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Our Reviews Team conducts in-depth research so we can provide a thorough, comprehensive review of the products and services we test. We spent two weeks researching 25 online erectile dysfunction (ED) treatment platforms and interviewing urologists to give you the most accurate review. To better understand the usefulness of getting an ED prescription online and accurately compare ED medications, we:
Erectile dysfunction (ED) isn’t always easy to talk about, but it’s a common condition affecting 30 million men* [1] National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Erectile Dysfunction. in the United States. Yet many find it challenging to discuss symptoms and seek treatment.
Even though ED can be easily treated, many people report waiting months or even years to seek care. Over 50% of respondents from our January 2024 survey said they lived with ED for years before they sought medical help. While taking the first step to treating ED can be difficult, doing so can be important for your physical and mental health. Untreated ED [1] National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Erectile Dysfunction. can lead to strained relationships, depression, anxiety, and low self-esteem.
“Remember that sexual health is essential to overall well-being, and seeking help for ED is a positive step toward improving your quality of life. Your sexual pleasure and satisfaction are rights that people of all ages deserve,” says Rhiannon John, certified sexologist ⓘ A specialist who studies human sexual behavior. .
If your doctor prescribes Cialis (tadalafil) for erectile dysfunction, you may want to consider generic Cialis, since it’s the same medication at a much lower price. The medication can be taken daily or as needed, and it lasts longer than Viagra. We spoke with urologists and sexual health experts to get a comprehensive understanding of tadalafil, including how it works and where you can get it.
*For brevity, we refer to all people assigned male at birth as men throughout this guide.
Tadalafil is a type of medicine called a PDE5 inhibitor used to treat erectile dysfunction, symptoms of benign prostatic hyperplasia (BPH), and the ability to exercise in people with pulmonary arterial hypertension (PAH). Tadalafil helps increase blood flow to the penis to cause an erection. [5] MedlinePlus. Tadalafil.
Tadalafil is the active ingredient in Cialis. Generic tadalafil and brand-name Cialis are the same medication, but different pharmaceutical companies make them. “Regarding safety, efficacy, and quality, generic tadalafil should be equivalent to Cialis when it meets regulatory standards and is obtained from a reputable source,” says Michael Green, MD, chief medical officer at Winona, Inc., based in Lake Arrowhead, California.
Tadalafil can be taken at any time of the day, with or without food. It comes in five-, 10-, and 20-milligram doses.
What is a PDE5 inhibitor? In those with erectile dysfunction, PDE5 inhibitors improve erections by increasing blood flow to the penis.
PDE5 inhibitors work by inhibiting the PDE5 enzyme. When PDE5 is blocked, cGMP levels increase, leading to the relaxation of smooth muscle cells in blood vessels. This increases blood flow, which can help treat conditions like erectile dysfunction and pulmonary hypertension.
Cialis has a longer half-life than Viagra, meaning it is effective as needed for a longer time. Cialis is effective for roughly 18 hours, while Viagra is only effective for four hours. You could take Cialis in the afternoon, and it should be effective that evening, any time overnight, and the next morning.
However, Cialis has a slower onset than Viagra. The effectiveness peaks around two to three hours after taking it, so it may be more beneficial for people who can plan sexual activities ahead of time. Viagra takes effect in 45 minutes to one hour, so it may be a good choice for those who engage in more spontaneous sex.
Cialis can be taken daily or as needed; Viagra is only taken as needed. If you’re interested in Cialis but still want room for spontaneous sexual activities, you can take Cialis as a daily dose. At a low dose, Cialis daily can build up in your system over time so that you don’t have to schedule sex around the time you take the medication.
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, [3] Defeudis G, et al. Diabetes/Metabolism Research and Reviews. 2022. Erectile Dysfunction and Diabetes: A Melting Pot of Circumstances and Treatments. leading to new or worsening ED that doesn’t respond to Viagra or Cialis. Fortunately, several other ED treatments are available, including penile injections, vacuum erection devices, and a discreet penile prosthesis. [4] McMahon CN, et al. BMJ. 2006. Treating Erectile Dysfunction When PDE5 Inhibitors Fail.
ED can also appear as one of the first symptoms of cardiovascular disease, hypertension, anxiety, and other chronic health concerns. 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 first to ensure underlying conditions are diagnosed and treated alongside ED before using an online platform.
Viagra and Cialis shouldn’t be taken with some of the medications 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 can interact 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. Cialis and Viagra may worsen abdominal pain in men with stomach ulcers.
