Sexual health is an important part of overall health, and it’s come a long way from its history of being a taboo subject in the doctor’s office. Historically, treatments for erectile dysfunction (ED) have involved charms, animal products, and herbal formulas. (1) Today, prescription medications are the first-line treatment for ED, yet many people may still try alternate treatments before speaking to their healthcare providers. (2) “ED is usually a sign of more,” begins Dr. Neil Paulvin, DO., a multiple board-certified physician. “It is a sign of high cholesterol, hypertension, low testosterone all conditions that can shorten their lives”
Over-the-counter (OTC) treatments for ED are available without prescription. In this review, we share our findings from researching the various OTC treatments available for ED, including dietary supplements, medical devices, and lifestyle modifications.
Compare erectile dysfunction treatments
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| Hims Cialis | Ro Sparks | Giddy Health Men’s Libido Bundle | Nature’s Bounty L-Arginine | Bluechew Sildenafil Chewables | |
| Rating | |||||
| Price | $16/month | Starting at $48/month | $45.60/month (Optional subscription) | $14.25 | $20 – $90/month |
| Key ingredients | Tadalafil | Sildenafil, tadalafil | B vitamins, vitamin D, vitamin d3, vitamin E, vitamin , selenium, zinc, magnesium, ashwagandha, longjack, | L-Arginine | Sildenafil |
| Dosage | One tablet every 24 hours (as needed) | One tablet every 24 hours (as needed) | One capsule every 24 hours | Three times per day | One tablet every 24 hours (as needed) |
| Form | Tablet | Tablet | Capsule | Tablet | Tablet |
Special considerations of erectile dysfunction medication for older adults
Viagra and Cialis may be ineffective or dangerous based on your health history and current medications.
Some of the most common chronic conditions affecting older adults—including high blood pressure, high cholesterol, heart disease, and diabetes—can damage penile blood vessels and nerves, leading to new or worsening ED that doesn’t respond to Viagra or Cialis. (3, 4) Fortunately, several other ED treatments are available, including penile injections, vacuum erection devices, and a discreet penile prosthesis. (5)
ED can also appear as one of the first symptoms of cardiovascular disease, hypertension, anxiety, and other chronic health concerns. (6) If you haven’t had a physical exam within the last year, don’t try to get ED medication online. Visit your doctor in person to ensure underlying conditions are diagnosed and treated alongside ED.
Who shouldn’t take Viagra or Cialis
Viagra and Cialis shouldn’t be taken with some of the medications that are used to treat chest pain, high blood pressure, or lower urinary tract symptoms. Viagra should also be avoided in men taking protease inhibitors—a specific class of medications used to treat HIV.
Combining nitrates or alpha-blockers with ED pills may cause a severe, life-threatening drop in blood pressure, which can be associated with feeling dizzy, fainting, falling, and even death.
This is not a complete list of medications that could interact badly with Viagra and Cialis. Talk to your provider about everything you take—including recreational drugs—when discussing potential ED treatments.
Cialis and Viagra also shouldn’t be taken by people with low resting blood pressure, uncontrolled high blood pressure, inherited disorders of the eye or retina, recent heart attack or stroke, or uncontrolled heart disease.
Dietary supplements
Dietary supplements, sometimes called “food supplements” or simply “supplements,” can add vitamins, minerals, proteins, oils, or herbs to your diet.
In a survey of men with ED who have tried ED treatments online, 37% of respondents shared that they took supplements for their sexual health. Some supplements have research supporting their effects on certain groups of people with ED. However, the American Urological Association (AUA) does not recommend any supplements for treating ED, stating that these treatments are “either ineffective, not safe, or lack a sufficient body of evidence” for a general recommendation. (7)
The Food & Drug Administration (FDA) does not approve supplements for their safety or effectiveness. It’s important to talk to your healthcare provider to see if any supplements are appropriate for you.
L-carnitine
L-carnitine is an amino acid, a building block of protein. (8) Preliminary studies have shown that supplemented propionyl-L-carnitine, a form of L-carnitine, can improve ED symptoms in men with diabetes who take Viagra (sildenafil). (9) Propionyl-L-carnitine combined with acetyl-L-carnitine, another form of L-carnitine, has been shown to improve the effectiveness of Viagra (sildenafil) in men who experienced ED after prostate surgery. (8)
Forms of L-carnitine have been studied for heart conditions, nervous system damage, and thyroid disorders. Its side effects are generally mild, but high doses can cause diarrhea. People with heart, liver, or kidney disease may be at risk of side effects from taking L-carnitine, and they should especially talk to their doctor before taking it.
