Over-the-Counter Options for Treating ED?
March 9, 2025
Erectile dysfunction is a condition that affects between 10 to 50 million men in the United States aged 20 and older, according to annual estimates from major men’s sexual health organizations. By age 40, about forty percent of men have been affected. While the percentage rises to around 70% by age 70, aging itself is not considered to be the primary cause of erectile issues.
While occasional difficulties with erections are normal and not usually a cause for concern, persistent ED can impact self-confidence and lead to relationship challenges. Common triggers for ED include fatigue, stress, excessive alcohol consumption, and certain medications. Addressing ED in a timely manner not only strengthens erections but can also contribute to well-being, as ED can sometimes signal more serious health issues, such as clogged arteries that limit blood flow.
Treatments that improve blood flow to the penile tissue, such as PDE5 inhibitors (like Viagra) and low-intensity extracorporeal shockwave therapy, are current prescriptive and minimally-invasive options to consider. Many over-the-counter supplements, gels and other products claim to address men’s sexual health concerns, but most OTC "male enhancement" options are not regulated by the FDA as medications and may include questionable ingredients. Genuine enzyme inhibitors prescribed to treat erectile issues are not available in OTC products.
FDA can provide an OTC marketing pathway...
In June 2023, the FDA approved a topical device as the first-ever over-the-counter gel for treating erectile dysfunction, marking a significant milestone in the accessibility of ED treatments. Although topical gels like Eroxon® are drug-free and don't require a prescription, they must still receive FDA approval before being sold over-the-counter in the U.S., ensuring their safety and efficacy for consumers. Unlike traditional oral prescription medications like sildenafil citrate, which can take up to 30 minutes to work, Eroxon® offers a quicker solution, helping men achieve an erection in as little as 10 minutes.
Scientists testing a topical medication containing nitroglycerin as its active ingredient discovered a revolutionary gel that provides a unique mode of action when applied to the head of the penis. Vasodilation, the natural widening of blood vessels, allows for greater blood flow and typically occurs in response to biological chemicals. The gel evaporates within seconds, creating an initial cooling sensation followed by a gradual warming effect, stimulating nerve endings and enhancing blood flow. Categorized as a Class II device and not a medication, Eroxon® has been deemed both safe and effective in inducing temperature changes that stimulate erection.
OTC Products for Erectile Dysfunction
It is important to note that while some supplements like L-arginine or DHEA are marketed over-the-counter as potential ED treatments, their effectiveness is not well-established and you should consider discussing your options with a men’s sexual health doctor before use, as they can interact with current medications being taken. The only FDA-approved OTC option for treating erectile dysfunction is a topical gel and a sex hormone booster (prasterone). Discussed below are some non-prescriptive ED options:
OTC Enzyme Inhibitors – According to the National Center for Complementary and Integrative Health, there are no safe and effective over-the-counter alternatives to PDE5 inhibitors like Viagra. In fact, OTC pills or capsules may contain unapproved drugs with potentially dangerous side effects that can even interact with medications you are currently taking for other health conditions. The most commonly discussed OTC with enzyme-inhibiting effects for ED is L-arginine, an amino acid naturally produced by the body that increases nitric oxide production to help stimulate an erection by improving blood flow, but effectiveness can differ from person to person.
Dietary ED Supplements – Pycnogenol is a French pine bark extract with antioxidant properties that supports cardiovascular health that has been combined with L-arginine to improve erectile function. Also derived from tree bark, yohimbine has traditionally been used to enhance sexual performance by increasing peripheral blood flow. Korean red ginseng (panax) may have a cumulative effect with ED, but the evidence is limited. Tongkat ali may increase testosterone levels, which can help with ED and low libido but test are needed. Some research reports improvements in erections and sexual satisfaction taking Tribulus Terrestris.
Androgen Supplements – DHEA is an anabolic steroid naturally produced by the adrenal cortex to help create sex hormones and aids smooth muscle relaxation. Most countries treat DHEA as a controlled steroid, so it is not available as an over-the-counter supplement. But in the United States, DHEA is exempt from the Controlled Substances Act. Unlike other steroid drugs, it can be included in dietary supplements to correct adrenal insufficiency or problems with natural aging. According to the Mayo Clinic, DHEA can cause serious side effects and you should avoid using the OTC supplement. Prasterone is a prescriptive FDA-approved DHEA medication.
Topical Gels or Creams – Eroxon® is an over-the-counter topical gel designed to help men achieve and maintain erections. The gel leverages nitric oxide, a natural vasodilator, which relaxes penile tissue and widens blood vessels to support erectile function. Though it does not contain an active pharmaceutical ingredient, Eroxon includes topical glyceryl trinitrate. Once absorbed into the bloodstream, this transforms amino acids into nitric oxide, aided by the gel’s cooling action, which helps dilate penile arteries. Reviews of the latest ED product suggests it may work better for some than others and may not work well for those with a more severe ED problem.
Sexual Hormone Boosters – Over-the-counter testosterone boosters have been a popular choice for men looking to raise testosterone levels. However, new research suggests T-booster supplements as having little to no known effect on restoring libido or boosting erectile function. A five-year-old study found that taking ashwagandha extract as improving T-levels but many experts say there is not enough evidence to support such claims. For men diagnosed by a clinician with hypogonadism, prescription testosterone replacement therapy often helps increase energy, libido and muscle mass. Certain lifestyle factors can also influence T-levels.
Traditional PDE5 inhibitors like Viagra and Cialis work by utilizing nitric oxide to block specific enzymes, improving blood flow and leading to harder, fuller erections. The FDA has approved Eroxon® as a Category II device under a new classification of non-medicated topical formulations for the treatment of erectile dysfunction. Since OTC treatment options can contain harmful ingredients that can cause dangerous side effects and interact with other medications, talk to a healthcare professional about your options.
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Nearly 90% of men with ED had at least one risk factor for cardiovascular disease, including diabetes, hypertension, having poor cholesterol levels or being a current smoker, and were also less likely to engage in vigorous physical activities. So, consider scheduling a men’s health exam with Dr. Earl Eye at GAINSWave Jacksonville and let our professional staff recommend a treatment protocol personalized for your sexual health needs.
