Best OTC ED Treatments: Do They Really Work?

Key Takeaways

• There are several over-the-counter ED treatments that can be safe and effective, including lifestyle treatments, dietary supplements, topical (skin care) products, and devices. 
• The American Urological Association supports non-medicinal approaches like lifestyle modifications and vacuum erectile devices (VEDs) for treating ED.
• Costs for OTC ED treatments can range from $5–$500 depending on the product, with some costing even more.
• The most effective ED treatments address underlying causes and match your personal preferences. A health care provider can help you find the best approach based on your needs.

Over-the-counter (OTC) treatments for erectile dysfunction (ED) have been linked to suspicious advertisements and bold claims. But there are also plenty of ED treatments that are well-researched and tested, safe for many users, and don’t require a prescription. 

In this article, we discuss some of the best over-the-counter ED treatment options to consider and which ones to avoid. To identify the best options, we asked practicing urologists, consulted guidelines from the American Urological Association (AUA), and reviewed published research on the effectiveness of ED treatments. 

Read on for the benefits, drawbacks, cost ranges, and possible insurance coverage of each over-the-counter option.

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Special considerations for older adult users of erectile dysfunction treatments

Just because a treatment is available over the counter doesn’t mean it’s safe or effective for everyone. OTC treatments can have negative side effects on your health and may interact badly with the medications you’re taking. Even all-natural herbal-based dietary supplements can trigger allergic reactions in some people or change the way medications interact with your body. 

Also, for some people, prescribed ED medications like Viagra and Cialis may be, at best, ineffective and, at worst, dangerous, depending on your health status and current medications.

Talk to your doctor about which ED treatments would be most appropriate for you. 

Andrew Allshouse, ND, a naturopathic doctor at Revibe Men’s Health, in Seattle, Washington, explained that there can be multiple factors that contribute to ED. He compared the penis to a machine that needs all of its systems and parts to be working properly to achieve an erection.

“It needs electricity and blood to flow in, [with] no leaks, and low flow of blood out to function properly. Anywhere along the line, these different components can break.”

If you haven’t been diagnosed with ED before, don’t try any ED medications or supplements until you have gotten an all-clear from your doctor. Visit your doctor in person so they can screen and diagnose you for treatable underlying conditions that may be contributing to your ED. 
This step is important, because ED can appear as one of the first symptoms of cardiovascular disease, diabetes, hypertension, anxiety, and other chronic health concerns. Treatments for ED may target your blood vessel health, nerve health, mental health, cholesterol, pelvic floor muscles, or hormone levels, said Allshouse.

Who shouldn’t take Viagra or Cialis

If you’re considering whether to ask your doctor for a prescription for Viagra or Cialis, know that they 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 by people taking protease inhibitors—a specific type of medications that can be used to treat HIV.

Combining nitrates or alpha-blockers with ED pills may cause a severe, life-threatening drop in blood pressure, which can lead to feeling dizzy, fainting, falling, and even death.

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.

This is not a complete list of medications or health conditions that can be affected negatively by Viagra or Cialis. Talk to your health care provider about your full health history and everything you take—including supplements and recreational drugs—when discussing potential ED treatments.

Our top picks for the best OTC ED treatment 

Based on our research and expert insights, here are some of the OTC ED treatments available:

• Lifestyle treatments, such as diet changes, weight management, and mental health support
• Dietary and herbal supplements
• Topical products, such as ED gels and creams
• Devices, such as vacuum erectile devices and penis rings

Table 1, Compare OTC ED treatments

Lifestyle treatments

Our expert take on lifestyle treatments for ED

The health experts we spoke with noted the importance of a healthy lifestyle for people with ED. Lack of exercise, excess weight, unhealthy food habits, and alcohol or tobacco use are among the factors that can contribute to ED symptoms. Lifestyle changes can require a lot of hard work, but the long-term benefits for your overall health may be worth it. 

Pros and cons of lifestyle treatments

Pros

• Can help to address the underlying causes of your ED
• May benefit your overall physical and mental health
• More likely to be covered by insurance

Cons

• Requires effort to build new habits
• Not a quick-fix—it can take time to see the effects of your hard work

Nutrition

The American Urological Association (AUA) recommends addressing any health conditions that may contribute to ED through lifestyle changes before seeking treatment with medications. Its guidelines for treating ED include diet changes and increased physical activity that can improve overall health, and potentially improve erectile function. 