- Cost: $4–$47 per month online, from health food stores, or at a pharmacy
- Covered by insurance: No
L-arginine
L-arginine is another amino acid that has been studied to support people with ED. A meta-analysis of 10 clinical trials found that L-arginine helped with erectile function, and it may be helpful for cases of mild to moderate ED. (10)
L-arginine, like L-carnitine, can cause gastrointestinal problems at high doses and can lower blood pressure. It can also increase the risk of bleeding and worsen asthma. (11)
- Cost: $6–$42 per month online, from health food stores, or at a pharmacy
- Covered by insurance: No
Dehydroepiandrosterone sulfate (DHEA-S)
DHEA is a hormone produced by the body and DHEA-S is the form of DHEA in dietary supplements. It’s the precursor to several hormones, including testosterone, and it may help people with ED through this mechanism. Studies have shown that DHEA levels in the body can decrease with age, but more studies are needed to confirm its effect on people with ED. (12)
There isn’t enough information about the long-term safety of the supplement DHEA-S. (13) People with hormone-related cancers such as breast, prostate, and testicular cancer, liver disease, and diabetes should not take DHEA-S. According to some experts, DHEA-S may also cause symptoms of mania or irritability in people with a history of depression or bipolar disorder. (14)
- Cost: $3–$51 per month online, from health food stores, or at a pharmacy
- Covered by insurance: No
Dangerous dietary supplements
There are many dietary supplements marketed as “natural Viagra” or “herbal Viagra” to treat ED. These formulations can look like a blend of vitamins and minerals, but we caution against any formulation that comes with claims of male sexual enhancement.
“Gas station pills” are dubious dietary supplements that can be found outside of health care settings, like at a gas station, convenience store, or online, instead of on the shelves of a pharmacy. Among our Reviews Team’s ED survey respondents, 78% had tried a “gas station pill” at least once before seeking online ED treatment. This is concerning because the FDA frequently warns consumers about sexual enhancement OTC products tainted with ingredients not listed on the label. (15) Hidden ingredients can pose a risk to people with certain medical conditions or who take medications that can interact with the product. The hidden ingredients in these “gas station pills” are often the active ingredients in the prescription medication used to treat ED (e.g., sildenafil and tadalafil).
A study on ED supplements found that 70% of tested products contained undeclared ingredients. (16) What’s more, the products that were found to contain unlisted sildenafil, the active ingredient in the drug Viagra, had doses above the maximum recommended dose of the medication. Having unknown or large doses of any drug increases the risk of overdose or side effects.
Herbal supplements
Herbal supplements are dietary supplements primarily made of medicinal herbs that can have certain effects on the body. Herbs like ginseng, ginkgo, yohimbine, and horny goat weed have some research on their effects on ED. However, herbal products require more caution around interactions and side effects because these plants often have multiple effects on the body.
We summarize the research on a few popular botanical herbs that can be found in herbal ED supplements.
Ginseng (Panax ginseng)
Ginseng, specifically Korean red ginseng, is typically used in traditional Chinese and Asian medicine. A 2021 review of available studies found that ginseng had a minimally positive effect on ED and a low side effect profile. (17) The review also found that men who took ginseng expressed that ginseng improved their ability to have intercourse.
Side effects of ginseng include diarrhea, nausea, insomnia, headaches, and hypertension. (18) The herb can interact with caffeine, blood thinners, diabetes medications, and some psychiatric medications (such as phenelzine). You should not take ginseng if you have high blood pressure, are experiencing asthma or infections, or have nosebleeds.
- Cost: $6–$48 per bottle online, from health food stores, or at a pharmacy
- Insurance coverage: No
Ginkgo (Ginkgo biloba)
Ginkgo is an herb associated with supporting circulation and memory. (19) Because of its possible effects on improving circulation, the herb may be found in ED supplements. A review of the research on ginkgo found that its extract has no positive effects on male sexual function. (20)
Headaches and digestive symptoms are the most common side effects of taking ginkgo. Ginkgo interacts with many medications, including seizure medications, antidepressants, and blood pressure medications. It also interacts with blood-thinning drugs and may increase the risk of prolonged bleeding if taken before surgeries or dental procedures. People who have epilepsy or have diabetes are cautioned against taking ginkgo.
