Your health · 6 min read
ED is often the first warning sign of heart disease
Erectile dysfunction can show up three to five years before a heart attack. Here is the mechanism, and what to ask for.
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Written for men over 50
Straight answers about erectile dysfunction, without the hype.
Every treatment explained in plain English — what it costs, how fast it works, and what it does to you. No products to sell you, and no pretending a supplement is a cure.
Educational information only. We are not a medical provider and we do not sell treatment.
Read this first
For men over 50, ED is often the first sign of heart disease.
The arteries in the penis are one to two millimetres wide. The ones feeding your heart are two to three times that. The same plaque narrows the small pipe first — which is why erectile problems can show up three to five years before chest pain does.
That gap is not bad news. It is a head start, and it is the single most useful thing on this website.
Treatments
Every option, in the order doctors actually try them
Nobody starts with surgery. Treatment for ED follows a fairly consistent ladder, and knowing where you are on it tells you what to ask for next.
- Start here
Lifestyle changes
The only approach that treats the cause rather than the symptom — and the only one that also lowers your risk of a heart attack.
- Typical cost
- Free to low cost
- First choice
Pills (Viagra, Cialis, and the rest)
Four prescription tablets that relax the arteries in the penis so more blood can get in. Where nearly every man starts.
- Typical cost
- $1–$5 per dose for generics; far more for brand names
- Next step
Topical gel (over the counter)
A drug-free gel rubbed on before sex, sold without a prescription. Works in ten minutes, works for fewer men than pills — and has no nitrate problem.
- Typical cost
- About $25 to $30 for four uses
- Next step
Vacuum erection devices
A cylinder and pump that draw blood into the penis mechanically, held in place with a ring. No drugs, no needles, works with almost any cause.
- Typical cost
- $100–$500 once; often covered by Medicare Part B
- Next step
Injections and urethral suppositories
A tiny needle into the side of the penis that produces an erection directly, without needing arousal first. The most reliable option short of surgery.
- Typical cost
- $10–$40 per dose, depending on the formulation
- Only if indicated
Testosterone therapy
Genuinely useful if your testosterone is measurably low. Widely oversold to men whose levels are normal.
- Typical cost
- $30–$150 a month, plus ongoing monitoring bloods
- Start here
Counselling and sex therapy
For ED that is driven by anxiety, depression, or what is happening in the relationship — and as support alongside any physical treatment.
- Typical cost
- $60–$200 per session; often partly covered by insurance
- Last resort
Penile implants
Surgery that places a device inside the penis. The highest satisfaction rate of any ED treatment — and the only permanent, irreversible one.
- Typical cost
- $15,000–$25,000 without insurance; often covered with documentation
- Not proven
Shockwave therapy
Sold aggressively by cash-pay clinics at $3,000 or more. Still classed as investigational, and not FDA-approved for ED.
- Typical cost
- $3,000–$6,000 for a course, almost never covered
Getting treatment
Online clinic, or a doctor down the road?
Both are legitimate. They are good at different things, and the honest answer for most men over 50 is that you want a bit of each.
Online clinics
Cheaper, faster, private.
- Generic pills from around $1 a dose
- No waiting room, no eye contact
- Prescription usually within a day
An in-person doctor
The part telehealth cannot do.
- Blood pressure, cholesterol, blood sugar
- A proper look at why this is happening
- Access to injections and surgery if needed
Reviews
We read the fine print so you do not have to
We read each service's own page and record what it tells you before you buy — whether it explains the nitrate interaction, publishes its doses, and states what happens when you try to leave.
Latest reviewRecommended product
CoreAge Rx 4PLAY
The most complete safety disclosure of any combination product we have audited — and nothing recurs unless you say so
Why this one is up here. It is our pick of the combination products: the fullest safety and compounded-drug disclosure of any we have audited, and one of only two services in this comparison whose refills are opt-in rather than automatic — no membership fee, no contract, and a refund if a clinician decides the treatment is not appropriate. We rate it 4.8 out of 5. CoreAge Rx supplies our giveaway prize, but not a commission — clicking through to them earns us nothing, and this rating predates the giveaway. The review sets out the case in full, including the two things to ask the prescriber before your first dose — it stacks three PDE5 inhibitors rather than two, and it publishes no dose for any of its four ingredients. How we make money.
