From dubious gas station supplements to exotic animal parts, the male enhancement space has long been troubled by less-than-legitimate products. Because treating male performance issues has often been a taboo subject, shady and predatory businesses have sought to take advantage of men’s reluctance to speak with medical professionals.
In 2020 alone, the U.S. Food and Drug Administration put out no less than 57 public notifications of hidden drugs contained in performance supplements.
Even as the world has transitioned toward virtual visits, free shipping, and telemedicine, many men have still found it difficult to sort through the fake stuff and legit Viagra online. Currently, the demand for easily obtained treatments has far surpassed the capacity of the FDA for effective regulation.
Here is a summary of the long and often ugly history of treatments for erectile dysfunction.
The Beginning: Male Superstition
Probably the first recorded attempt at male performance enhancement comes from the period just after the fall of the Roman Empire, when, rather optimistically, men wore talismans of goat and rooster genitalia. While this practice was certainly ineffective from a medical standpoint, it does illustrate the kind of mysticism and superstition surrounding male sexual performance that would continue for centuries afterward. It also suggests the considerable importance of the placebo effect.
The preceding centuries, among the darkest in medical history, saw little scientific innovation. The majority of emerging treatments focused almost ritualistically on the consumption of the genitalia of animals like wolves and eagles that were perceived to have exceptional virile qualities.
While this practice was misguided, it served as the basis for the first real advancement in human understanding of sexual performance.
In 1869, a scientist named Dr. Charles-Édouard Brown-Séquard began the practice of injecting semen into the blood of patients. Eventually, this led to the discovery of testosterone’s effects on male performance, which culminated in the first effective synthesis of testosterone by the German biochemist Adolf Butenandt in 1935.
While weird, some good may have come from this cringe-worthy, misguided practice.
The Modern Age of Sexual Wellness
It wasn’t until 1998 that the first truly effective, federally approved treatment for sexual dysfunction emerged. Sildenafil, or Viagra, was initially discovered by accident. Pfizer researchers looking to treat angina, a condition in which blood vessels supplying the heart constrict and cause tightness and breathing problems, were experimenting with compounds intended to dilate blood vessels.
Initial trials appeared ineffective at treating angina…when trial patients began reporting that they were instead experiencing robust erections.
Viagra had to overcome many cultural hurdles before it could be marketed as an effective product. Pfizer, a relatively conservative company, carried out numerous internal debates as to the effect on the company’s reputation of marketing sexual performance pills. After thousands of focus groups, however, it became clear that sexual performance was a significantly larger problem among the general population than had been previously realized. Viagra offered a legitimate and effective solution.
Viagra is a phosphodiesterase 5, or PDE-5, inhibitor that works by increasing and maintaining blood flow to the penis. While it does not stimulate arousal on its own, it does dilate blood vessels, making it a poor option for migraine sufferers or for those who have suffered a heart attack or stroke. It is recommended to take Viagra approximately an hour before sex. This makes it effective when its use is discussed openly with a partner but possibly limiting for patients who wish to avoid the discomfort of “planning” sex.
Though Viagra was the first drug to use PDE-5 inhibition, competition soon brought about alternative products, including Cialis (tadalafil), and Levitra (vardenafil). While each relies on the same mechanism of action, they offer different duration effects that allow patients a larger window during which to engage in sex.
The Birth of Alternative Supplements
Following the unprecedented mainstream success of sildenafil and its alternatives, various companies began to introduce a slew of Viagra-like compounds and supplements onto store shelves and company inventories. Possibly because of patients’ unwillingness to speak about sexual health with doctors, these products soon became worryingly popular, especially online.
Because the supplement market is notoriously unregulated, ingredients intended to promote sexual enhancement are often present in supplements without being listed on the packaging. A supposedly natural supplement available in Canada called Hua Fo, for example, was found to contain a sildenafil-like compound.
Even dietary supplement ingredients that are listed properly and accurately, however, can result in serious adverse health effects. Although supplements available over the counter are required to state that they have not been verified by the FDA, customers often ignore these warnings under the assumption that downright dangerous products would not be permitted to be sold.
One major 2015 study found that over 23,000 emergency visits per year were prompted by the use of dietary supplements. Some relatively common serious side effects of unregulated supplements for erectile dysfunction are:
- Kidney failure
- Pulmonary embolism
- Liver damage
- Stroke
- Death
A key danger of ingesting unmarked pharmaceuticals is that certain serious drug interactions and side effects can occur unbeknownst to the consumer. Sildenafil and its alternatives can interact with medications like blood thinners to produce such serious side effects. When the contents of a product are not listed, it’s impossible, even for a doctor, to determine whether or not ingesting it is safe.