- Cost: $5–$39 per bottle online, from health food stores, or at a pharmacy
- Insurance coverage: No
Tongkat Ali (Eurycoma longifolia)
Tongkat Ali, sometimes called longjack or Malaysian ginseng, is a plant native to Southeast Asia that’s traditionally used as an aphrodisiac. A review of studies on Tongkat Ali extracts found a possible clinical benefit on erectile function, but more studies are needed to have a clearer answer. (21) One clinical trial found that Tongkat Ali improved erectile function in men who had lower testosterone levels due to aging. (21) “Tongkat Ali can work by lowering SHBG and raising testosterone levels,” adds Dr. Paulvin.
Tongkat Ali can cause side effects such as insomnia, irritability, and restlessness. (22) Because of its possible effects on testosterone levels, people with prostate cancer, breast cancer, diabetes, heart disease, sleep apnea, or kidney disease are cautioned against using it.
- Cost: $10–$45 per bottle online, from health food stores, or at a pharmacy
- Insurance coverage: No
Yohimbe (Pausinystalia yohimbe)
Yohimbe is a tree native to parts of Africa, and its bark has been used as an aphrodisiac. (23) The active ingredient in Yohimbe bark, yohimbine, can also be found as a prescription drug. (24) A review of the studies on yohimbine shows that it can improve erectile function in people with ED. (25) However, the National Center for Complementary and Integrative Health (NCCIH) warns that the amount of active ingredient in supplements with Yohimbe can vary and may not have the same effects as the prescription extract version. (26)
However, it’s important to note that Dr. Paulvin warns that this supplement can have serious high blood pressure and cardiac side effects.
Yohimbe has been associated with serious side effects such as heart attacks and seizures. It may also cause stomach problems, anxiety, and high blood pressure. Yohimbe can interact with medications like phenelzine (Nardil) and tranylcypromine (Parnate).
- Cost: $4–$22 per bottle online, from health food stores, or at a pharmacy
- Insurance coverage: No
Horny goat weed (Epimedium species)
Horny goat weed is used in traditional Chinese medicine to support ED. However, there’s not much research to summarize its effects on humans.
Taking horny goat weed can cause minor side effects like abdominal discomfort and nausea. (27) The herb can interact with certain medications, including blood pressure drugs and blood thinners.
- Cost: $6–$31 per bottle online, from health food stores, or at a pharmacy
- Insurance coverage: No
Maca (Lepidium meyenii)
Maca root is commonly used in Peruvian traditional herbal medicine. (28) There is limited evidence for maca’s effect on erectile function in men with mild ED. (29)
Maca isn’t recommended for hormone-sensitive conditions such as breast cancer. (30) There currently aren’t any known, published interactions between maca and any medications.
- Cost: $7–$49.69 per package online, from health food stores, or at a pharmacy
- Insurance coverage: No
Topical products
As of June 2023, the FDA has approved only one topical product for treating ED in people age 22 and older. (31) It’s a gel called Eroxon, or MED3000, and it doesn’t contain any medications. The gel is applied 10 minutes before intercourse and works by causing a cooling effect while evaporating, followed by a warming effect, causing an erection.
The gel has very few side effects: Only 3% of men using it reported a headache, and 1% reported a burning sensation in the area where the gel was applied. (32) But because of its high cost (an average of $15.63 per single-use tube) and lack of evidence for its effectiveness, we don’t recommend it as a good OTC option for ED.
- Cost: $45–$80 for a box of four single-dose tubes
Insurance coverage: No
Medical devices
Vacuum erectile devices (VEDs), also called vacuum constriction devices or penis pumps, are devices that can help achieve an erection. (33) The pump creates a vacuum to draw blood into the penis to achieve an erection. A constriction band is placed at the base of the penis to help maintain the erection.
Constriction bands, also called constriction rings or penis rings, can also be sold separately. “It helps best to maintain an erection because it keeps the blood in the penis,” explained Michael Werner, MD, founder and medical director of Maze Men’s Sexual and Reproductive Health in Purchase, New York.
Unlike dietary supplements, VEDs don’t have interactions with other medications. Learning to use the VED while minimizing side effects might take some time. Too strong of a vacuum or tight constriction bands may cause bruising or small broken blood vessels in the penis with use. For this reason, people who are taking blood thinners or who are at risk of prolonged bleeding shouldn’t use VEDs.
When prescribed by a health care provider, VEDs may be covered by some private insurance plans or Medicare plans. (34) We recommend checking with your health insurance provider to clarify what’s needed to cover a VED purchase.
