online ed treatment · compared 2026
licensed telehealth providers, side by side. prescription required.
last updated: October 2026
how it works
review licensed online providers, their treatment options and how their process works.
complete a confidential medical questionnaire on the provider’s own website.
a licensed clinician reviews your health history and decides if treatment is right for you.
if prescribed, medication is dispensed by a licensed pharmacy and shipped discreetly.
top providers · 2026
chewable tablets
Chewable sildenafil and tadalafil tablets, prescribed after an online consultation with a licensed provider and delivered monthly in discreet packaging.
full-service telehealth
A telehealth platform offering generic and brand-name ED medication, with ongoing messaging access to its care team after your online assessment.
daily or as-needed
A men’s health platform with daily and as-needed ED treatment plans. The process is fully online and prescriptions are written by licensed providers.
combination formula
A compounded, prescription-only sublingual treatment that combines several active ingredients. Requires an online medical review.
multiple formats
Online consultations for a range of conditions, including ED. Several treatment formats are available where clinically appropriate.
subscription plans
Best known for hair-loss care, Keeps also offers ED treatment through an online consultation, with subscription pricing and automatic refills.
affordable generics
A prescription savings platform that also offers telehealth visits for ED, focused on lower-cost generic sildenafil and tadalafil.
* offers as advertised by each provider and subject to change. a prescription from a licensed clinician is required. scores reflect our editorial assessment — see methodology.
the VigorPath Health guide
erectile dysfunction is one of the most common health concerns men face, and it can affect men at any age. it is also something many men find hard to talk about, which is why private, online care has become so popular. the challenge is that dozens of services now offer ed treatment online, and their formats, pricing and follow-up care differ a lot.
we reviewed the main telehealth platforms available in the united states in 2026 and put them side by side above. below, you’ll find a plain-language guide to what ed is, what causes it, how the common treatments work, and what to check before you start. every provider we list requires a consultation with a licensed clinician — that’s a feature, not a hurdle.
erectile dysfunction (ed) is the ongoing difficulty getting or keeping an erection firm enough for sex. an occasional problem is normal and usually nothing to worry about — tiredness, stress or alcohol can all play a part. ed is generally considered a concern when it happens regularly over several weeks or months.
it is very common. in the landmark massachusetts male aging study, around half of men aged 40 to 70 reported some degree of ed, and the likelihood rises with age.1 the good news is that ed is one of the most studied conditions in men’s health, and there are several effective, well-understood treatments.
symptoms can come and go, or become more persistent over time. the main signs are:
diagnosis usually starts with a conversation with a clinician about your symptoms, health history and medications. if treatment doesn’t help, or if there are signs of an underlying condition, a physical exam or blood tests (for example blood sugar, cholesterol or testosterone) may be recommended.2
an erection depends on healthy blood vessels, nerves, hormones and mood all working together. a problem with any of them can contribute to ed, and often more than one factor is involved.2,3
never stop a prescribed medicine on your own — ask your clinician about alternatives.
because ed shares risk factors with heart disease and diabetes, it can sometimes be an early warning sign of those conditions. that’s one reason an honest, complete consultation matters.
the most widely prescribed ed medicines are called pde5 inhibitors. they relax the smooth muscle in the blood vessels of the penis, which allows more blood to flow in when you are sexually aroused. they don’t cause an erection on their own, and they don’t increase sex drive or testosterone — sexual stimulation is still needed.3,4
the four pde5 inhibitors approved by the fda are sildenafil (the active ingredient in viagra®), tadalafil (cialis®), vardenafil and avanafil (stendra®). generic sildenafil and tadalafil contain the same active ingredient as the brand-name versions and must meet the same fda standards, but usually cost far less.
many online providers also offer these ingredients in different formats — chewables, dissolving tablets, sublingual (under-the-tongue) products or combination formulas. some of these are compounded, meaning they are prepared by a pharmacy for individual patients. compounded medicines can be legally prescribed, but the finished products are not fda-approved, so it’s worth asking your provider what is in them and why.
