separating is molecule from format. A combination of two PDE5 inhibitors in a fast-dissolving sublingual is a new product built from old, well-studied ingredients. The trial evidence belongs to the ingredients. It does not automatically transfer to the combination, the dose, or the route.
This is the part that gets least attention and deserves most. Because a compounded preparation sits outside the approval system, it can contain a dose no approved product contains — and the number on the label is not automatically a number anyone has studied.
For reference, the maximum approved single dose of sildenafil is 100mg. For tadalafil taken on demand it is 20mg. Those ceilings are not arbitrary; they are where the trials stopped finding more benefit and started finding more side effects. A compounded product containing more than either, or containing both together, is operating past the edge of the evidence that made these drugs first-line in the first place.
More is not better here. PDE5 inhibitors lower blood pressure as part of how they work. Stacking agents that share that mechanism stacks that effect, and the men most likely to be attracted to a stronger formulation — the ones for whom a standard dose disappointed — are frequently the men whose disappointment was caused by something a higher dose will not fix.
None of this makes the online model wrong. It makes it something you should enter with an accurate picture of what you are getting, and a dosing table is a good place to look for that picture.
04 — In fairness
It would be convenient for us to argue that the online model is simply bad. It is not, and pretending otherwise would fail the standard we hold everything else on this site to.
The barrier to treating this condition has never been the medicine. It is saying it out loud to another person. These companies deleted that step, and enormous numbers of men were treated who otherwise would not have been.
Openly, before you commit. Much of medicine still does not, and we adopted the practice on our own pricing page for the same reason.
Plain packaging, no waiting room, no receptionist. We build our clinic around the same principle.
A low-risk man with a recent physical who needs a familiar prescription refilled is well served here, and would be poorly served by paying for a full workup he has already had.
The distinction we would draw is between refilling and diagnosing. These services do the first well. They are not built to do the second, and the trouble starts when a man uses one as though they were the same thing.
On coverage
This list is not exhaustive and is not a ranking of the market. Most entries here were read directly from the company's own published pages. Where a company blocks access to those pages, the entry is built from third-party reporting instead and is labelled 'not verified at source' in the review itself — that label is a real caveat, and an entry carrying it should be checked against the company directly before you act on it. Prices and formulations in this category change constantly; check the date on each review.
Important
The information on this website is provided for general education and does not constitute medical advice, diagnosis, or treatment. Erectile dysfunction can be the first sign of cardiovascular disease, diabetes, or hormonal disorders. Always consult a licensed physician about your individual circumstances, and never start, stop, or change a prescription based on what you read here.
If you want the other thing
If you have already been assessed and just need a refill, the products above may serve you perfectly well. If nobody has taken your blood pressure in years, that is the appointment to make.
Giveaway
One reader gets 12 months of CoreAge Rx 4PLAY, free. At $114 / month, that is a $1,368 value.
CoreAge Rx is a featured partner and pays for placement. Our independent review of 4PLAY is unchanged by that.