The best male enhancement pills

Patricia Weiser, PharmD - Contributor Avatar

Written by Anna Brooks 

Patricia Weiser, PharmD - Contributor Avatar

Written by Anna Brooks 

last updated: Jun 10, 2024

8 min read

Key takeaways

  • Unlike prescription ED medications, male enhancement pills are not approved by the FDA and may contain hidden ingredients that could be harmful.

  • The FDA has issued hundreds of warnings about unregulated amounts of sildenafil (Viagra) and tadalafil (Cialis) found in sexual enhancement products.

  • The safest and most effective way to treat ED is through FDA-approved treatments prescribed by a healthcare provider.

If you’re experiencing erectile dysfunction, it might be tempting to find a quick fix and skip a potentially awkward conversation with your doctor. 

What about male enhancement pills? You may have seen advertisements for these “all-natural” products online or in the windows of health supplement stores promising longer, stronger erections (some even claim to increase penis size) – all with no prescription needed.

But do male enhancement pills work? And more importantly, are they safe? Not exactly. Male enhancement pills are not approved by the FDA, meaning they haven’t been tested for safety and efficacy the same way prescription medications for erectile dysfunction like Viagra have. Over the years, the FDA has issued many warnings about hidden ingredients found in hundreds of sexual enhancement products that may pose serious health risks.

Besides safety concerns, there is little to no scientific evidence backing up the sexual health claims of most of these products. The good news is, there are lots of FDA-approved medications for ED that are safe and effective for most people. Here’s what you need to know.

Viagra Important Safety Information: Read more about serious warnings and safety info.

Ro Sparks

Harder erections, faster than Viagra/Cialis

(sildenafil/tadalafil)

What are male enhancement pills? 

Male enhancement pills are over-the-counter supplements (meaning no prescription is required) that you can easily get online, at local pharmacies, and even in gas stations

They contain a mix of herbs, vitamins, and other ingredients, the combo of which is supposed to increase stamina, produce better erections, and improve sexual performance. Though they promise some of the same effects, sexual enhancement supplements are not the same as FDA-approved ED medications like Viagra and Cialis

Some common ingredients you may find in male enhancement pills include:

These ingredients are safe for most people to consume at low doses. Some, like ashwagandha and L-arginine, have been shown to potentially improve sexual function in men with mild to moderate ED. 

However, others are ineffective at best – and dangerous at worst. Ginkgo biloba, for example, is generally considered safe but it can interact with certain medications; high doses also raise the risk for more serious adverse effects including allergic reactions, bleeding, and seizures. Likewise, too much yohimbine can cause anxiety, insomnia, and high blood pressure.

Male enhancement pills have also been flagged by the FDA for containing hidden ingredients like sildenafil (the generic version of Viagra). If you have ED this may sound like a good thing, but drugs like sildenafil should never be used unless prescribed by a medical professional due to the risks of serious side effects and interactions.

Cialis Important Safety Information: Read more about serious warnings and safety info.

Do over-the-counter male enhancement pills actually work? 

The short answer? Probably not. 

Though scientific studies are lacking on the effectiveness of many ingredients in male enhancement pills for ED, early research shows promise for some. For instance, studies have found that L-arginine can improve blood flow; since ED is typically a result of impacted blood flow to the penis, L-arginine is a naturally occurring ingredient that could potentially be beneficial for ED.

Another ingredient, ginseng, has been used for thousands of years in Asia to enhance sexual arousal and performance. A review of multiple studies  has indicated that Korean red ginseng could benefit sexual function, but the evidence is considered weak. Overall, this review concluded that the impact of Korean red ginseng on erectile function and satisfaction isn’t much better than placebo (a “fake” treatment with no active ingredients). 

Though it’s possible some of the natural ingredients found in male enhancement pills could be helpful for ED, it’s not a guaranteed treatment. As with any diagnosed health condition, unregulated supplements should never replace recommended medical treatments from a healthcare professional. 

Why over-the-counter male enhancement pills can be unsafe 

Even though male enhancement pills are mostly made up of herbal ingredients that aren’t typically harmful, many products have been found to contain other hidden ingredients that could be unsafe. 