tip · desire vs. performance
ed medicines help with the physical side of an erection, not with desire. if low libido is the main issue, it’s worth raising with a clinician — sleep, stress, mood, relationship factors and hormone levels can all play a part, and they are often treatable.
the table below summarises typical, label-based information for each pde5 inhibitor.4,5 your clinician will choose the medicine and dose that fits your health and needs.
| medication | common doses | starts working | lasts up to | food | good to know |
|---|---|---|---|---|---|
| sildenafil viagra® |
25, 50, 100 mg | about 30–60 min | around 4 hours | a heavy, fatty meal can delay it | the most widely used option; taken as needed |
| tadalafil cialis® |
daily: 2.5, 5 mg as needed: 10, 20 mg |
about 30 min–2 hours | about 36 hours | not significantly affected | longest window; low daily dose also available |
| vardenafil generic |
5, 10, 20 mg | about 30–60 min | around 4–5 hours | a heavy, fatty meal can delay it | similar to sildenafil; an alternative if one doesn’t suit |
| avanafil stendra® |
50, 100, 200 mg | as little as 15–30 min | around 6 hours | less affected by food | fastest onset; less widely available as a generic |
times are typical ranges and vary between people. do not take more than one dose in 24 hours or combine ed medicines unless your clinician tells you to.
no. erectile dysfunction is about getting or keeping an erection; premature ejaculation (pe) is about climaxing sooner than you or your partner would like. the two can happen together, and sometimes one leads to the other — for example, worry about losing an erection can make men rush.
pe is usually treated differently: with behavioural techniques (such as the “stop-start” method), desensitising sprays or creams, or certain prescription medicines used off-label. some online providers offer both ed and pe treatment, but they are separate prescriptions and one doesn’t replace the other.
pills are the first choice for most men, but they aren’t the only option. here is an overview of the approaches you’re likely to come across.3,4
pde5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) are the standard first-line treatment and work for most men who try them. it can take a few attempts — and sometimes a dose change — to see the full effect, so don’t judge a medicine on one try.
several telehealth brands offer the same active ingredients as chewable, dissolving or sublingual products, sometimes combining more than one ingredient. they can be more convenient, but the active ingredient is what does the work. if a product is compounded, ask about the ingredients and doses.
in 2023 the fda authorised an over-the-counter topical gel (eroxon®) that is applied shortly before sex. it works through a physical cooling and warming effect rather than as a drug, and some users report mild local irritation.
a plastic cylinder and pump draw blood into the penis, and a ring at the base helps maintain the erection. they are drug-free and can be used alongside other treatments. the ring should not be left on for more than about 30 minutes.
medicines such as alprostadil can be injected into the side of the penis or inserted into the urethra. they work quickly and don’t depend on arousal in the same way pills do, so they are often used when pills don’t work. a clinician will teach you how to use them safely.
low-intensity shockwave therapy aims to improve blood flow by encouraging new blood vessel growth. research is ongoing and results are mixed; urology guidelines rate the evidence as limited and treat it as an option only for some men with blood-flow-related ed. it is usually paid for privately.
testosterone treatment can help when blood tests confirm low testosterone, and may improve the response to ed pills in those men. it isn’t an ed treatment for men with normal levels and requires ongoing monitoring.
a surgical option for men who haven’t responded to other treatments. implants have high satisfaction rates but are permanent, so they are usually considered last.
there are no fda-approved over-the-counter pills for ed. evidence for most herbal and amino-acid supplements (such as l-arginine, l-citrulline or ginseng) is limited or mixed. the fda has repeatedly warned about “male enhancement” products that contain hidden prescription drugs, which can be dangerous if you take nitrates or have heart problems.6
regular exercise, a healthier weight, better sleep, less alcohol and stopping smoking can all improve erectile function and overall health. when stress, anxiety or relationship issues are involved, talking therapy or sex therapy — alone or with a partner — can be very effective, often alongside medication.