Every other review
4.5/5
Lemonaid Health
The only service that turns unsuitable patients away — and asks for your blood pressure
Read the review
4.3/5
CNL Med ED consultation
One flat fee, no subscription, and a safety section better than most of this market
Read the review
4.3/5
PlushCare tadalafil consultation
One of only two services here that says outright who should not take this — and the only one that takes insurance
Read the review
4.3/5
Vybrique (sildenafil) oral film
An FDA-approved sildenafil film that does what the compounded troches were never approved to do
Read the review
4.2/5
BosleyRx 2:1 Sildenafil + Tadalafil Blend
The only combination product that publishes its doses, its FDA status and a cancellation phone number
Read the review
4.1/5
4.1/5
Generic sildenafil and tadalafil
$1.99 a pill for FDA-approved generics, at any strength, with the safety copy on another page
Read the review
4.0/5
4.0/5
Empower Tadalafil / Apomorphine Troche
A 503A compounding pharmacy that documents its product properly — bring your own prescriber
Read the review
4.0/5
Eroxon ED Treatment Gel
The first ED treatment cleared to sell without a prescription — and the only one here with no nitrate problem
Read the review
3.9/5
BlueChew Gold
Four ingredients, three strengths, and the best safety information we found
Read the review
3.9/5
Sesame ED consultation
A real video visit with a doctor you choose, no subscription, and the lowest per-tablet prices we found
Read the review
3.7/5
Hard Mints
The category's biggest advertiser, with the best safety writing and no published dose
Read the review
3.4/5
Kare Sildenafil Citrate Rapid Dissolve Tablet
Textbook clinical safety copy, five published strengths, and the dietary supplement disclaimer on a prescription drug
Read the review
3.4/5
Eddie by Giddy
A sized constriction device for men who keep the erection but cannot hold it
Read the review
3.3/5
ZipHealth generic tadalafil
Publishes four strengths and the real price, and not one word about nitrates
Read the review
3.1/5
CareFirst Compounded Sildenafil
The only one you can actually verify — accredited, licensed, and it publishes the numbers to check
Read the review
3.1/5
Shameless Duo
81 mg of sildenafil and 12 mg of tadalafil in one troche, and it tells you so
Read the review
3.0/5
3.0/5
Ro Daily Rise Gummies
A daily tadalafil gummy at a dose above the approved daily range
Read the review
2.8/5
AgeMD Vardenafil Sublingual Troche
Publishes the dose and the FDA status, prices three plans clearly, and puts the safety information behind a link
Read the review
2.8/5
WebDoctors ED consultation
The most expensive consultation in this comparison, with a safety section that is brief but real
Read the review
2.6/5
Q Care Plus ED treatment
Names poppers, bills through insurance, and will only sell you ED medication if you are already a PrEP patient
Read the review
2.5/5
2.5/5
Push Health ED request
Names the nitrate drugs by name, then stops — no price, no priapism warning, no terms
Read the review
2.2/5
Rocket RX Rocket Rise
Gets the compounded and FDA disclosure exactly right, then prices three other products and not this one
Read the review
2.2/5
2.1/5
2.1/5
Hone Health ED treatment
The only service that runs your bloods first — and the page tells you nothing about risk
Read the review
1.9/5
Modern Wellness Tadalafil / Sildenafil Troches
A real clinic that takes insurance — and charges $199 before telling you if you qualify
Read the review
1.9/5
ZipHealth MAXX Chews
Says it is compounded, then explains the FDA away in the same sentence — and never shows a price
Read the review
1.6/5
Mt. Everest RDT
A three-ingredient compounded tablet at $3 a dose, sold with no safety information at all
Read the review
1.6/5
24hrdoc ED consultation
A prescription for four vasodilators in forty-five minutes, and not one word about when they are dangerous
Read the review
1.4/5
MaxRx ED treatment
Prices, a quiz, and not one word about what the medication can do to you
Read the review
1.2/5
Invigor Medical ED treatments
Injections, orals and peptides described in a video, with no prices and almost no warnings
Read the review
0.9/5
Guides
Start with these
Longer reads that answer the questions men tend to search for at two in the morning.
Causes · 8 min read
What actually causes ED after 50
Age itself is rarely the problem. Here is what is usually going on underneath, and how to work out which cause applies to you.
Read more
Medications · 7 min read
Sildenafil vs. tadalafil: which one should you ask for?
Viagra and Cialis in generic form, compared on timing, food, side effects and cost — with a plain recommendation at the end.
Read more
Directory
Clinics that treat ED properly
We list 9 practices across 4 states so far — urologists and men's health clinics that offer more than a prescription pad.
How we work
Why you can trust what you read here
We do not sell treatment
No pills, no consultations, no subscription. We have nothing to gain from you choosing one option over another.
We name the risks
The nitrate interaction, priapism, the things clinics gloss over. If a treatment is unproven, we say so plainly.
We disclose the money
Some links to online clinics are paid. Which ones is stated on the page, and it does not affect our ratings.
This is more common than you think.
Around half of men in their fifties have some degree of it, and most of them never mention it to anyone. It is treatable — usually easily. The hard part is the first conversation.
Questions about ED Treatment Spot? Contact us.