How Online ED Treatment Really Works

Step 1: Online Consultation

• Medical History Review: You will answer questions about your general health, current medications, cardiovascular history, and sexual health concerns. This helps the provider determine if ED medication is safe for you.
• Symptom Assessment: The provider will ask about the frequency and severity of ED symptoms, how long you have experienced them, and any factors that worsen or improve symptoms.
• Contraindication Screening: Critical questions identify contraindications like nitrate medication use (for chest pain), recent heart attack or stroke, severe liver/kidney disease, or uncontrolled blood pressure.
• Video vs Asynchronous: Video consultations happen in real-time (15-20 minutes), while asynchronous consultations involve completing a detailed questionnaire that a provider reviews within 24-48 hours. Both are equally valid clinically.
• Privacy and Security: All consultations occur on HIPAA-compliant platforms that protect your medical information. Your data is encrypted and providers are bound by the same confidentiality rules as in-person doctors.
• Cost: Many telehealth platforms offer free consultations, though some charge $15-$50. The consultation fee is often waived if you proceed with a prescription.

Step 2: Doctor Review & Prescription

• Medical Approval Process: The physician evaluates your cardiovascular health, medication interactions, and overall suitability for ED medications. PDE5 inhibitors (like sildenafil and tadalafil) affect blood pressure, so cardiovascular screening is essential.
• Prescription Options: If approved, the doctor prescribes the most appropriate medication and dosage. Common options include generic sildenafil (Viagra), tadalafil (Cialis), or brand-name versions. The doctor considers your preferences, budget, and medical factors.
• Dosage Selection: Starting doses are typically conservative (25-50mg for sildenafil, 5-10mg for tadalafil). The provider explains how to take the medication, when to expect effects, and how to adjust dosage if needed.
• Approval Timeline: Video consultations often result in same-day prescriptions. Asynchronous consultations typically receive approval within 24-48 hours. You will receive email or text notification when your prescription is ready.
• If Treatment Is Not Appropriate: If the physician determines ED medication is unsafe for you (due to contraindications or underlying conditions), they will explain why and may recommend alternative approaches like in-person evaluation, lifestyle changes, or referral to a specialist.
• Second Opinions: If denied, you can seek a second opinion from another telehealth provider or in-person physician. Some conditions require in-person evaluation before telehealth treatment can be safely provided.

Step 3: Medication Delivery

• Pharmacy Fulfillment: Prescriptions are sent to partner pharmacies (often accredited mail-order or compounding pharmacies). These pharmacies are licensed, regulated, and inspected just like local pharmacies.
• Shipping Times: Standard shipping takes 3-5 business days. Expedited shipping (available from some providers) delivers in 1-2 days for an additional fee. Some providers offer free shipping on subscriptions.
• Discreet Packaging: All medications arrive in unmarked packages with no indication of contents. Billing statements use generic company names rather than "ED medication" to protect privacy.
• Prescription Options: You can choose one-time purchases (try before committing) or subscription plans (automatic refills at discounted prices). Subscriptions typically save 10-25% compared to one-time orders.
• Generic vs Brand: In September 2026, generic sildenafil ran $4 to $10 per dose at Hims and Ro, and generic tadalafil ran from $6 per use at Hims to $44 per dose at Ro. Brand Viagra was $90 per dose at Ro and $135 to $139 per use at Hims, and brand Cialis started at $20 per 5 mg dose at Ro. Generic medications contain identical active ingredients and are FDA-approved as bioequivalent.
• Delivery Confirmation: You will receive tracking information to monitor your shipment. Most providers require signature upon delivery for controlled medications.

Step 4: Follow-up Care

• Checking In: Most providers follow up 2-4 weeks after your first prescription to ask about effectiveness, side effects, and satisfaction. This helps optimize your treatment plan.
• Dosage Adjustments: If the initial dose is not effective or causes side effects, your provider can adjust the dosage or switch medications. Common adjustments include increasing from 25mg to 50mg sildenafil, or switching from as-needed sildenafil to daily low-dose tadalafil.
• Side Effect Management: Common side effects (headaches, flushing, nasal congestion) are usually mild and temporary. Your provider can suggest timing changes, dosage reduction, or alternative medications if side effects persist.
• Ongoing Access: You can message your provider through the platform with questions or concerns. Most telehealth services offer unlimited messaging at no extra cost.
• Subscription Management: If on a subscription, you can pause, cancel, or modify delivery frequency anytime. No long-term commitments or cancellation fees.
• When to Seek In-Person Care: Contact emergency services if you experience chest pain, vision changes, prolonged erection (over 4 hours), or severe allergic reactions. Your telehealth provider can also refer you for in-person evaluation if needed.

Online vs In-Person Treatment Comparison