If you are asking whether online erectile dysfunction (ED) services are safe, the short answer is that many are legitimate and some are not, so the checks matter. Harvard Health says a safe online medication retailer always requires a prescription from a provider, lists a U.S. address and phone number, and is licensed with a state board of pharmacy. The studies on online ED care are limited, so below you will find what they did find, what is still open, and what to ask a clinician before you use one.
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Are online erectile dysfunction services safe?
Online ED services connect you with a provider through a telehealth visit. Harvard Health explains that you fill out an online form about your health history and upload proof of identity, such as a photo of your driver’s license. A provider licensed in your state, which Harvard Health notes is not necessarily a doctor, reviews your information and can prescribe if it is appropriate. Some states require a video visit, while in others the visit can happen without video. The medicine is then mailed in an unmarked package, and Harvard Health says medical information is kept private and secure.
The convenience is real. Harvard Health says you avoid an in-person visit, which can spare you embarrassment, and follow-up visits are not required, which can make the route more cost-effective. The trade-off is the missing physical exam. An exam can reveal factors such as elevated blood pressure or Peyronie’s disease, and without one a provider cannot test for risks such as high cholesterol or blood sugar. Harvard Health also says you cannot be sure a medicine bought from an online retailer contains the correct active ingredient at the correct dose. It points to a CDC alert from October 2024 about illegal online pharmacies selling millions of unregulated, counterfeit prescription medications. It also points to the FDA’s BeSafeRx website, which has tips for making safer decisions when buying prescription medications online.
The Spokane Urology article (published July 22, 2025) cites WebMD as reporting that when researchers tested a sample of Viagra pills bought online, just 10% were even near the promoted strength.
Use this table as your checklist before you use any online service.
| What to check | What to look for |
|---|---|
| Prescription | Harvard Health says a safe retailer always requires a provider’s prescription |
| Contact details | Harvard Health says a safe retailer has a U.S. address and phone number |
| Pharmacy licence | Harvard Health says a safe retailer is licensed with a state board of pharmacy. The Spokane Urology article suggests searching the seller on the National Association of Boards of Pharmacy’s “Safe Pharmacy” directory. |
| Your health history | Harvard Health says to answer every question from the provider truthfully, accurately and completely |
What studies of online and direct-to-consumer ED care found
Few studies test online ED care directly. The table below shows the closest matches, with the design, what each one measured and what it found.
| Study | Design and size | What it measured | What it found |
|---|---|---|---|
| 2023 online CBT trial, Shanghai, China, during COVID-19, nonorganic ED | Randomized, wait-list-controlled trial. The authors list its sample size as a limitation. | 5-item International Index of Erectile Function, Rosenberg Self-esteem Scale, 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder scale | The CBT group improved from pretreatment to posttreatment in erectile functioning, intercourse satisfaction, orgasmic functioning, sexual desire and overall satisfaction. Compared with the control group, the CBT group had better self-esteem, depression and anxiety scores at posttreatment. |
| 2019 analysis of online ED supplements, Journal of Sexual Medicine | Analysis of the top 6 ED supplements on Amazon.com, plus a literature review of 413 studies on 21 ingredients | Price, ratings, reviews, manufacturer and ingredients, with reviews sorted by IIEF subtopics | Among 69 human studies, only 12 (17%) investigated supplement ingredients individually and reported improvement in ED. After filtering out untrustworthy reviews with ReviewMeta.com, reviews reporting improved erection strength fell by 77%. |
The 2023 trial is the only one in this group that tests an online service itself. It tested online cognitive behavioral therapy rather than a medicine, and the authors say its sample size and reliance on self-report data are limitations. They also write that “Online CBT clearly improved the emotional state and self-esteem of patients with ED during the COVID-19 pandemic.”
The 2019 analysis is about supplements sold online, not telehealth prescriptions. Its authors conclude that human studies of ED supplement ingredients “are limited and have yielded no definitive findings of the effects on ED.” They also advise that patients considering these products “should receive appropriate counseling, given the prevalence of disingenuous reviews and the ready availability of Food and Drug Administration-approved drug therapies.”
What is erectile dysfunction, and when should you see a doctor?
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) describes NIDDK’s erectile dysfunction overview as a condition that prevents males from getting or keeping an erection firm enough for sex. Symptoms include getting an erection sometimes but not every time, getting one that does not last long enough for sex, and being unable to get one at any time. NIDDK says ED is not a routine part of aging.
The Spokane Urology article offers a rule of thumb: if you cannot get an erection more than half the time, it may be time to discuss a treatment approach with your doctor that suits your lifestyle and overall health. MedlinePlus erectile dysfunction topic says ED can be a sign of health problems, such as clogged blood vessels or nerve damage from diabetes, and that if you have ED you should tell your doctor. A 2013 review in the 2013 Lancet review of erectile dysfunction describes ED as a strong predictor for coronary artery disease, and says cardiovascular assessment of a non-cardiac patient presenting with erectile dysfunction is now recommended.
A diagnosis, according to NIDDK, uses a medical, sexual and mental health history, a physical exam, and lab and other tests. That is the work an online intake form cannot fully replace.
