Every ED treatment.
Ranked by the evidence.
Around half of men over 40 experience it, and almost all of them can be treated. We cover every option — what the research actually shows, what it costs, and when the symptom is warning you about something more important than sex.
52%
Men 40–70 affected
Some degree of erectile difficulty, per the Massachusetts Male Aging Study.
3–5 yr
Cardiac warning window
Typical interval between ED onset and a cardiovascular event.
18
Treatments covered
Graded from strong evidence through to investigational.
0
Data we collect
Our tools run in your browser and transmit nothing.
This symptom is usually a message about your arteries.
The arteries in the penis are roughly 1–2 mm across. The coronary arteries are 3–4 mm. The same plaque burden blocks meaningful flow in the smaller vessel first — which is why erectile dysfunction is an independent predictor of heart attack and stroke, and why it typically shows up three to five years ahead of one.
That makes this a warning delivered early enough to act on. It is also why a prescription on its own is an incomplete answer.
Why this matters- Penile artery
- 1–2 mm
- Coronary artery
- 3–4 mm
- Carotid artery
- 5–7 mm
- Femoral artery
- 6–8 mm
Where are you right now?
Four common starting points. Pick whichever sounds most like you.
- 01
This is new to me
What counts as ED, what causes it, and what a proper assessment looks like.
→ - 02
Compare treatments
Every option ranked by evidence — from first-line tablets through to surgery.
→ - 03
Tablets haven't worked
What comes next when PDE5 inhibitors fail, and why most men still have options.
→ - 04
I want to spend less
Why the same generic varies tenfold in price, and how to pay the low end.
→
Graded, not listed
From first-line tablets with decades of randomised trial data behind them, through to treatments clinics charge thousands for without the evidence to justify it.
- Strong evidenceRx
Sildenafil
Sildenafil is the most-prescribed erectile dysfunction medication in the world and the one most people try first. Here is what it does, how to take it properly, what it realistically costs, and when it is not safe.
- Onset
- 30–60 minutes
- Lasts
- 4–6 hours
- Strong evidenceRx
Tadalafil
Tadalafil lasts far longer than any other ED tablet and is the only one with a licensed daily dose. That changes how sex fits into a relationship. Here is how to choose between the two regimens.
- Onset
- 30 minutes – 2 hours
- Lasts
- Up to 36 hours (on-demand) · continuous (daily dosing)
- Strong evidenceRx
Vardenafil
Vardenafil is the least-prescribed of the mainstream ED tablets, which says more about marketing than about the molecule. It is a reasonable switch when sildenafil disappoints or its side effects are intolerable.
- Onset
- 30–60 minutes
- Lasts
- 4–8 hours
- Strong evidenceRx
Avanafil
Avanafil is the newest PDE5 inhibitor and the fastest to take effect — as little as 15 minutes. Its drawback is price: it is the one mainstream ED tablet with no cheap generic in most US pharmacies.
- Onset
- 15–30 minutes
- Lasts
- About 6 hours
- Strong evidenceRx
Injections
Intracavernosal injection therapy works for most men in whom tablets have failed — success rates above 80% are typical. The barrier is not effectiveness. It is the needle.
- Onset
- 5–20 minutes
- Lasts
- 30–60 minutes
- Strong evidenceRx
Implant
A penile prosthesis has the highest satisfaction rate of any ED treatment — consistently above 90%. It is also surgical, irreversible, and the end of natural erections. Both facts are true at once.
- Onset
- Usable about 4–6 weeks after surgery
- Lasts
- Permanent, with mechanical lifespan of 10–20 years
Treat the cause, not just the symptom
A tablet restores function. Working out why it stopped is what protects the rest of your health.
Heart disease
The same endothelial damage that narrows coronary arteries narrows the smaller penile arteries first.
Read →Diabetes
High glucose damages both the small blood vessels and the autonomic nerves that trigger an erection, and lowers testosterone alongside.
Read →Low testosterone
Testosterone maintains libido and supports the nitric oxide machinery in erectile tissue; deficiency reduces desire more than it reduces blood flow.
Read →Obesity
Adipose tissue converts testosterone to oestrogen, drives inflammation and insulin resistance, and impairs the endothelium.