Because male enhancement pills are considered dietary supplements, the FDA regulates them as food, not medications. This means that male enhancement pills don’t undergo the same rigorous testing as FDA-approved medications and aren’t reviewed (if reviewed at all) until after products hit the market. 

Over the past decade, the FDA has issued more than 400 warnings about sexual enhancement products containing hidden ingredients like sildenafil and tadalafil, two popular prescription ED drugs. Though generally safe, these treatments require a prescription for a reason. Unknowingly taking a random dose could have serious consequences, especially if you have a heart condition or are on other prescription medications. 

Mixing ED medications with nitrates, for example, could lead to dangerously low blood pressure. Sildenafil may also interact with seemingly innocuous things like alcohol and grapefruit juice. Acetaminophen is another hidden ingredient that’s been found in male enhancement pills. While safe for most if taken as directed, too much acetaminophen could lead to liver damage.

Because male enhancement pills aren’t regulated by the FDA, the onus is on companies selling these products to ensure they’re probably labeled and don’t contain pharmaceutical-grade drugs. As you can see, that’s not always the case.

 

FDA-approved treatments to consider instead of male enhancement pills 

While there’s no magic prescription-free pill for ED, don’t worry – you still have lots of options. 

The first-line treatment for ED is oral prescription medications called PDE5 inhibitors. These work by relaxing muscles and blood vessels in the penis, which increases blood flow to the area, resulting in a stronger, longer-lasting erection. 

PDE5 inhibitors are considered safe and effective, with up to 76% of people reporting treatment helped alleviate their ED symptoms. Keep in mind that taking a PDE5 inhibitor won’t suddenly give you an erection; you have to be sexually aroused for them to work. 

Let’s take a look at common PDE5 inhibitors below.

Viagra (sildenafil) 

Famously nicknamed “the little blue pill,” Viagra is one of the most well-known and commonly prescribed ED medications. It’s also the original ED med, approved by the FDA back in 1998. 

You can take Viagra or its generic version, sildenafil. Both drugs contain the active ingredient, sildenafil citrate, and function the same way in the body. The main difference between the two is cost; Viagra is double the cost (or more) of sildenafil. The other difference is Viagra is approved to treat ED only, while sildenafil is also used for pulmonary hypertension, a condition that causes high blood pressure in the lungs. 

Viagra can be taken anywhere from four hours to 30 minutes before sexual activity. Its effects last up to five hours. Viagra comes in doses of 25, 50, and 100 mg, with 50 mg as the typical starting dose.

Do not take this medication more than once a day as it can lead to side effects like low blood pressure, severe headache, and priapism, a painful erection lasting four hours or longer. Priapism requires immediate medical attention or permanent damage can occur.

Cialis (tadalafil) 

Another common PDE5 inhibitor you may have heard of is Cialis, which was approved by the FDA in 2003. Tadalafil is the generic version, again, the main difference being cost (generic medications are generally more affordable than the brand name version). Tadalafil can also be used to relieve symptoms of benign prostatic hyperplasia (enlarged prostate).

How does Cialis stack up against Viagra? Both medications are equally as effective for ED, though studies have found some people prefer tadalafil, reporting that it gives them more sexual confidence compared to sildenafil.

The main difference between the two is tadalafil lasts longer – up to 36 hours – while sildenafil lasts about four hours. Cialis is available in 2.5, 5, 10, and 20 mg doses. What dose you’re prescribed depends on your needs; for example, people taking Cialis daily usually start at 2.5 mg while those using it on an as-needed basis start at 10 mg. You can take Cialis anywhere from two hours to 30 minutes as needed before sexual activity – or any time of day for those taking it once daily.

Levitra (vardenafil) 

Also approved in 2003, Levitra is another PDE5 inhibitor. The Levitra brand is no longer made, but its generic form vardenafil is available. Vardenafil is similar in structure to Viagra but is much more potent. The benefit of this is it can be prescribed at a lower dose, reducing the potential for side effects. 

