NATION — Viagra is a well-known treatment for erectile dysfunction (ED), but many other approaches may help a person get and keep erections. They include medical devices, supplements, and lifestyle adaptations.
Research indicates that erectile dysfunction (ED) affects over 30 to 50 million men in the United States each year. Although the prevalence of this issue increases with age, it does not only affect older adults.
A range of treatments and strategies can improve or reverse ED. Options include drugs, other medical treatments, lifestyle adaptations, and alternative herbal treatments.
In this article, we look into various alternatives to Viagra, answer some frequently asked questions, and discuss when to contact a doctor about ED.
Viagra vs. alternatives at a quick glance
The table below offers a quick comparison of Viagra to its alternatives.
Why use it?
Price
Lasts for
Pros
Cons
Viagra (sildenafil)
starts working in 30 to 60 minutes
depends on insurance, location, and pharmacy
4 hours
different doses available, available in generic form at a lower price
Other medication (vardenafil, tadalafil, avanafil)
starts working between 30 minutes and 6 hours
depends on insurance, location, and pharmacy
up to 36 hours, depending on the type
different doses available, can take them with or without food, some dissolve on the tongue
Medical devices
may suit people who cannot take ED medication
from $95 to $650, average cost of $250
up to 30 minutes per use, a few months of regular use, depending on the type
few side effects, cost-effective
Supplements
not recommended, as they do not have FDA approval
prices vary depending on the supplement type
insufficient available information
available online, affordable
Lifestyle modifications
quitting smoking, exercising, and avoiding heavy drinking may improve sexual function
not applicable
not applicable
reduces the risk of developing certain conditions, including type 2 diabetes, stroke, and cancer
Drug alternatives to Viagra (sildenafil)
Beyond Viagra (sildenafil), several medications can help erections.
Oral medications
Oral drugs, including Viagra, may be the first approach to treating ED.
Viagra is effective because it slows the action of phosphodiesterase type 5 (PDE5), an enzyme in the blood vessel walls. This helps the muscles in the penis relax and encourages blood flow, helping a person get an erection.
Other prescription-only PDE5 inhibitors include:
Vardenafil: It is available under the brand names Levitra and Staxyn and comes in regular and disintegrating tablet forms. A person takes it 1 hour before sex, and it can be effective for up to 5 hours.
Tadalafil: It is available under the brand names Adcirca and Cialis. A person takes it at least 30 minutes before sex. Each dose can last up to 36 hours.
Avanafil: It is available as Stendra in the United States, and people take it 15 to 30 minutes before sex. The effects can last up to 6 hours.
The following are some pros and cons of using ED medications:
Pros
different doses available
can take them with or without food
some dissolve on the tongue
rely on a prescription from a doctor or other prescribing healthcare professional, so a person can be reasonably assured they are safe and have Food and Drug Administration (FDA) approval
Cons
side effects are possible
may interact with certain medications
Where can I buy alternative ED drugs?
Various telehealth companies stock ED medication, including:
Roman: This company offers sildenafil or tadalafil and requires people to schedule an online appointment with its doctors. A person can benefit from personalized treatment, free delivery, and ongoing follow-ups. The platform also offers treatment for those concerned about hair loss, premature ejaculation, and allergies.
Hims: This company addresses men’s health concerns. First, people complete an online form so that a physician can learn more about their symptoms. Once a person receives a treatment plan, they can have a follow-up appointment with Hims doctors.
Lemonaid Health: This brand offers medication for various health conditions. People can access ED medication starting from $2 per pill after scheduling an online appointment with a doctor.
Non-oral ED drugs
Alternatives to ED pills and tablets may include:
Penile self-injections
Certain medications, such as alprostadil (Caverject), papaverine, and phentolamine (Regitine), are available as an injection that goes directly into the side or base of the penis.
This method generally works very quickly and is highly effective. However, it may cause side effects, including swelling, pain, and stinging. It may also cause permanent damage with improper use.