Read →Sleep apnoea
Repeated overnight oxygen dips damage the endothelium and disrupt the nocturnal testosterone surge.
Read →Smoking & alcohol
Nicotine and combustion products damage the endothelium; alcohol and other drugs act on nerves, hormones and central arousal pathways.
Read →Performance anxiety
Anxiety activates the sympathetic nervous system, which constricts penile arteries — the exact opposite of what an erection requires.
Read →Depression & stress
Depression reduces central sexual drive and dopaminergic signalling; chronic stress raises cortisol and sympathetic tone.
Read →
The practical questions
Dosing, safety, cost, counterfeits — and the conversations nobody prepares you for.
ED Symptoms and How It Is Diagnosed
What counts as erectile dysfunction, what a proper assessment involves, and which tests are worth asking for. Diagnosis is mostly conversation — the tests are about finding the cause.
How to Bring Up ED With Your Doctor
Most men wait years before mentioning erectile dysfunction to a clinician. Here is how to make the conversation short, unembarrassing and useful — including the exact words to open with.
What Happens at Your First ED Appointment
A walkthrough of what a first consultation for erectile dysfunction actually involves — the questions, the examination, the tests, and what you should leave with.
Talking to Your Partner About ED
Erectile dysfunction is rarely a solo problem. The silence around it usually causes more damage than the symptom — and partners are almost always drawing worse conclusions than the truth.
How Erections Actually Work
Understanding the mechanism is the fastest way to understand the treatments. Every option on this site intervenes at one specific step — and knowing which step yours has failed at tells you which option to reach for.
Morning Erections: What They Mean and What Losing Them Means
Nocturnal erections are the closest thing to a free diagnostic test you have. Whether you still get them, and how that has changed, tells a clinician more than almost anything else you can report.
Where to actually get treatment
Telehealth made ED treatment accessible. It also made it a subscription business. We review the main services — and include the route that earns us nothing, because it is frequently the best one.
Ad disclosure:We earn a commission if you buy through some links on this page, at no extra cost to you. How this works.
CoreAge Rx
2.9Men who have already tried approved generics, understand what a compounded combination is, and have discussed one with a clinician who knows their cardiac history.
Full review →Hims
4.2Men who want one account covering several men's health concerns, with a polished, low-friction experience.
Full review →Ro
4.2Men who want a clinically-oriented telehealth service and value an integrated pharmacy.
Full review →BlueChew
3.8Men who dislike swallowing tablets or want the discretion of a chewable format.
Full review →Lemonaid Health
3.9Men who want ED treated as part of general healthcare rather than through a men's-health-specific brand.
Full review →Rex MD
3.7Men who want a straightforward ED-focused service and are comparing prices across providers.
Full review →Your local pharmacy
4.4Pays us nothingAnyone who already has, or can easily get, a prescription — and wants the lowest price.
Full review →GoodRx
4.5Anyone who already has a prescription and wants the lowest cash price at a pharmacy they can walk into.
Full review →Cost Plus Drugs
4.6Pays us nothingAnyone with a prescription who can plan ahead and wants the lowest transparent price on a generic.
Full review →Amazon Pharmacy
4.0People already inside the Amazon ecosystem who want prescriptions handled the same way as everything else.
Full review →Costco Pharmacy
4.4Pays us nothingAnyone with a prescription who wants a low cash price and same-day collection.
Full review →Sesame
4.1Men who want a real consultation and a prescription they can fill anywhere, without a recurring subscription.
Full review →Teladoc Health
4.0Pays us nothingAnyone whose employer or health plan already includes it — where the marginal cost of a consultation may be zero.
Full review →
25 products, reviewed individually
A service is not one thing. The same provider may sell an FDA-approved generic, a brand-name original and a compounded formulation that never went through FDA review — at wildly different prices. Every product review shows what the same molecule costs at a pharmacy.
- Compounded2.7
4Play sublingual
Sildenafil, tadalafil, vardenafil and apomorphine — doses not published
4Play is a compounded sublingual liquid combining sildenafil, tadalafil, vardenafil and apomorphine. The pitch is fast onset and a long window. The problem is that no dose is published for any of it.
