Every ED treatment, ranked by evidence
There are far more options than the four tablets everyone has heard of. Some are backed by decades of randomised trials. Others are sold for thousands of dollars on the strength of a plausible mechanism and a testimonial. This page separates them.
- Total covered
- 18
- Strong evidence
- 6
- Moderate
- 6
- Limited / investigational
- 6
How we grade the evidence
- Strong evidence
- Supported by multiple randomised controlled trials and recommended in major clinical guidelines.
- Moderate evidence
- Supported by controlled trials or long clinical experience, usually as a second-line option.
- Limited evidence
- Small, short or mixed studies. May help some people, but the benefit is not well established.
- Investigational
- Still being studied. Major guidelines advise using it only inside a research setting or with clear counselling about uncertainty.
Quick comparison
Onset, duration and typical US cash cost for every option on this site.
| Treatment | Evidence | Onset | Duration | Typical cost | Rx |
|---|---|---|---|---|---|
| Sildenafil | Strong evidence | 30–60 minutes | 4–6 hours | $5–$40 per month (generic) · $70–$100 per tablet (brand Viagra) | Yes |
| Tadalafil | Strong evidence | 30 minutes – 2 hours | Up to 36 hours (on-demand) · continuous (daily dosing) | $10–$50 per month (generic) · $70–$90 per tablet (brand Cialis) | Yes |
| Vardenafil | Strong evidence | 30–60 minutes | 4–8 hours | $20–$80 per month (generic) · brand pricing varies widely | Yes |
| Avanafil | Strong evidence | 15–30 minutes | About 6 hours | $30–$100+ per month, depending heavily on pharmacy and coupons | Yes |
| Testosterone | Moderate evidence | 3–6 weeks for libido; up to 6 months for erectile function | Ongoing while treatment continues | $20–$150 per month depending on formulation, plus monitoring bloodwork | Yes |
| Sex therapy | Moderate evidence | Typically several weeks | Benefits can persist after therapy ends | $100–$250 per session; some insurance coverage; low-cost options exist | No |
| Lifestyle | Moderate evidence | 6 weeks to 6 months | Sustained while the changes are maintained | Free to low cost | No |
| Pelvic floor | Moderate evidence | 6 weeks to 3 months | Maintained with continued practice | Free, or $80–$200 per session with a pelvic floor physiotherapist | No |
| Supplements | Limited evidence | Weeks, where any effect exists | Not established | $15–$80 per month | No |
| Vacuum device | Moderate evidence | 2–5 minutes | Up to 30 minutes with the constriction ring in place | $100–$500 one-off for a medical-grade device | No |
| Injections | Strong evidence | 5–20 minutes | 30–60 minutes | $30–$80 per compounded vial (multiple doses) · $50–$100 per single-use alprostadil kit | Yes |
| MUSE pellet | Moderate evidence | 5–10 minutes | 30–60 minutes | $40–$70 per dose | Yes |
| Implant | Strong evidence | Usable about 4–6 weeks after surgery | Permanent, with mechanical lifespan of 10–20 years | $15,000–$25,000+ before insurance; frequently covered when criteria are met | Yes |
| Shockwave | Investigational | Weeks to months, if it works at all | Benefit typically studied over 6–12 months | $3,000–$6,000 for a typical course of 6–12 sessions | No |
| PRP / stem cell | Investigational | Claimed over weeks to months | Not established | $1,500–$3,000 per injection; packages often sold in multiples | No |
| Constriction rings | Limited evidence | Immediate, once applied | Maximum 30 minutes per use | $10–$60 one-off | No |
| Topical gels | Limited evidence | About 10 minutes | Around 1–2 hours | $25–$60 per pack of single-use doses | No |
| Vascular surgery | Limited evidence | Months, as the graft matures | Potentially long-term in correctly selected patients | $15,000–$40,000+; insurance coverage is inconsistent | Yes |
Costs are US cash estimates and change frequently. Verify current pricing before buying.
Oral medication
- Strong evidenceRx
Sildenafil
Sildenafil is the most-prescribed erectile dysfunction medication in the world and the one most people try first. Here is what it does, how to take it properly, what it realistically costs, and when it is not safe.
- Onset
- 30–60 minutes
- Lasts
- 4–6 hours
- Strong evidenceRx
Tadalafil
Tadalafil lasts far longer than any other ED tablet and is the only one with a licensed daily dose. That changes how sex fits into a relationship. Here is how to choose between the two regimens.