Pros
generally works quickly
requires a prescription, so it is safe to use
available in different doses
Cons
side effects are possible
can cause damage with improper use
Urethral suppositories
A person can use a special applicator to insert very small alprostadil suppositories into the urethra, which can help stimulate erections.
A person can self-administer this treatment, and it generally works quickly.
However, these suppositories can affect a fetus if a sexual partner is pregnant. It can also cause side effects and be less effective than other methods.
Pros
generally works quickly
requires a prescription, so it is safe to use
available in different doses
Cons
side effects are possible and may be less effective than other methods
can cause damage with improper use
harmful if a person’s sexual partner is pregnant
Testosterone replacements
A doctor or healthcare professional may recommend this approach if they believe that ED is due to low testosterone levels.
A person can take synthetic testosterone via pills, patches, and injections.
Some pros and cons of testosterone include:
Pros
increased energy
increased muscle mass
increased libido
Cons
risk of unwanted physical changes, such as swollen breast tissue
risk of conditions affecting prostate health
risk of reducing sperm count
Other medical treatments
Drug treatments may be unsuitable for some people, perhaps due to other health difficulties. In these cases, a doctor may recommend:
Wearable devices
Some wearable devices can help a person maintain an erection, such as Eddie by Giddy.
Eddie by Giddy
Eddie by Giddy is a nonprescription, class 2 wearable medical device that people can wear on a flaccid or erect penis. It is a C-shaped device that hooks onto the base of the penis. It has a tension band that constricts the penis.
The device constricts the veins in the penis, enabling blood flow into the penile shaft. This helps a person to keep an erection.
Although the FDA has registered the device, no scientific studies have evaluated its effectiveness.
It comes in various sizes and has a 30-day money-back guarantee.
Pros
reusable
simple to use
more discreet than other options
drug- and surgery-free option
Cons
helps with maintaining an erection but not getting one
people must get the right size
people cannot wear it longer than 30 minutes
price is comparably high
Penis implants
Implants are inflatable or bendable rods that a surgeon implants into the erection chambers of the penis. However, doctors typically only recommend this approach as a last resort.
Pros
allows for control over erections
typically a long lasting solution
typically effective, even when other methods are not
Cons
invasive and requires recovery time
risk of injury
risk of infection
Vacuum pump
Vacuum pumps help people get an erection, but they do not help a person sustain one. One option a person can consider is the Pos-T-Vac Erectile Vacuum System.
Pos-T-Vac Medical Grade Vacuum
The Pos-T-Vac is a manual or battery-operated vacuum pump. The manual options offer more control over the suction.
To use a vacuum pump, a person puts their penis into the pump. This creates a vacuum around the penis to enhance blood flow. The suction helps facilitate an erection, but a person must weara tension band to sustain it.
The manufacturers state not to wear a tension band longer than 30 minutes.
Pros
drug- and surgery-free treatment
easy to use
reusable
fast acting
Cons
people must use a tension band to keep their erection
it is not as discreet as other options
buyers must ensure they are using the correct-sized model
Natural alternatives to Viagra
Many companies sell dietary supplements, herbal preparations, and food products as remedies for ED.
It’s essential to be careful when purchasing or consuming any alternative products, including those that claim to be herbal versions of Viagra.
The FDA has issued several statements warning consumers about the safety of such goods. It says these products may contain hidden synthetic chemicals or other ingredients that could be harmful. There has not been enough research to support these supplements’ usage fully.
Supplements and foods that supposedly enhance sexual function could contain undisclosed drug ingredients. This includes undisclosed sildenafil and tadalafil, which can be dangerous for some people. They can interact with nitrate medication and lower blood pressure to dangerous levels.
People with diabetes, heart disease, high blood pressure, or high cholesterol may take nitrate medication.
These supplements do not undergo FDA analysis for quality or purity.
With this in mind, it is vital to consult a healthcare professional before starting a supplement. Additionally, people should choose a brand that engages in third-party testing and certification.
Some alternative herbal treatments, include the following:
Spring Valley DHEA 50 mg
A 2018 article states that aging causes a decline in DHEA, which leads to symptoms of depression, aggressive behavior, and low libido, among others. The research also notes that some trials suggest DHEA supplements may help improve a person’s well-being.