Read the review → - Generic4.8
Generic sildenafil
Sildenafil citrate
This is the number every other page on this site is measured against. What sildenafil actually costs when you walk into a pharmacy — and why it varies by a factor of ten.
Read the review → - Generic4.0
Generic sildenafil
Sildenafil citrate
The same molecule as Viagra, delivered on a subscription with a consultation included. Effective and convenient — and rarely the cheapest way to buy sildenafil.
Read the review → - Generic4.2
Generic tadalafil
Tadalafil
Generic tadalafil through Ro, in both dosing regimens. The 36-hour window is the reason most men who try both end up preferring this molecule.
Read the review → - Compounded3.8
Chewable tadalafil
Tadalafil
Tadalafil's long window in a chewable format. The better of BlueChew's two mainstream options for most men — with the same compounded caveat.
Read the review → - Generic4.6
Generic tadalafil
Tadalafil
Coupon pricing on generic tadalafil, including the daily low-dose strengths. Because tadalafil needs fewer doses than sildenafil, this is often the lowest annual cost route of all.
Read the review →
The decisions people get stuck on
- Viagra (sildenafil)vsCialis (tadalafil)
Sildenafil and tadalafil are similarly effective. The decision comes down to how long you want the effect to last, how much food matters to you, and which side effects you would rather avoid.
Compare → - Brand name (Viagra, Cialis)vsGeneric (sildenafil, tadalafil)
Generic sildenafil contains the same active ingredient, at the same strength, held to the same bioequivalence standard as Viagra — at a small fraction of the price. Here is what does and does not differ.
Compare → - Daily low-dose tadalafilvsOn-demand tadalafil
The same drug, two very different experiences. The decision is less about pharmacology than about how often you have sex and how much the planning bothers you.
Compare → - Telehealth servicevsIn-person clinician
Telehealth removed the biggest barrier to ED treatment: the conversation. It also removed the blood pressure cuff and the blood test. Both facts matter.
Compare → - HimsvsRo
The two largest men's telehealth platforms in the US operate very similar models. The differences are real but narrower than the marketing suggests — and neither is the cheapest way to buy generic sildenafil.
Compare → - BlueChewvsHims
BlueChew sells one thing — chewable ED tablets — and sells it well. Hims sells a men's health platform. The right answer depends on whether the format is what you actually want.
Compare → - Sex therapy / CBTvsPDE5 inhibitors
Medication works faster. Therapy lasts longer. The evidence for combining them is stronger than for either alone — and yet almost nobody is offered both.
Compare → - Injection therapyvsPenile implant
Both work when tablets have failed. One is reversible, cheap and requires a needle every time. The other is permanent, expensive and requires nothing at all afterwards.
Compare → - Testosterone therapyvsPDE5 inhibitors
These treat different things. Testosterone drives desire; PDE5 inhibitors drive blood flow. Confusing the two leads men to take a hormone they do not need — with consequences including infertility.
Compare → - Avanafil (Stendra)vsSildenafil (Viagra)
Avanafil works in half the time and causes fewer side effects. Sildenafil costs a fraction as much. That is genuinely the whole comparison.
Compare → - Vacuum erection devicevsInjection therapy
Both work when tablets have failed, and both work through mechanisms that do not care whether your nerves or arteries are damaged. The choice comes down to a needle against a pump.
Compare → - Shockwave therapyvsPRP / stem cell
Both are sold as regenerative cures. Both are classed as investigational by urological guidelines. One at least has sham-controlled trials behind it — which is the only reason this comparison is not a tie.
Compare →
Why you should trust any of this
Health content funded by affiliate commissions has an obvious conflict of interest. Here is exactly how we handle ours.
- 01
Sources on every page
Clinical guidelines, regulator publications and peer-reviewed research, cited and linked so you can check the work.
Editorial policy → - 02
Every paid link disclosed
Partner links are labelled where you see them, not buried in the footer, and carry the rel attributes the FTC expects.
How we make money → - 03
Ratings follow a rubric
Five weighted criteria, applied identically to every service — including the ones that pay us nothing.
Review process → - 04
Corrections in public
Substantive corrections are noted on the page. Health content that quietly edits its errors has not earned your trust.
Corrections policy →