pde5 inhibitors are well studied and generally well tolerated, but they are not right for everyone. common side effects are usually mild and short-lived:4,5
do not take ed medicine if…
you take any form of nitrate (for example nitroglycerin for chest pain) or the drug riociguat — the combination can cause a dangerous drop in blood pressure. extra care is also needed with alpha-blockers, some heart and liver conditions, and after a recent heart attack or stroke. seek emergency care for chest pain during sex, sudden vision or hearing loss, or an erection lasting more than four hours.
it depends on the cause. ed medicines treat the symptom rather than cure the condition, but ed is often improvable — and sometimes reversible. long-term studies have found that a meaningful share of men see their ed improve or resolve over time, particularly when underlying factors are addressed.1,3
losing weight, getting more active, managing blood pressure, blood sugar and cholesterol, stopping smoking and treating anxiety or depression can all make a real difference. a good clinician will look at the whole picture, not just write a prescription.
before you choose
licensing
legitimate services connect you with clinicians licensed in your state before any prescription is written.
safety
ed medications can interact with nitrates and other drugs. be complete and honest in your consultation.
pricing
compare consultation fees, per-dose cost, subscription terms and how to cancel before you sign up.
privacy
look for clear privacy practices, secure checkout and plain, unbranded packaging.
sildenafil
the active ingredient in viagra®. typically taken shortly before activity, as directed by a clinician.
tadalafil
the active ingredient in cialis®. available as-needed or as a low daily dose when prescribed.
lifestyle
sleep, exercise, alcohol, smoking and stress can all affect erectile function. ask your clinician.
frequently asked questions
Yes. Sildenafil, tadalafil and similar medications are prescription-only in the United States. Every provider listed here requires a medical consultation with a licensed clinician, who decides whether treatment is appropriate for you.
Yes, when it is provided by licensed clinicians and dispensed by licensed pharmacies in your state. Avoid any website that offers prescription medication without a consultation.
You usually complete a medical questionnaire about your health history, current medications and symptoms. A licensed provider reviews it, may ask follow-up questions, and issues a prescription only if it is safe and appropriate.
It depends on the medicine. Most are taken around 30 to 60 minutes beforehand, some can work in as little as 15 to 30 minutes, and low-dose daily tadalafil is taken at the same time every day regardless of timing. Follow the instructions from your prescriber.
Both are PDE5 inhibitors. Sildenafil is typically taken shortly before sexual activity and lasts several hours, while tadalafil lasts longer and is also available as a low daily dose. Your clinician will recommend what suits you.
FDA-approved generics contain the same active ingredient, in the same strength, as the brand-name version and must meet the same standards for quality and effectiveness. The main difference is usually price.
No. ED medications can interact with nitrates, some blood pressure medicines and other drugs, and may not be suitable for people with certain heart, liver or kidney conditions. Always share your full medical history with the prescribing clinician.
Not without medical advice. Taking two ED medicines together, or more than one dose in 24 hours, increases the risk of side effects such as low blood pressure. Ask your clinician before combining any treatments.
There are no FDA-approved over-the-counter pills for ED. One topical gel has been authorised for over-the-counter use, and vacuum devices are available without a prescription. Be wary of "male enhancement" supplements: the FDA has found many contain hidden prescription drugs.
Many telehealth services do not accept insurance and instead offer low-cost generics or subscription plans. Some platforms and pharmacies can work with insurance. Check each provider’s pricing page and compare the total cost, including visit fees.
references
medical disclaimer. the content on VigorPath Health is for general information only and is not a substitute for professional medical advice, diagnosis or treatment. all prescription medications require a consultation with a licensed healthcare provider, who decides whether treatment is appropriate. individual results vary. if you experience chest pain or an erection lasting more than four hours, seek emergency care.
brand names, logos and trademarks are the property of their respective owners and are used for identification purposes only. their use does not imply endorsement. offers marked * are as advertised by the provider and may change; please check the provider’s website for current terms. this site is intended for adults 18+ in the united states.