This supplement offers 50 mg of DHEA per serving of 1 tablet. The company warns that people who are taking medication should consult with a doctor before taking this supplement.
Pros
is a drug- and surgery-free option
available over the counter without a prescription
may have benefits to a person’s overall well-being as well as improvement in ED symptoms
Cons
may cause some side effects
there is limited research regarding the long-term safety of DHEA supplementation
Pure Encapsulations Panax Ginseng
A person can expect to pay around $66 from Amazon for this product.
According to a 2021 study, ginseng may improve an individual’s ability to have intercourse.
This ginseng supplement is hypoallergenic and free from gluten and GMOs. The capsules are also vegan and vegetarian.
The company recommends taking 1 capsule per day. Each serving contains 250 mg of Panax ginseng.
Pros
is a drug- and surgery-free option
available over the counter without a prescription
this product is suitable for vegans
Cons
may cause some side effects
this particular brand is fairly expensive
Mason Natural Korean Ginseng
A person can expect to pay around $9 for a 60-count bottle of this product.
As mentioned above, ginseng may be beneficial for improving a person’s ability to have intercourse.
This type of tablet contains two different kinds of Korean ginseng for added support. It also contains calcium and is free from soy, sugar, preservatives, fragrance, and artificial colors and flavors. It is suitable for vegans and vegetarians.
The company recommends taking 1 tablet daily. Each serving contains 1,000 mg of ginseng and 110 mg of calcium.
Pros
is a drug- and surgery-free option
available over the counter without a prescription
inexpensive product
suitable for vegans
Cons
may cause some side effects
may interact with other medications
Horbäach L-Arginine 4,000 mg
A person can expect to pay around $29 for this product from Amazon.
A 2019 study found that people who took 1,500 to 5,000 mg of L-arginine significantly improved their ED symptoms.
This L-arginine supplement is free from gluten, wheat, soy, milk, lactose, and GMOs.
The company recommends taking 4 caplets every day. Each serving contains 4,000 mg of L-arginine.
Pros
is a drug- and surgery-free option
available over the counter without a prescription
inexpensive product
Cons
may cause some side effects
1 dose is 4 tablets
Lifestyle adaptations
Certain lifestyle modifications may help improve erectile function, including:
Eating a balanced diet: Flavonoid-rich foods, such as blueberries, strawberries, blackberries, and citrus fruits, may reduce ED for some people.
Maintaining a moderate body weight: Having overweight or obesity may cause or worsen ED.
Getting regular exercise: Physical activity can improve circulation, reduce stress, and contribute to moderate body weight.
Quitting smoking: Research indicates a strong link between cigarette smoking and ED.
Avoiding heavy drinking: Limiting or stopping alcohol use may improve sexual function.
Seeking help for mental health conditions: Addressing anxiety, depression, and sources of sustained stress, for example, may help.
About Viagra (sildenafil)
The generic name for Viagra is sildenafil. The drug also has another brand name: Revatio. It works by slowing down the action of PDE5, an enzyme in the blood vessel walls.
This enzyme breaks down a substance responsible for blood flow in the penis. Inhibiting the enzyme increases blood flow to the area and helps achieve and maintain erections.
However, sildenafil can only help maintain an erection that a person has physically stimulated.
Common side effects of the drug include headache, facial flushing, indigestion, nasal congestion, and a blue tint to an individual’s field of vision.
Viagra pros and cons at a glance
The following are some of the advantages and disadvantages of Viagra (sildenafil).
Pros
effective ED treatment
readily available by prescription in most pharmacies and online telehealth services
some insurance providers may cover part, or all, of the costs of this medication
available in different strengths
available in both generic and brand-name forms
Cons
more expensive than generic sildenafil
can cause side effects, such as headaches, nausea, and rash
unsuitable for people who take nitrates
unsuitable for people who have ischemic optical neuropathy or other inherited degenerative eye conditions
Cost-effective alternatives to Viagra
When looking for help with ED, people can look at the following cheaper alternatives to Viagra:
Leading a more active lifestyle: Being more active can help improve ED. For instance, a 2018 study found that 160 minutes of weekly exercise reduced the symptoms of ED in the participating males.