According to research, diets that have been found to reduce ED symptoms are:

• Mediterranean-style diets
• Diets high in whole grains, vegetables, and fruits
• Diets low in red meat and full-fat dairy
• Avoidance of foods and drinks that are high in added sugars

High blood pressure, high cholesterol, and Type 2 diabetes (high blood sugar) are three of the health conditions most commonly related to ED. Michael Werner, MD, FACS, medical director and founder of Maze Sexual and Reproductive Health in New York, recommends preventing or managing these three conditions to improve circulation and blood flow to the penis. 

Most ED symptoms are due to blood flow issues, Dr. Werner explained, so improving blood flow to the heart will also improve blood flow to the penis. “Whatever is good for your heart is good for your penis,” said Dr. Werner. 

For more information on diets that support heart health, read our Reviews Team’s article on the best diets for heart health. For diets that can help control blood sugar, read our review of the best diets for people with diabetes.

Weight management

Excess weight can increase a person’s risk of developing ED. People with a body mass index (BMI) of 25 or higher have a 40%–96% higher chance of developing ED symptoms when compared to people who are considered average weight (BMI 18.5–24.9). Studies have found that people who achieved a healthy weight through diet, exercise, or surgery were less likely to experience ED symptoms. 

There are many options for weight management, including online weight management programs, fitness boot camps, and consulting with a registered dietician nutritionist. 

Depending on your insurance coverage and other health conditions you’re being treated for, your insurance plan (including Medicare) may cover weight management programs. Check with your insurance provider to find out how to qualify for coverage.

Mental health support

The AUA also suggests professional mental health support to address related factors like performance anxiety and relationship issues. Seeking mental health support or sexual health counseling together with a treatment plan can help people deal with emotional concerns and build a healthier connection with their partner. These approaches can improve your overall sense of well-being and enhance the effectiveness of ED treatments.

A review of studies suggests that mental health care supports people with ED by reducing anxiety, challenging unhelpful thoughts, increasing sexual stimulation, increasing intimacy, and improving communication in the relationship. 
Online mental health support can be a convenient way to access and attend therapy or psychiatry sessions. Read our Reviews Team’s reviews of the best online therapy platforms and the best online psychiatry platforms.

Dietary supplements

Our expert take on dietary supplements for ED

There are a lot of dietary supplements on the market for ED. Though there’s some evidence that supports the effectiveness of certain types of supplements,  not all supplements are right for everyone. The AUA doesn’t recommend supplements for the treatment of ED.

Supplements have the potential to interact negatively with medications or health conditions, and they may cause allergic reactions in some people, so it’s a good idea to check with your health care professional first to make sure supplements are a good OTC option for you.

About unsafe dietary supplements

Be cautious with “natural” or “herbal” supplements marketed for male sexual enhancement. “Gas station pills” are potentially harmful pills often sold outside of pharmacies, making bold claims as an OTC ED treatment. When we surveyed 400 people who had experience with online ED treatment, 79% of respondents had tried a “gas station pill” before seeking treatment.

The Food and Drug Administration (FDA) warns that these pills may contain hidden, unlisted ingredients, often the same ones found in prescription ED medications like sildenafil (Viagra). One study showed that 70% of ED supplements tested had undeclared ingredients, some at unsafe doses, raising the risk of side effects or overdose.

Always consult a health care provider before trying supplements to make sure they’re safe for you to use.

Pros and cons of dietary supplements

Pros

• Can be simple to include in your daily routine
• Available online, in pharmacies, and in health-food stores

Cons

• Aren’t FDA-approved for the treatment of ED
• Come with risks of side effects and interactions
• Possibly unsafe or undeclared ingredients 

Herbal supplements for ED 

Some herbs have been studied for their effects on ED symptoms. Here are a few common ingredients that can be found in herbal supplements for ED:

• Red ginseng (also known as Korean ginseng or Panax ginseng)
• Puncture vine (also known as tribulus or Tribulus terrestris)
• Ashwagandha (Withania somnifera)
• Horny goat weed (Epimedium grandiflorum)
• Yohimbe (Pausinystalia johimbe or Corynanthe yohimbe)
• Fenugreek (also known as methi or Trigonella foenum-graecum)
• Maca root (also known as Lepidium meyenii)

Some herbs, like red ginseng, may help with ED symptoms by improving blood flow, or by supporting hormone balance. But since many herbs affect more than just sexual health, they can react with other medications or health conditions. 