- Cost: $95–$438 online
- Insurance coverage: Some
Lifestyle treatments
While not considered over-the-counter, other non-prescription lifestyle modifications can support people with ED. The American Academy of Family Physicians (AAFP) and the AUA recommend weight management, exercise, a healthy diet, and mental health support to help alleviate the symptoms of ED or address some of the factors that contribute to ED, such as cardiovascular issues. (35, 36) “Generally, anything that is going to be good for your body will be good for your penis,” explains Werner.
Lifestyle modifications recommended for ED
| Recommendations from the AAFP (37) | Recommendations from the AUA (38) |
| Increased exerciseWeight managementMental health supportSmoking cessation | Increased exerciseWeight managementMental health support Smoking cessationDietary changes |
Weight management
Higher weight in men is associated with an increased risk of ED. Men with a higher body mass index (BMI) have almost double the chance of developing ED compared to those with a lower BMI. (39) One study found that about one-third of men with obesity and ED improved their ED symptoms when they lost 10% or more of their body weight through diet and exercise. (40)
Also, one study found that people who don’t respond well to treatment with ED medication tend to be insulin resistant, which can cause excess weight gain. (41) But when given an additional drug, such as metformin, to address insulin resistance, subjects with ED had improved erectile function.
Mental health support
When psychological or relationship stress is a main factor contributing to someone’s ED symptoms, it is called psychogenic ED. In psychogenic ED, there may be no physical or biological cause of the dysfunction, but mental health support, either alone or in combination with other ED treatments, can help.
Therapy can help reduce performance anxiety, help manage stress, and promote a healthy connection with your partner. Particularly, mental health treatments like cognitive behavioral therapy, relationship counseling, and sex therapy were found to benefit people with ED. (42) And when used alone or combined with medication, group therapy can also be effective in treating ED. (43) The study found that group therapy was just as effective in reducing ED symptoms as penile injections and VEDs.
Talking to your doctor about erectile dysfunction medication
It’s estimated that more than 70% of men with ED are undiagnosed because of the stigmas of discussing their sexual health with their doctors. (44) Healthcare providers are trained to have an open and nonjudgmental approach to any health issue you may raise. Often, medical intake forms include questions about sexual health, which can help you start a conversation with your doctor.
“ED is common. With some lab work and other testing ED can usually be helped very easily,” says Dr. Paulvin. “The treatments are a combination of lifestyle changes, addressing hormone issues, and fixing medical problems.”
If you experience the following symptoms of erectile dysfunction, we recommend asking your healthcare provider about your treatment options (45):
- Not being able to get an erection any time you want to
- Not being able to maintain an erection to have satisfactory sexual intercourse
OTC treatments for ED can be accessible ways to support your condition, and it’s still important to have professional medical guidance to avoid side effects and interactions.
Get ED medication online
Telehealth visits can help more people get the care they need by overcoming geographic or transportation barriers. Attending appointments online and getting treatments delivered may save you commuting to and from your doctor’s office and pharmacy. However, online ED treatment platforms may cost more than a traditional visit. Some telehealth platforms, such as Sesame, Hims, and Lemonaid, don’t take insurance, so visits and medication delivery may cost more than in-network insurance copays.
For people who may be underinsured or uninsured or who just prefer convenience, there are a few online ED treatment platforms that can provide an ED assessment and medication delivery.
Hims
Hims is an online men’s telehealth platform that offers assessments and treatment delivery for men’s sexual, hair, skin, and mental health. For users seeking ED treatment, it starts with a health questionnaire that asks about their medical history, including any conditions or medications they may be taking.
Based on your questionnaire, you may be recommended sildenafil (generic Viagra) or tadalafil (generic Cialis). You then select how frequently you want to receive the medication, and the platform will ask for your payment information.
A licensed prescriber will determine whether you are eligible for the platform’s ED treatment. Depending on your state of residence, your prescriber may call or video call you to clarify any details about your health history. Hims offers the following prescription medication treatments for ED:
- Sildenafil (generic Viagra): Starting at $4 per pill
- Tadalafil (generic Cialis): Starting at $1.33 per pill
- Viagra: Starting at $135 per pill
- Cialis: Starting at $32 per pill
- Stendra (avanafil): Starting at $53 per pill
With Hims, you only pay for your medication and won’t be charged unless prescribed. The platform doesn’t charge for provider visits or medication delivery services. Hims does not take insurance, and its per-pill costs are generally higher than out-of-pocket costs. For example, filling a prescription for 50 mg of sildenafil can cost as low as $0.62 per pill without insurance, a six-and-a-half times cost difference. (46) However, the convenience of Hims’ telehealth and medication delivery may be worth it for some.