Nutritious diet: A nutritious and balanced diet can lower a person’s risk of developing ED. A 2020 study involving 21,400 males found that people following a Mediterranean or Alternative Healthy Eating Index 2010 diet had a reduced risk of experiencing erectile difficulties.
Generic medications: Viagra is the branded version of the generic drug sildenafil. Buying generic versions of ED drugs can save people a lot of money. Doctors may prescribe other generic ED drugs, such as tadalafil (Cialis) and vardenafil (Levitra).
Wearable devices: Devices people can wear before or during sex to get or maintain an erection may be more cost-effective than medication. They are typically reusable, and a person may not have to replace them as often as they would have to renew a prescription for ED medication.
ED risk factors
ED can result from physical, psychological, and emotional factors.
Medical conditions that may cause ED include:
high blood pressure
diabetes
heart disease
obesity
stress and anxiety
atherosclerosis, a narrowing of the arteries due to a buildup of plaque
kidney disease
multiple sclerosis
Peyronie’s disease, which involves scar tissue in the penis
injury to the penis, prostate, bladder, pelvis, or spinal cord
The American Urological Association also lists dyslipidemia as a risk factor for ED. This is an imbalance of lipids, including cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides.
Mental health conditions and factors that may contribute to ED include anxiety, depression, guilt,
stress, and low self-esteem.
Other factors that may play a role include:
alcohol and illegal or recreational drug use
overweight or obesity
low levels of exercise
smoking
When to contact a healthcare professional
Anyone with symptoms of ED that last for a few weeks or more should contact a healthcare professional.
This is particularly important for people who suspect that an underlying health issue, such as heart disease, may be causing their ED.
This health issue can also be a side effect of certain medications, so a doctor may address it by changing a person’s ongoing treatment plan.
Drugs that may cause ED can include antidepressants, blood pressure medications, antihistamines, benzodiazepines, and opioids.
Frequently asked questions about Viagra alternatives
Below are some of the most common questions and answers about alternatives to Viagra.
Is a prescription needed for Viagra alternatives?
People in the United States must have a doctor’s prescription for ED medication.
Can herbs and supplements treat ED?
Insufficient scientific evidence suggests that herbs and other supplements can treat ED. However, various lifestyle modifications, such as quitting smoking and eating a balanced diet, may help.
How do I know if a telehealth company is legitimate?
Some companies employ licensed healthcare professionals to help determine if someone may benefit from a Viagra alternative. The company can ship the treatment to the person’s front door if the healthcare professional approves.
What is the best alternative to Viagra?
As an alternative to Viagra, a person may wish to try any of the following:
Alternative oral drugs: including vardenafil, tadalafil, and avanafil
Non-oral drugs: such as penile self injections, urethral suppositories, and testosterone replacements
Medical devices: such as Eddie by Giddy, penis implants, and vacuum pumps
Natural alternatives: including ginseng, DHEA, and L-arginine supplements
A person may also wish to consider making some lifestyle adjustments instead of using Viagra.
Can I buy Viagra alternatives over the counter?
There are no over-the-counter alternatives to Viagra. However, people may wish to try natural supplements that people can purchase without a prescription.
Natural supplements that may benefit individuals with erectile dysfunction include ginseng, DHEA, and L-arginine.
Additionally, some medical devices are available to purchase without a prescription.
What is the best over-the-counter substitute for Viagra?
A person may wish to consider natural supplements containing ginseng, DHEA, and L-arginine.
However, it is important to consult with a doctor or healthcare professional before taking these supplements in order to avoid unwanted side effects and to achieve the best medical outcome.
Summary
There are various options for people who cannot or do not want Viagra. These alternatives include other medications, medical devices, and lifestyle adaptations. Individuals should speak with a doctor about treating ED safely.
–Jayne Leonard and Kristina Iavarone