Most herbal supplements are made with a combination of different herbs, or a combination of herbs and vitamins. Herbal supplements typically aren’t covered by insurance, and costs can vary widely depending on the herb, brand, dose, and supplier. For example, maca root can cost anywhere between $7 to $50 per bottle from online retailers, pharmacies, and health food stores. 

Other dietary supplements for ED

Vitamins, minerals, and nutrients like amino acidsⓘ Building blocks of proteins have also been studied for their effects on ED. Similar to herbal supplements, these ingredients may help with ED by supporting healthy blood flow:

• L-arginine, an amino acid that has been studied for its support of healthy circulation
• L-carnitine, an amino acid that has also been studied for treating heart conditions, nervous system damage, and thyroid disorders 
• Vitamin D, used for the support of healthy hormone levels and overall health

In general, unless someone is tested and found to be deficient in a nutrient, they may not benefit from taking supplements, and some supplements may even be harmful t. Taking too much of a supplement can increase the risks of side effects. For example, people who take L-arginine may experience a flare-up of cold sores or genital herpes. 

Supplements are not regulated by the FDA, and the contents and concentrations cannot be verified. One study found that roughly only half (52%) of marketed dietary supplements for ED contain scientifically studied components.

The FDA doesn’t review supplements for safety or effectiveness before they hit the market. Check with your health care provider to ensure any supplements you consider are safe and right for your health goals.

Topical products

Our expert take on topical products for ED

Topical, or skin care, products can be a relatively quick treatment for ED, but they don’t have much evidence to support their use, and they may not work for everyone. Still, they can be simple to use and don’t involve taking a pill. 

Pros and cons of topical products

Pros

• Quick to use before intercourse
• Can have less intense side effects than an oral medication

Cons

• Not much evidence to support them
• May not work for everyone
• May cause skin irritation for the user or partner

Eroxon gel

Eroxon is a topical gel approved by the FDA as an ED treatment for people age 22 and older. It’s an over-the-counter gel that comes in single-dose tubes. On Amazon, it costs $25.99 for a package of four tubes. At $6.50 per tube, the cost of Eroxon is more expensive than some generic medications, but it can be worth considering as an OTC option.

Eroxon’s manufacturer tested the gel in a clinical trial and found that 71% of subjects were able to have intercourse within 15 minutes, with few side effects reported. Despite the positive clinical trial results, user reviews are mixed. On Amazon UK, where Eroxon has been available longer than in the U.S., the product has a rating of 2.5 out of five stars from more than 2,000 ratings. Some buyers wrote that the gel worked well, while others did not experience any results.

Medicated wipes for premature ejaculation

People who experience premature ejaculation (PE) are four times as likely to experience ED. And the risk of PE symptoms increases with age. One over-the-counter option for PE is medicated wipes, which contain a numbing ingredient such as benzocaine and lidocaine.

Online platforms are one way to get medicated wipes. Ro is an online men’s health platform that sells Roman Swipes, which are wipes infused with benzocaine. Ro offers monthly subscriptions starting at $22 for eight wipes.

Devices

Our expert take on devices for ED

Vacuum erectile devices (VEDs), especially when paired with penis rings (also known as constrictive devices), can help encourage blood flow to the penis and help keep it there. The AUA supports VEDs as a treatment option for ED. 

Though some of the experts we interviewed agreed that devices can be valuable OTC options for ED symptoms, they noted that people may need patience and practice to use the devices the right way. 

Pros and cons of devices

Pros

• One-time purchase 
• May be covered by insurance 

Cons

• Requires practice to learn how to use properly
• May cost hundreds of dollars out-of-pocket

Vacuum erectile devices

VEDs are also called vacuum constriction devices or penis pumps. They’re made of a plastic tube, a vacuum pump, and a constriction band. Pumps may be powered by battery (electric) or hand (manual pump). The vacuum encourages blood flow into the penis, while the constriction band keeps the blood in the penis to maintain the erection. 

