What is ED?
Erectile dysfunction (ED) means having trouble getting or keeping an erection firm enough for sex. Almost every man has an off night now and then. When it happens regularly, that's ED, and it's far more common than most people think.
The good news: it is one of the most treatable conditions in medicine, and today you can get treatment privately, online, without a waiting room.
How erections work
An erection is really about blood flow. Here's what happens, and where treatment steps in:
- 1
Desire starts it
Arousal sends a signal from your brain. Apomorphine works here, supporting that signal.
- 2
Vessels relax
Sildenafil, tadalafil, and vardenafil block PDE5, an enzyme that would otherwise switch the signal off.
- 3
Blood flows in
Relaxed vessels let more blood in, making it easier to get and keep an erection.
Desire. Arousal starts in the brain, which sends signals down to the penis. Apomorphine supports this step.
Relaxation. Those signals relax the smooth muscle in the blood vessels. An enzyme called PDE5 normally switches this off; sildenafil, tadalafil, and vardenafil block it.
Blood flow. Relaxed vessels let blood rush in and stay there, creating a firm erection.
Why it happens
ED is usually a sign that something is affecting blood flow, nerves, hormones, or your headspace, and often a mix.
Less growth hormone every decade
After your 20s, your body releases less GH each decade. It shows up as lighter sleep, slower recovery, and less muscle.
Illustrative of the age-related decline described in published research.
The most common causes:
Blood flow & heart health
Anything that narrows blood vessels, like high blood pressure, high cholesterol, or diabetes, can affect erections.
Age
Blood vessels and nerves change over time, and ED becomes more common every decade.
Stress, anxiety & sleep
Your mind plays a big role. Stress, performance worries, and poor sleep can all get in the way.
Lifestyle
Smoking, heavy drinking, and inactivity all take a toll on circulation.
ED is common, treatable, and nothing to be embarrassed about. It can also be an early sign of heart health changes worth mentioning to your doctor.
Signs it's time to talk
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Start nowThese signs have many possible causes and aren't a diagnosis. Only a licensed provider can evaluate you.
Your treatment options
There are several ways to treat ED. Here's how they compare.
Exercise, better sleep, less alcohol, quitting smoking, and managing stress.
- Improves blood flow and overall health
- Helps every other treatment work better
- Takes time
- Often not enough on its own
Best for: Everyone, as a foundation
Standard sildenafil (the Viagra ingredient) or tadalafil (the Cialis ingredient).
- Proven and widely used
- Simple
- One ingredient, one profile
- Pharmacy pickup
Best for: People who get good results from one medication
Tides formulas combine sildenafil, tadalafil, vardenafil, and apomorphine in mints, a daily tablet, or liposomal form.
- Fast onset and a long window together
- Options for desire and maximum strength
- Prescribed online, shipped discreetly
- Requires a prescription
- Compounded, not brand-name
Best for: People who want more flexibility and strength
Injections, vacuum devices, or counseling, usually through a specialist.
- Can work when pills don't
- More involved
- Often in-person care
Best for: When oral treatments aren't enough
The four ingredients
Tides formulas are built from four ingredients, each with a different job.
Sildenafil Fast and reliable
The most familiar ED medication. Works in about 30–60 minutes and lasts around 4–6 hours.
Tadalafil The long window
Nicknamed "the weekend pill." Works within 30 minutes to 2 hours and can last up to 36 hours.
Vardenafil Potent and quick
Similar to sildenafil in timing, and often used for extra strength in combination formulas.
Apomorphine The desire boost
Works in the brain rather than the blood vessels, supporting arousal. Fast, and short-acting.
Approximate times. Onset and duration vary by person, dose, and formula, and a heavy meal can slow sildenafil and vardenafil.
They come in three formats:
Mint chews
Chew as needed, about 30–60 minutes before. Tastes like a mint.
Daily tablet
One small tablet a day keeps you ready anytime.
Liposomal
As-needed formulas designed for enhanced absorption.
What to expect
Here's what the first few weeks typically look like.
- Day 1
Take a 5-minute online assessment
Private questions about your health and medications. A licensed provider reviews it.
- Week 1
Your formula arrives discreetly
Plain packaging, no labels on the outside.
- First try
Keep it relaxed
Take it as directed, about 30–60 minutes ahead for as-needed formulas. Arousal is still needed for it to work.
- Weeks 2–4
Find your rhythm
Your provider can adjust your formula or dose based on how it goes.
- Ongoing
Confidence comes back
Many men find that taking the pressure off helps as much as the medication itself.
Individual results vary. Your licensed provider will help you set realistic expectations.
Safety & side effects
These medications have been used by millions of men for decades. Most side effects are mild and short-lived, but a few rules really matter.
Common and mild
- Headache or flushing
- Stuffy nose
- Indigestion
- Back or muscle aches (tadalafil)
- Nausea (apomorphine)
Never combine with
- Nitrates, like nitroglycerin for chest pain
- Riociguat
- Recreational "poppers" (amyl nitrite)
Talk to your provider first if you
- Have heart disease or had a recent heart attack or stroke
- Take blood pressure medication or alpha-blockers
- Have liver or kidney problems
ED and your overall health
Healthy erections depend on healthy blood vessels, which is why ED is closely linked to heart health, blood sugar, weight, sleep, and energy. Taking care of the whole picture helps everything work better.
If weight is part of the picture, our GLP-1 weight loss options can help too. Your provider can build a plan that fits.
Quick answers
Further reading
- Feldman HA, et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. Journal of Urology, 1994.
- Burnett AL, et al. Erectile dysfunction: AUA guideline. Journal of Urology, 2018.
- Goldstein I, et al. Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine, 1998.
- Porst H, et al. The efficacy and tolerability of tadalafil for up to 36 hours after dosing. Urology, 2003.
- Heaton JP, et al. Recovery of erectile function by the oral administration of apomorphine. Urology, 1995.
This guide is for education only and isn't medical advice. Always talk to a licensed healthcare provider before starting any treatment.