None of this requires medical knowledge. Every question is answerable by reading the page in front of you, and the answers tell you more about a company than any star rating.
1. Does it warn me about nitrates — and say why?
This is the one that matters most. ED medication taken with a nitrate can drop your blood pressure to a fatal level. If you take nitroglycerin, isosorbide, or use “poppers”, this is the question.
A good page does not just list the word. It explains the consequence, because that is what changes behaviour. The best we have found reads: *“Do not use with nitrates or guanylate cyclase stimulators such as riociguat; the combination can cause a dangerous drop in blood pressure.”*
Fifteen of the thirty-one pages we have audited say nothing about it at all. Which medicines count as nitrates.
2. Does it tell me what to do if an erection will not go down?
An erection lasting more than four hours is a medical emergency. Trapped blood loses its oxygen, tissue damage begins within hours, and permanent loss of function is a real outcome.
It should say four hours, and it should say to seek emergency care. Seventeen of thirty-one never mention it. One raises it and frames it as manageable, which is worse than useful — it tells you there is an antidote without telling you to hurry.
3. Does it name actual side effects?
Not *“like all medications, this may cause side effects”*, which is a sentence that could describe aspirin. Named ones: headache, flushing, nasal congestion, indigestion, back pain.
A good list includes low blood pressure and vision changes, which are the two most often dropped. If a page names those, somebody wrote it who understood the drug. What the common effects actually are.
4. Does it ask about my heart?
These drugs work by opening blood vessels, so they lower blood pressure by design. Anyone with heart disease, low blood pressure, or taking an alpha-blocker for prostate symptoms needs to know that before ordering, not after.
Seventeen of thirty-one never raise it. Several list low blood pressure as a side effect and then never connect that to the people for whom it is dangerous, which is a strange place to stop. Why ED and heart health are the same conversation.
5. Is it FDA-approved, or is it compounded?
This is the distinction the category works hardest to blur, so it is worth being precise.
| What it means | |
|---|---|
| FDA-approved generic | Sildenafil or tadalafil as approved. Reviewed for safety, effectiveness and quality. |
| Compounded | Mixed to order by a pharmacy. Legal and often appropriate — but NOT FDA-approved, and not reviewed for safety, effectiveness or quality. |
Almost every multi-ingredient “3-in-1” or “4-in-1” product is compounded, because no approved product combines these drugs. A page selling one should say so plainly. Watch for two dodges: the dietary-supplement disclaimer — *“these statements have not been evaluated by the Food and Drug Administration”* — which is the wrong instrument entirely for a prescription drug, and a bare “Rx only” left to imply approval.
6. What dose am I actually getting?
Nineteen of thirty-one will not tell you. They name the ingredients and leave out the quantities, which is the difference between a label and a marketing claim.
It matters for two reasons. If you already keep sildenafil or tadalafil at home, you cannot tell whether you would be doubling up. And on a product stacking two or three drugs of the same class, the total is the number that decides whether the formulation is conservative or aggressive.
7. How do I stop it, and what is the second charge?
Billing is where this category behaves worst, and the two halves of this question are separate.
How do I stop it? *“Cancel anytime”* is an assertion, not a policy. A policy says *how* — in the account portal, by email, with how much notice, and whether there is a fee. Nineteen of thirty-one publish nothing at all.
What is the second charge? The advertised figure is frequently a first-order discount. One service advertises $28 and renews at $48. Another prints a footnote saying whatever price you are looking at is a first-order rate, without saying what the next one is. Budget on the renewal. We ranked every service on that figure.
What to do with the answers
Nobody passes all seven — not one of the thirty-one pages on this site. So the question is not whether a page is perfect but how far short it falls, and on which of the seven.
- Question 1 is not negotiable. If you take any nitrate and the page does not warn you, do not buy from it — and do not buy the product elsewhere either without asking a clinician first.
- Questions 4 and 5 are close behind if you have a heart condition or are being sold a combination product.
- Questions 6 and 7 are about being treated as an adult. A company that will not tell you the dose or the terms has decided those facts are bad for conversion.
- Questions 2 and 3 are the cheapest to fix and the easiest tell: a page that has them usually has the rest.