Hims is an online platform offering generic Cialis and other treatments for erectile dysfunction. It can be a good option if you have already met with a health care provider but prefer the convenience and discretion of an online platform to fill your prescription. You’ll receive the medication in discreet packaging, and you can complete the online questionnaire in five minutes or less. Our focus group participants liked how easy it was to complete the sign-up process.
“The Hims sign-up process was very easy. That’s one of the reasons I picked it. It took literally less than 45 seconds to get all the information right.”
Despite the quick sign-up process, the questionnaire is still comprehensive. Hims asks about your medical history, medications or supplements you may be taking, your history of smoking, and if you’ve used any recreational drugs within the last six months. These questions are necessary for providers to ask before patients start Cialis, or any PDE5 inhibitor, because the answers may affect your treatment plan.
Your Hims subscription includes follow-up appointments, but you may not need one depending on your location and needs. If you need to change your medication, you may be able to do so through messaging in the app. The requirements for managing your medication through telehealth services depend on the telehealth laws in your state.
When you message your provider, you can expect to hear back from them within 48 hours. According to customer service, Hims will flag time-sensitive messages. Your provider will be notified if your message is urgent and will get back to you as soon as possible. We appreciate this feature because it adds a level of confidence to know the platform is responsive to questions.
In addition to pill form, Hims offers generic Cialis as a chewable medication and a hard mint. However, these forms are not FDA-approved. Check with your doctor first to see if these are acceptable forms of the medication for you to take.
You can reach Hims customer service through the following methods:
When we used the chat feature on the website, connecting to a customer service representative took less than one minute, even though we were listed as fifth in the queue. We found customer service to be helpful and thorough. Additionally, our questions appeared to be answered by a real person, not an automatic chatbot, and they responded in detail.
Credit card payment options include Visa, MasterCard, American Express, Discover, JCB, and Diners Club. Hims does not accept insurance, including Medicare and Medicaid.
Sesame is a good option for people seeking a virtual exam appointment with a health care provider before getting a prescription. We recommend every person seeking ED treatment first speak to a health care provider about their symptoms and medical history before buying an online prescription. With Sesame, you can do both. You can make an appointment with a provider and have medication sent to your pharmacy or shipped to your home. In addition, Sesame has providers available for same-day appointments. But through Sesame, the exam won’t be as comprehensive as an in-person appointment since you’re meeting virtually with a provider, so it won’t include a physical exam, taking your vitals, or lab work.
The cost of generic Cialis through Sesame is tough to beat. Although the price may fluctuate based on your provider, the average cost for any medication through Sesame is $5 for a 30-day supply, or $0.17 per dose, the lowest cost in this review. To fully consider Sesame’s prescription costs, you should also factor in the cost of the visit and the $5.99 shipping fee if you’re having the medication delivered to your home.
When we searched for providers in Philadelphia, consultations ranged in cost from $42–$303 per visit, but most of the visits were below $100. For someone without insurance, Sesame could be an affordable alternative to paying out-of-pocket for a visit with an in-person provider.
You can reach Sesame customer service through the following methods:
Annoyingly, no agents were available each time we tried to use the chat feature, and we had to submit a ticket to their team. We received an email response 18 minutes later. The lack of available chat agents was inconvenient as we had a simple question that could have been answered over chat. The email we received, though, was very detailed and provided extensive information on our question.
Credit card payment options include Visa, MasterCard, American Express, and Discover. You can also use a health savings account (HSA) or flexible spending account (FSA). Sesame does not accept insurance, including Medicare and Medicaid.
The Optum Store makes it easy to sign up and receive erectile dysfunction medication. It took us less than five minutes to complete their sign-up questionnaire. It asked for information on our medical history, current medications, and which ED medication(s) we preferred, if any. A provider reviews your responses and considers your preferences, but ultimately, they will make a recommendation based on their assessment and your questionnaire answers.
Through the Optum Store, generic Cialis costs $7–$9 per dose, while brand name Cialis costs $17–$19 per dose. This is the most expensive option in this article. Similar to most platforms, purchasing generic Cialis through the Optum Store is significantly less expensive than the brand name. Unfortunately, you can only buy up to 10 tablets per month, which isn’t ideal for people wanting to take generic Cialis daily rather than as needed.
Optum Store users reported in our January 2024 survey that their providers were responsive, often interacting with them two to four times per month. If you need any medication changes or adjustments, you have the reassurance that your Optum provider will respond to your messages or to schedule a virtual visit.
