Discreet, ad-free rankings · 6 ED brands independently reviewed
Updated April 2026
MenPerformanceED & Libido

Clinician-prescribed ED treatment that fits your life

Compare sildenafil, tadalafil and newer alternatives from six discreet telehealth brands — by format, dosing style and real price per dose.

Brands
6compared
From
$20/mo
Options
Daily or as-needed
80%+
respond to first medication
Independently compared · 6 providers reviewed
HimsNumanRoRomanBlueChewlemonaid
Personal to you

Find the right treatment for your situation

A few short questions helps us match you with the provider and format that suits your lifestyle — daily pill, on-demand dose, or chewable. Takes under 2 minutes.

What's being prescribed

The medications explained. What each one actually does.

Four proven options. Different onset times, durations and price points — here's the honest breakdown.

At a glanceSildenafilTadalafilAvanafilVardenafil
Generic priceCheapestLowHighestModerate
Onset30–60 min30 min – 2 hr15 min25–60 min
Duration4–6 hours36 hours4–6 hours4–5 hours
FormatTablet · ChewableTabletTabletTablet · ODT
Best forCost-consciousSpontaneitySide-effect sensitiveSildenafil non-responders

← Swipe to compare all four medications →

Sildenafil

PDE5 inhibitor · as-needed
Tablet · Chewable
From$1/pillOnset30–60 minDuration4–6 hr
What is it?Inhibits the PDE5 enzyme, sustaining cGMP in penile smooth muscle and allowing increased blood flow in response to sexual stimulation. Doesn't cause erections on its own — arousal is required.
Ideal forThe most studied, most cost-effective starting point — generic widely available.

How it works

More cGMP means sustained relaxation of blood vessel walls, allowing increased blood flow in response to sexual stimulation. Most widely studied PDE5 inhibitor; largest evidence base.

Dosing

  • Standard doses: 25mg, 50mg, 100mg
  • Take 30–60 minutes before activity
  • Duration: 4–6 hours effective window
  • Do not take more than once in 24 hours

Price range

Generic sildenafil: ~$1–5/pill (pharmacy or telehealth). Branded Viagra: ~$30–60/pill (rarely price-competitive). Compounded chewables: often $2–4/dose on subscription.

Key considerations

Affected by food — high-fat meals delay onset by 60–90 min. Avoid grapefruit: interferes with metabolism. SAFETY: Contraindicated with any nitrate medications (GTN spray, isosorbide, amyl nitrate/poppers) — risk of severe hypotension.

Tadalafil

PDE5 inhibitor · daily or as-needed
Tablet
From$1/pillDuration36 hrDailyAvailable
What is it?Same mechanism as sildenafil but with a longer half-life (17–18 hours). Daily low-dose maintains a constant blood level — a more natural response without planning ahead. The “weekend pill” — 36-hour window for as-needed dosing.
Ideal forSpontaneity. Daily dosing means no timing, no planning — sex when it happens.

How it works

Daily low-dose tadalafil (2.5–5mg) maintains a constant blood level, producing a more natural response without planning ahead. As-needed doses (10–20mg) offer a 36-hour window.

Dosing

  • Daily option: 2.5mg or 5mg every day (no timing around activity)
  • As-needed: 10mg or 20mg, taken 30 min–2 hours before
  • 36-hour effective window for as-needed dosing

Price range

Generic tadalafil: ~$1–6/pill. Daily tadalafil: often $30–60/month on subscription. Compounded: comparable to generic pricing.

Key considerations

The “weekend pill” (36-hour window) — most popular for spontaneity. Daily dosing is preferred by many men for its “always on” quality. Not affected by food or alcohol in the same way as sildenafil. Also approved for benign prostatic hyperplasia (BPH) — dual benefit for some users. SAFETY: Same nitrate contraindication as sildenafil.

Avanafil

3rd-gen PDE5 inhibitor · faster onset
Tablet
From$25/pillOnset15 minBrandStendra
What is it? A newer, more selective PDE5 inhibitor with faster onset and lower rate of visual or nasal side effects than older drugs.
Ideal forMen who've experienced side effects on sildenafil — flushing, blue-tint visual disturbance, headaches.

How it works

Greater selectivity for PDE5 over PDE6 (found in retinal cells) means fewer reports of blurred vision or blue-tint visual disturbance.

Dosing

  • 50mg, 100mg, or 200mg
  • Can be taken as soon as 15 minutes before activity
  • Duration: 4–6 hours
  • Can be taken with or without food

Price range

Brand only; limited generic availability. ~$25–50/pill; not widely available via compounding.

Key considerations

Best option for men with side-effect sensitivity to sildenafil. Fastest onset of all PDE5 inhibitors (15 min in some users). Less widely available from telehealth providers than sildenafil/tadalafil. Higher cost; limited compounding options.

Vardenafil

PDE5 inhibitor · alternative profile
Tablet · ODT
From$3/pillOnset25–60 minODTAvailable
What is it?Chemically similar to sildenafil with a slightly different selectivity profile. Some men who don't respond well to sildenafil find vardenafil more effective — and vice versa. Staxyn (ODT) is dissolvable and doesn't require water.
Ideal forSildenafil non-responders, or men who prefer a discreet dissolve-on-tongue format.

How it works

Chemically similar to sildenafil with a slightly different selectivity profile. Some men who don't respond well to sildenafil find vardenafil more effective, and vice versa.

Dosing

  • 5mg, 10mg, 20mg standard doses
  • Take 25–60 minutes before activity
  • 4–5 hour effective window
  • ODT format is discreet, no water needed

Price range

Generic vardenafil: ~$3–8/pill. Less widely offered via telehealth than sildenafil/tadalafil.