Allshouse said that VEDs can be a different experience compared to taking a pill for ED symptoms. Users need to practice using the device to create a proper seal and achieve an effective erection. “It’s more cumbersome, and it takes some work,” he said.

Unlike a medication or supplement, there are fewer side effects with VEDs. Still, strong suction can bruise the skin, so it’s not recommended for people who have bleeding disorders or are taking blood thinners.

The cost of a VED may be covered by insurance if it’s prescribed by a health care provider. Coverage will depend on your insurance plan, the device, and the retailer. VEDs cost between $300 and $500 online and from medical supply stores. 

Penis rings

Penis rings are devices that constrict blood in the penis to keep it erect. Unlike VEDs, penis rings aren’t typically covered by insurance but are more affordable than VEDs. Urologists we interviewed warn that it’s important to never use a ring that is difficult to remove, as it can cause long-term damage to the penis. To prevent a medical emergency due to a ring that is stuck, look for penis rings that have quick release. If a penis ring does get stuck, you should get medical help immediately.

Do OTC ED treatments work?

Not everyone will respond to OTC ED treatments the same way, and not all OTC ED treatments are recommended by medical experts. The treatments mentioned in this article are recommended with caution by experts we interviewed, or are supported by studies that show their safety and effectiveness for ED. Always consult with your health care provider before trying an ED treatment of any kind. 

There are many OTC ED treatments that promise big results but don’t have proper labeling, aren’t regulated or well-researched, or just don’t work. 

OTC treatments also may take time to work. For example, Allshouse said that some dietary supplements can take 12 months or more to notice consistent results. “Taking your supplement for a year, a year and a half, or two years before it finally starts to do something is a long time,” said Allshouse. 

People who are considering OTC ED treatments will need to consider the time it may take for them to work, along with the costs and related risks of using them. Your urologist or primary health care provider can help you to decide whether an OTC treatment is a safe and effective option for you.

Benefits and drawbacks of OTC ED treatments 

Here are a few of the general benefits and drawbacks of OTC ED treatments to consider: 

Benefits

• Convenient: doesn’t require a prescription to buy
• Accessible: may be bought online or in stores rather than just in pharmacies
• Many options to choose from: including lifestyle treatments, topical products, and devices

Drawbacks

• Not as effective compared to prescription medications
• Lack of research to support their effectiveness for ED
• Still requires medical guidance to determine if it can be safe and effective for you

How much does over-the-counter ED treatment cost?

The cost of OTC ED treatments will vary depending on the treatment and where you buy it from. Here are some cost ranges of OTC ED treatments, according to our research:

• Nutritionist sessions: $70–$150 for an initial visit
• Weight loss programs: Starts at $20 per month for online programs
• Therapy sessions: $100–$200 per visit in person, $70–$110 per online visit, $0–$30 with insurance
• Dietary supplements: $3–$51 per bottle, online or in stores
• Eroxon gel: $25.99 for a package of four tubes on Amazon
• VEDs: $300–$500, online and from medical supply stores
• Penis rings: $6–$130 online

Medicare and Medicaid coverage for OTC ED treatments

Medicare and Medicaid typically don’t cover most OTC ED treatments like supplements, gels, and ED devices. But nutrition services and mental health support related to ED might be covered through medical nutrition therapy (MNT) or behavioral health benefits, often without needing prior approval. 

Since coverage varies by plan, it’s a good idea to contact your insurance provider to confirm what’s covered for the OTC ED treatments and related services you’re considering. 

Table 2, Compare OTC ED treatment insurance coverage

* May need prescription for coverage

Bottom line

OTC ED treatments are convenient and easy to access, with no prescription required. Options like lifestyle changes and dietary supplements can address factors like heart and sexual health, while devices like VEDs encourage blood flow to get and maintain an erection. Dietary supplements can have mixed results and may interact negatively with other medications or health conditions. Topical gels have few side effects, but may cause skin irritation for the user or partner, and reviews on how well they work are mixed.

Depending on the type of treatment, OTC ED treatments may not be as effective as prescription options, and some treatments lack strong research to support their effectiveness. Even though these treatments don’t require a prescription, it’s important to consult your health care provider to make sure they’re safe and appropriate for you.

Have questions about this review? Email us at reviewsteam@ncoa.org.

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