- Onset
- 30 minutes – 2 hours
- Lasts
- Up to 36 hours (on-demand) · continuous (daily dosing)
- Strong evidenceRx
Vardenafil
Vardenafil is the least-prescribed of the mainstream ED tablets, which says more about marketing than about the molecule. It is a reasonable switch when sildenafil disappoints or its side effects are intolerable.
- Onset
- 30–60 minutes
- Lasts
- 4–8 hours
- Strong evidenceRx
Avanafil
Avanafil is the newest PDE5 inhibitor and the fastest to take effect — as little as 15 minutes. Its drawback is price: it is the one mainstream ED tablet with no cheap generic in most US pharmacies.
- Onset
- 15–30 minutes
- Lasts
- About 6 hours
Behavioural & lifestyle
- Moderate evidenceOTC
Sex therapy
Psychological factors are involved in most erectile dysfunction, including cases with a clear physical cause. Talking therapy is the only treatment that addresses them — and it works.
- Onset
- Typically several weeks
- Lasts
- Benefits can persist after therapy ends
- Moderate evidenceOTC
Lifestyle
Exercise, weight loss, stopping smoking and better sleep improve erectile function in controlled trials. They are slow, unglamorous, and the only interventions that address why this happened.
- Onset
- 6 weeks to 6 months
- Lasts
- Sustained while the changes are maintained
- Moderate evidenceOTC
Pelvic floor
Pelvic floor muscle training has randomised trial evidence behind it for erectile dysfunction, and it costs nothing. It is also the treatment most men do incorrectly.
- Onset
- 6 weeks to 3 months
- Lasts
- Maintained with continued practice
Hormonal
Devices
- Moderate evidenceOTC
Vacuum device
A vacuum erection device produces an erection mechanically, without any drug. It works when tablets do not, it costs little to run, and it is genuinely unromantic. Here is an honest account of both sides.
- Onset
- 2–5 minutes
- Lasts
- Up to 30 minutes with the constriction ring in place
- Limited evidenceOTC
Constriction rings
If your erection starts well and fades within a couple of minutes, the problem may be holding blood in rather than getting it there. A ring costs less than a month of tablets and addresses exactly that.
- Onset
- Immediate, once applied
- Lasts
- Maximum 30 minutes per use
Injectable & intraurethral
- Strong evidenceRx
Injections
Intracavernosal injection therapy works for most men in whom tablets have failed — success rates above 80% are typical. The barrier is not effectiveness. It is the needle.
- Onset
- 5–20 minutes
- Lasts
- 30–60 minutes
- Moderate evidenceRx
MUSE pellet
MUSE delivers the same drug as a penile injection through the urethra instead of a needle. It avoids the needle — and gives up a good deal of effectiveness in exchange.
- Onset
- 5–10 minutes
- Lasts
- 30–60 minutes
Surgical
- Strong evidenceRx
Implant
A penile prosthesis has the highest satisfaction rate of any ED treatment — consistently above 90%. It is also surgical, irreversible, and the end of natural erections. Both facts are true at once.
- Onset
- Usable about 4–6 weeks after surgery
- Lasts
- Permanent, with mechanical lifespan of 10–20 years
- Limited evidenceRx
Vascular surgery
Arterial bypass surgery can restore erections in a very specific group — young men with an isolated arterial injury and no vascular risk factors. For everyone else, guidelines are clear that it does not work.
- Onset
- Months, as the graft matures
- Lasts
- Potentially long-term in correctly selected patients
Emerging & unproven
- Limited evidenceOTC
Supplements
A handful of supplements have modest evidence behind them. Most have none. And a disturbing number of products sold for 'male enhancement' contain undeclared prescription drugs.
- Onset
- Weeks, where any effect exists
- Lasts
- Not established
- InvestigationalOTC
Shockwave
Low-intensity shockwave therapy is marketed as a cure that treats the cause rather than the symptom. The research is more interesting than the marketing admits — and considerably less conclusive.
- Onset
- Weeks to months, if it works at all
- Lasts
- Benefit typically studied over 6–12 months
- InvestigationalOTC
PRP / stem cell
Platelet-rich plasma injections and stem cell treatments are sold as regenerative cures for erectile dysfunction. Neither is approved for this use, and the human evidence remains thin.
- Onset
- Claimed over weeks to months
- Lasts
- Not established
- Limited evidenceOTC
Topical gels
Topical treatments are the newest category in erectile dysfunction, and the first to reach US shelves without a prescription. The convenience is real. The effect size is modest.
- Onset
- About 10 minutes
- Lasts
- Around 1–2 hours