Key considerations

Dissolvable format (ODT) is discreet and popular among men who dislike swallowing tablets. Slightly shorter window than tadalafil; similar to sildenafil. May be a useful switch for sildenafil non-responders. SAFETY: Same nitrate contraindication; avoid with certain antiarrhythmics.

How ED treatment works

Simple science. Real results.

PDE5 inhibitors don't create erections — they remove the biochemical barrier to them when arousal is present.

80%

Most men respond to their first PDE5 inhibitor. Among the 20% who don't, switching to a second agent resolves it in about 70% of those cases — bringing total response near 95%.

Cumulative response rate by attempts
80%100%75%50%25%01st2nd3rd+Treatment attempts

Quick intake, no awkward visit

A short online medical questionnaire covers your health history and any medications. A clinician reviews and prescribes (or doesn't) remotely — no waiting room, no face-to-face.

Match to your dosing style

Daily tadalafil if you want spontaneity and a constant baseline. Sildenafil or avanafil for on-demand. Chewable or dissolve-tab formats if you prefer something discreet.

Discreet doorstep delivery

Plain external packaging — no brand names visible outside. Most telehealth brands ship in 2–3 days. Subscription plans include free shipping.

What to expect

How ED treatment gets to work

Unlike most chronic medications, ED treatment works on demand — but finding your right dose and agent can take a few weeks.

  1. Day 1 · First dose

    Onset varies by medication: avanafil works in as little as 15 minutes; sildenafil and vardenafil 25–60 minutes; tadalafil 30 min – 2 hours.

  2. Week 1–2 · Find your dose

    Most men start at a moderate dose. Your clinician adjusts based on response — increasing if needed, decreasing if side effects appear.

  3. Week 4 · First check-in

    By this point ~80% of men are getting reliable results. If you're in the 20% who aren't, this is when most clinicians suggest switching agents.

  4. Week 6–8 · After a switch

    Around 70% of initial non-responders find their match with a second agent — bringing the total response rate close to 95%.

  5. Long-term · Confidence restored

    Most men stay on their chosen protocol indefinitely. Daily tadalafil reaches steady state by day 5; as-needed dosing works each time you take it.

Is this right for you?

Common reasons men start an ED programme

Occasional difficulty

Happens sometimes — often stress, alcohol or fatigue related. Even episodic ED benefits from treatment to restore confidence.

Frequent difficulty

More than 50% of the time. A consistent pattern that's affecting relationships or self-confidence.

Loss of morning erections

A natural physiological marker of healthy function. Reduced frequency is often an early indicator of vascular or hormonal change.

Linked to low libido

If desire is also low, a testosterone check is worth adding. Some providers include baseline labs in the intake.

Performance anxiety

Performance anxiety creates a self-reinforcing cycle. Knowing medication is there — even if not taken every time — often breaks the pattern.

Cardiovascular risk awareness

ED is frequently an early marker of cardiovascular disease. A telehealth intake is a good opportunity to flag this to a clinician.

Medication side effects

SSRIs, beta-blockers and some blood pressure medications commonly affect erectile function. A clinician can often adjust or add a PDE5 inhibitor alongside.

Returning after a gap

Previously treated but stopped? Providers make re-starting straightforward — your history helps them recommend the right dose quickly.

Safety firstPDE5 inhibitors are contraindicated with nitrate medications (including GTN spray, isosorbide mononitrate, and amyl nitrate / poppers) due to risk of severe blood pressure drop. If you use nitrates or have significant cardiovascular disease, please consult an in-person physician before starting. All providers on this platform perform a clinical screening before prescribing.
Real results

What patients actually say after starting treatment

“

I put it off for two years thinking it was just me getting older. Daily tadalafil through Roman changed everything — and nobody at work or at home even knows I take it.

JK
James K, 46
Roman
“

Hims was so easy. Filled in a form, had a prescription in an hour, pills arrived two days later. £25 a month is nothing for what it's given back.

MT
Marcus T, 39
Hims
“

I tried sildenafil first and the flushing put me off. Avanafil through Numan was completely different — no side effects and it worked in about fifteen minutes.

DR
Daniel R, 52
Numan
Our process

We do the research. You make the call.

01

Answer 7 short questions

We ask about frequency, duration, format preference, and any medications. No embarrassing detail — just what we need to surface a relevant shortlist.

02

See your personalised shortlist

Up to six providers ranked by match — with real per-dose prices, format availability, and discreetness ratings side by side.

03

Compare, choose, and go

Pin up to three brands for a direct comparison. Click through to the provider you choose — and start your clinical intake on their platform.

Questions, answered

Honest answers to common questions

All providers on this platform include a clinical assessment as part of the intake — a licensed clinician reviews your health history before any prescription is issued. Telehealth prescribing for ED is legal, common and follows the same clinical standards as an in-person visit.
Daily tadalafil (2.5–5mg) keeps a constant level in your system — no timing required. As-needed tadalafil (10–20mg) gives a 36-hour window when taken before activity. As-needed sildenafil or avanafil works faster but requires more timing. Many men prefer daily dosing for the spontaneity it provides.
Some combinations are safe and commonly prescribed together, but this depends on the specific medications involved. Your clinician will review your full medication list. Nitrates (GTN spray, isosorbide) are a hard contraindication — do not combine with any PDE5 inhibitor.
Non-response to one PDE5 inhibitor doesn't mean the class won't work. Switching from sildenafil to tadalafil (or to avanafil) resolves most non-response cases. About 70% of initial non-responders respond to a second agent or a different dose.
Generic sildenafil and tadalafil are sometimes covered, but ED treatment is frequently excluded from insurance plans. At $20–50/month for generic options, most men find cash-pay straightforward.
No. All providers on this platform use plain external packaging with no branding, product names, or medical descriptions visible on the outside.
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