Through mystery-shopping the platform, our testers found it easy to get started on Hims. The live chat tool with customer service helped clarify any questions quickly. Users on Hims also have access to a provider messaging portal to ask questions about their ED treatment.
Medicare and Medicaid coverage
Generally, Medicare and Medicaid don’t cover most OTC ED treatments. Dietary supplements and topical gels are typically not covered, but some Medicare and private insurance plans may cover ED support devices like VEDs with a doctor’s prescription.
For those looking to make some lifestyle changes with professional help, nutrition services may be covered under medical nutrition therapy when recommended by a doctor.
Behavioral health benefits from Medicare, Medicaid, and private insurance plans can cover mental health support for ED without needing prior doctor approval.
As insurance coverage can vary by the plan administrator, we recommend talking to your insurance plan provider to find out which OTC options are covered.
Comparing OTC ED treatment insurance coverage
| OTC Treatment | Medicare Coverage | Medicaid Coverage | Private Insurance Coverage |
| Dietary supplements | No | No | No |
| Herbal supplements | No | No | No |
| Topical products | No | No | No |
| VEDs | Some* | No | Some* |
| Professional nutrition services | Yes* (47) | Some* (48) | Yes* |
| Mental health care (Therapy, psychiatry) | Yes (49) | Yes (50) | Yes |
How we chose the best online ED treatment platforms
Based on our expert consultations, research, and testing, we determined the following factors to be essential for our readers when signing up for an erectile dysfunction medication platform:
- Ability to conduct live calls (video or phone) with prescriber
- Ability to message prescriber through the platform
- Ability to get an ED diagnosis through the platform
- Name-brand and generic prescriptions available
- Discreet shipping
- Affordable prices for medications and consultations
- Ease of use of the app or website
Bottom line
OTC options for ED include dietary supplements, topical gels, medical devices, and lifestyle modifications. Although most have few side effects and interactions, you should get professional recommendations and monitoring for some OTC options, especially dietary supplements.
Medical professionals still consider ED medications as the first-line treatment for ED. We recommend speaking to your doctor about your ED symptoms to discuss the risks and benefits of your treatment options.
FAQs
Are OTC treatments for erectile dysfunction safe?
Some OTC treatments for ED are safe. The FDA approves treatments such as VEDs and topical gels for treating ED, and they can be safe when used correctly. Other OTC ED treatments may be less safe. Some dietary supplements, especially ones labeled for male sexual enhancement, may contain undeclared ingredients that may not be safe.
Is there an over-the-counter Viagra?
Viagra and generic Viagra (sildenafil) are not OTC medications. They’re available only with a prescription and dispensed from a licensed and accredited pharmacy. Talk to your healthcare provider to see which ED treatments are right for you.
What causes erectile dysfunction?
Erectile dysfunction can be caused by many factors affecting your blood vessels, heart, nervous system, or hormones. Conditions such as Type 2 diabetes, high blood pressure, high cholesterol, and kidney disease can increase your risk of developing ED. Injuries to the penis, spinal cord, prostate, or bladder can also cause ED. (51) Low testosterone is also a cause for ED, according to Dr. Paulvin.
Our experts
Dr. Neil Paulvin, DO.
Dr. Neil Paulvin, DO., is a multiple board-certified physician with certifications in Family Medicine, Osteopathic Manipulation, and Anti-Aging and Regenerative Medicine. His practice in Manhattan combines traditional and alternative medicine to help patients live a healthy lifestyle and perform at their best. He has helped Fortune 500 executives, Olympic athletes, top trainers, and A-list celebrities optimize their health, recover faster from injury, and improve their sports performance.
Heather Morsellino
Heather Morsellino is a freelance writer and fact-checker with over four years of experience in healthcare. She has worked as a pharmacy technician, emergency room medical scribe, and anesthesia technician in the operating room and will finish her ADN within the following year.
Vanessa Ling, ND, CNS
Fortune Recommends Writer
About Author
Vanessa Ling, ND, CNS, is a health writer, licensed naturopathic doctor, and certified nutrition specialist. She has a passion for all things that build long-term health and wellness. Her mission is to educate her patients and readers not only on the foundations of health but also on the best products and services that support whole-person wellness. She brings her clinical expertise to researching and writing stories about sleep, nutrition, and mental health. To date, she’s researched more than 95 adjustable bed models, 70 online therapy platforms, and 65 meal delivery kit brands.