You can reach the Optum Store customer service Monday to Friday from 7 a.m. to 5 p.m. CT through the following methods:
Survey respondents who used the Optum Store for erectile dysfunction treatment reported positive experiences with customer service.
The Optum Store accepts all major credit and debit cards, including Mastercard, Visa, American Express, Discover, and Diners Club. You can also use a health savings account (HSA) or flexible spending account (FSA). Optum does not accept insurance, including Medicare or Medicaid.
Generic tadalafil costs less than name-brand Cialis, and it is usually the most affordable erectile dysfunction treatment option. In this review, the cost of generic Cialis ranges from $0.17–$9 per dose. Depending on your insurance coverage and other factors, you may end up paying more through a telehealth platform like the Optum Store. If you do not plan to use insurance, platforms like Hims or Sesame can be more affordable. In general, Cialis is more affordable than other ED medications like Viagra.
If you already have a prescription from a health care provider, you can also use platforms like GoodRx or CostPlus Drugs to find affordable ED medications, including tadalafil. GoodRx provides coupons you can use at your local pharmacy, while CostPlusDrugs is an online pharmacy where you can purchase affordable medications.
PDE5 inhibitors are the first line of treatment for erectile dysfunction, according to the American Urological Association (AUA) Guidelines for ED treatment. [6] American Urological Association. Erectile Dysfunction: AUA Guideline (2018).
Four oral PDE5 inhibitors are FDA-approved for ED in the United States:
When sexual stimulation occurs, nerve impulses release neurotransmitters, which cause the blood vessels of the penis to relax and widen so that more blood can flow into the penis.
PDE5 inhibitors help to maintain an erection, but they don’t cause the erection. They work by blocking the breakdown of a substance that strengthens the erection. For the medication to work, you still need sexual stimulation, limited stress, healthy hormone levels, and relatively normal blood vessels that can allow for increased blood flow. If the medication doesn’t work, talk to your doctor about alternative or additional treatment options.
In addition to PDE5 inhibitors, the AUA also recommends patients see a mental health professional and make lifestyle changes such as increased physical activity or dietary changes. These might improve your erectile function and overall health.
With any medication, there is a risk of side effects. The risk of side effects is slightly higher for people who take on-demand dosing rather than daily dosing. The PDE5 enzyme is located in multiple tissues in the body. Because of that, side effects may include headache, facial flushing, muscle aches, and diarrhea due to an increase in blood flow in those different tissues.
Here are some potential tadalafil side effects [5] MedlinePlus. Tadalafil you should discuss with your doctor:
You should also be on the lookout for more severe tadalafil side effects. If you experience any of the following symptoms, you should seek emergency medical treatment:
Erectile dysfunction can be an early sign of heart disease. If you suspect you have erectile dysfunction, you should talk to your health care provider to be referred to a cardiologist. A cardiologist can help you prevent the development of heart disease.
Before taking tadalafil, consult with your doctor about your specific health conditions and medications. “ED in the older population should be treated carefully, and treatment should be individualized. Online platforms can be beneficial to patients experiencing ED. However, prior to utilizing them, I would recommend a comprehensive history taking and thorough exam by your care provider prior to any treatment,” says Christian Reutter, DO, an osteopathic physician at Pelvic Rehabilitation Medicine.
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:
We have all our articles medically reviewed by an expert in the field to ensure the information is appropriate for NCOA readers’ needs. Read more on our methodology here.
Generic Cialis, tadalafil, is an affordable treatment of erectile dysfunction. After receiving a prescription from your health care provider, you can purchase generic Cialis through an online platform like Hims or the Optum Store, or you can see a health care provider virtually and purchase your prescription in one visit through Sesame. Before you shop online for generic Cialis, talk to your health care provider to make sure it’s the right medication for you.
Yes, tadalafil is the same as Cialis. They contain the same ingredients, but different pharmaceutical companies make them.
Tadalafil usually starts to work two to three hours after taking it.
The effects of tadalafil last longer than Viagra does. Tadalafil can last up to 36 hours, while Viagra lasts up to four hours.
After taking tadalafil, the effects will last 30 minutes to 18 hours. If you participate in sexual activities within this time, it will be easier to have and maintain an erection. You should not take more than one tadalafil in 24 hours.
You can get generic Cialis through your health care provider or an online platform like Hims, Sesame, or the Optum Store.
Have questions about this review? Email us at reviewsteam@ncoa.org.
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