What can you do about erectile dysfunction, and can it be reversed?
NIDDK says health care professionals treat the underlying causes of ED first and then focus on improving sexual function. It also says research shows a healthy diet can lower the risk of developing ED or improve ED symptoms. MedlinePlus adds that getting more exercise, losing weight or stopping smoking may also help. Whether any of this changes your erections depends on your cause, which is a question for your clinician.
The Spokane Urology article lists other options to ask about. One is a penile pump, which it describes as a device that draws blood into the penis manually with the aid of a hand pump, with a ring placed around the base of the penis to maintain the erection. Another is self-injection, where an erection-enhancing medication is injected into the base of the penis. For some men, it notes, surgical options such as vascular surgery and penile implants may be discussed. The 2019 Primary Care review notes that patients may be treated with oral, intraurethral or intracavernosal medications, vacuum devices, or a penile prosthesis. Treatment, it says, should be guided by patient preference. Among the newer areas, a ClinicalTrials.gov shockwave registration describes low-intensity shockwave therapy for ED as having shown “the potential to improve baseline erectile function but requires further study.” A registration describes a study; it is not a result.
Is there a newer pill than Viagra, and what is the latest treatment?
MedlinePlus says your doctor can offer several new treatments for ED, and that for many men the answer is as simple as taking a pill. The Spokane Urology article says the prescription erection medicines work the same way, by increasing nitric oxide in the blood, but that “each drug company formulates its pill differently, so one might differ from another in terms of how fast it works, how long it is effective, and possible side effects.” The 2018 AUA guideline calls for shared decision-making as the cornerstone of care, and says all patients should be informed of all treatment modalities that are not contraindicated as potential first-line treatments.
For new work on treatments, a 2016 Nature Reviews Disease Primers review summarizes new treatment targets and ongoing preclinical studies of new pharmacotherapies. Whether a newer option suits you is a question for a clinician who knows your health history.
If a seller says a product is 10 times more powerful than Viagra, ask for the study that made that comparison and bring it to your clinician. A comparison of strength is only meaningful if it comes from a study of that exact product.
What is the downside of tadalafil?
Tadalafil is one of the prescription ED medicines. The evidence here does not give tadalafil-specific downsides, so for its side effects, check the label or ask a pharmacist. What a registered trial on ClinicalTrials.gov’s tadalafil registration describes is how long it acts: tadalafil “has the longest duration of action among PDE5 inhibitors, with effects lasting up to 72 hours,” and it is recommended to be taken at least 30 minutes before sexual activity.
The table below is from the Spokane Urology article. It describes ED medicines in general, not tadalafil specifically.
| Area | What the Spokane Urology article (July 2025) lists for ED medicines |
|---|---|
| Common side effects | Light-headedness, body aches, headaches and indigestion |
| Vision | Retinal detachment, retinal blood clots and sudden vision loss, linked to regular ED drug use according to a report in JAMA; also light sensitivity, blurriness and problems distinguishing colors |
| Hearing | Some men who take ED meds have reported hearing loss or ringing in one or both ears within a day of taking the drug |
| Conditions that raise risk | Very high or low blood pressure, recent heart or blood vessel issues, kidney or liver disease, and retina-related eye disease |
| Interactions | Alpha-blockers (for blood pressure), nitrates, and medications that suppress the enzyme CYP3A4 |
| Dosing | The article notes that Viagra is not meant to be taken daily. Ask your prescriber how often your medicine is meant to be taken. |
Harvard Health says all medications, including those for ED, have risks and side effects, and that these risks may be higher if you have certain health conditions. Give your prescriber a full list of every medicine you take, including blood pressure medicines, before any prescription is written. If you notice sudden vision changes or new hearing loss or ringing, contact your prescriber promptly.
What about the salt trick, gummies and other supplements?
For the salt trick, read our guide to the blue salt trick for erectile dysfunction, which covers what the research says about it.
Gummies and other ED supplements are a separate route from prescription care. The 2019 analysis of supplements sold on Amazon concluded that human studies of ED supplement ingredients have yielded no definitive findings on effects on ED, so a “most effective” claim is not something this research can confirm. If you are comparing gummies, ask each maker for the study on that exact formula, with the amount of each ingredient, before you choose. For a closer look at the research, see our page on gummies for erectile dysfunction.
NIDDK says a healthy diet can lower the risk of ED or improve symptoms, and foods that lower the risk of diabetes, heart disease and obesity can also help. For more on that, see research to results.
What to confirm before you use an online ED service
- Confirm the provider is licensed in your state and the pharmacy is licensed with a state board of pharmacy.
- Confirm the seller lists a U.S. address and phone number.
- Check the medicine’s name, strength and dispensing details against the label when it arrives, and ask a pharmacist if anything differs.
- List every medicine you take, including those for blood pressure and any nitrates, and answer the health questions in full.
- Ask which symptoms need a same-day call to your prescriber.
- Check the total cost, including any consultation fee, on the service’s own page before you book. This site does not list prices.
For the wider picture, see men’s health and sexual wellness and erectile dysfunction treatment, which compares the medicines and options in more detail.
By the Clinical Research Explained Editorial Team
This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.