Vardenafil typically starts working within an hour and lasts four hours or longer. It comes in doses of 2.5, 5, 10, and 20 mg, with 10 mg as a common starting dose. Like other PDE5 inhibitors, this ED medication should only be taken once per day.

Stendra (avanafil) 

The newest PDE5 inhibitor on the market, Stendra (avanafil) was approved in 2012. It’s also the fastest-acting ED medication, with effects kicking in after about 15 minutes. While Stendra works similarly to other ED medications, studies have found it may be superior to improving ED compared to sildenafil.

Stendra comes in 50, 100, and 200 mg doses (with 100 mg as the typical starting dose) and should not be taken more than once per day. 

Compounded ED medications 

Another ED treatment new to the market is Ro Sparks, a tablet that dissolves under your tongue over several minutes (think of it like a lozenge). Ro Sparks is a compounded medication that  contains more than one drug (in this case, a mix of Viagra and Cialis).

Why would you want to use a compounded medication? These can come in handy if an individual has specific needs and could benefit from a combination of drugs that may not typically be taken at the same time. For example, Ro Sparks offers a safe dose of Viagra and Cialis to be taken together. 

Ro Sparks contains 55 mg of Viagra and 22 mg of Cialis. The benefit of taking it sublingually (under the tongue) is it’s absorbed directly into the bloodstream, allowing the medication to start acting faster, usually within 15 minutes. Not only does it kick in quicker, but the effects can last up to 36 hours. Ro Sparks may also be a good option for people who have trouble taking pills.

Keep in mind that compounded medications do not undergo FDA safety or effectiveness review, but they are permitted to be prescribed under federal law. This doesn’t put compounded medications in the same camp as male enhancement pills though; even though compounded drugs are not FDA-approved, a prescription from a licensed healthcare provider is still needed. 

Other emerging ED products are chewables and gummies. Again, you need to be careful where you’re getting them from. Male enhancement gummies are easy to get your hands on and don’t require a prescription, but like male enhancement pills, there’s not much evidence that they work for ED.

If you’re looking for ED gummies that actually work, Ro’s Daily Rise Gummies deliver Cialis in a fruit-flavored gummy. Daily Rise Gummies contain 7 mg of tadalafil, and as the name implies, are only taken once daily. Because they come in gummy form, they can be easier to take every day than a pill. 

Frequently asked questions about male enhancement pills 

What pills make you hard right away?

All ED medications are designed to make you hard, but some work faster than others. For example, Ro Sparks can make you hard in 15 minutes, whereas Viagra takes anywhere from 30 minutes to two hours. Because of its delivery route, Ro Sparks is absorbed faster and starts working much quicker than traditional ED medications. Stendra can also make you hard in about 15 minutes. 

Unregulated male enhancement pills, on the other hand, aren’t likely to get you hard. And if they do, they may contain hidden ingredients that could put your health at risk. 

Do male enhancement pills make you bigger?

There’s no evidence to suggest that male enhancement pills can make your penis bigger. Neither can approved ED medications like Viagra, though they can help you get better erections. If medication doesn’t work, penile implants are another option for treating ED, but the procedure is costly and won’t make your penis bigger.

The only way to permanently increase your penis size is through surgery. However, penis enlargement surgeries carry quite a few risks and the outcomes are inconsistent. Other penis enlargement methods like vacuum pumps and “jelqing” can be harmful and should be avoided.

If you’re experiencing symptoms of ED like having trouble getting or maintaining an erection, the first step is speaking to a healthcare provider so they can determine the best course of treatment for you. 

If the idea of seeing a doctor seems daunting, there are telehealth services like Ro you can utilize discreetly without having to leave home. Always speak with your doctor before trying any dietary supplements, especially if you have an existing health condition or are taking any medication.

DISCLAIMER

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.


How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

June 10, 2024

Written by

Anna Brooks

Fact checked by

Patricia Weiser, PharmD


About the medical reviewer

Patricia Weiser, PharmD is a licensed pharmacist and medical writer. She has more than 14 years of clinical experience in community and hospital pharmacy.