The Problematic Process of Recalling Tainted Supplements
Although the FDA has the ability to issue mandatory recalls for tainted or dangerous supplements, it has not exercised it in the vast majority of known cases. It’s not clear why the agency has hesitated, but some sources claim that the bureaucratic process of allocating resources to carrying out such a recall is prohibitive in most instances.
Asking companies to voluntarily recall products is a simpler and seemingly more popular alternative to mandatory recalls. Voluntary recalls, however, depend entirely on the company in question. If a supplement-producing company isn’t particularly interested in the wellbeing of customers, it can legally ignore requests for a voluntary recall.
By 2018, voluntary recalls had been carried out in less than half of the instances in which the FDA requested them.
The dismal success rate of voluntary recalls is made even more dismal by the fact that the FDA has only cataloged a small fraction of tainted supplements. While the FDA lists approximately a thousand such supplements on its government webpage, warnings have often failed to make their way to consumers. Because a significant portion of concerning supplements are marketed to enhance sexual performance, it is generally recommended for consumers to avoid any supplement for sexual performance provided over the counter.
Marketing in Dangerous Products
With names like “Blue Steel,” “Energy Max,” and “Rhino V Max,” certain dubious products are relatively easy to spot. Unfortunately, identifying and avoiding misleading or tainted supplements is not always so simple. Some companies market their products convincingly as legitimate herbal or natural alternatives to Viagra or prescribed medications. Consumers looking to avoid the side effects of legitimate Viagra, such as headaches or nausea, of sildenafil and related products may be frustrated to discover that they have indeed ingested pharmaceutical products, albeit unregulated ones.
Some of the most notorious products have sought to prey upon mens’ senses of virility. Some consumers may buy into the marketing of products like “Black Panther,” and “King of Romance,” but another, equally powerful reason for the popularity of such products is the desire for a quick solution; in the heat of the moment, products available at gas stations, drug stores, and supermarkets are particularly appealing.
Treating Erectile Dysfunction Online
In the wake of the internet boom, it didn’t take enterprising companies long to realize the potential of sexual health medications prescribed and sold online. Since the shame and sensitivity surrounding male performance issues prevent many men from visiting a doctor in a face-to-face environment, offering prescriptions remotely is an ideal solution.
Both legitimate and shady businesses have sought to bring the multi-billion-dollar male performance market online. Unfortunately, regulatory agencies have often been reluctant or unable to catch up with rapid changes in technology and distribution methods. In one study, as much as 77% of Viagra sold online was impure, tainted, or packaged in improper concentrations.
Supplements
When buying supplements over the internet, the same risks apply as buying over-the-counter products in stores, making online dietary supplements for erectile dysfunction no safer an option. In fact, the level of risk may be greater, since products available online haven’t been through the low-level screening of having to be approved by store owners before becoming available.
Online Pharmacies
Consumers may assume that online pharmacies offering brand-name medications undergo a rigorous vetting process. A comprehensive study, however, found that a large percentage of companies posing as legitimate retailers of prescription medications were operating illegally or without proper oversight. Though there is still debate regarding the extent of the problem with legit Viagra online, the enforcement branch of the FDA has already expended considerable energy seizing fake Viagra for online distribution. In response to growing concerns, the FDA has launched its own website, BeSafeRX, for reporting and verifying online pharmacies.
Counterfeits
In 2013, customs authorities at the Miami airport confiscated 180,000 counterfeit Viagra pills. In recent years, the production of counterfeit drugs appears to have increased dramatically. Since smugglers and distributors are often internationally active, ingredients in counterfeit medications often bypass basic safety assurances required for sales in U.S. and European markets. For this reason, counterfeits may surpass even the dangers of tainted or unverified supplements. Confiscated counterfeit viagra pills have been found to contain these hazardous substances:
- Inedible ink
- Ground-up drywall
- Amphetamine
- Unknown inorganic compounds
- Antibiotics
Telemedicine or Telehealth Services
Spurred to growth through the popularity of podcast and internet radio advertising, companies like Hims and Blue Chew now offer online consultations for men’s health issues, including erectile dysfunction. These services have enjoyed the increasingly rigorous social proof of highly visible advertising campaigns, and have reached a high level of trust among millennials and younger adults.
Marketing for these telemedicine services often focuses on elements of the prescription process considered most uncomfortable for men, instead offering medications packaged in unlabeled materials and requiring only a video or phone call with a doctor. Services assure patients that their products are produced in the U.S and certified as legitimate.
The success of telemedicine services in men’s health has several possible drawbacks. One such drawback is that marketing seems to suggest that sildenafil or tadalafil are superior options for patients than healthy lifestyle practices that might eventually achieve resolution of the symptoms. Since online visits with doctors are done remotely, it can be difficult for a doctor to understand the full picture of a patient’s background before making a prescription decision.
Exacerbating critics’ concerns over marketing, the doctors responsible for prescribing medications are often contractors paid by the services. While this practice seems fine at first blush, whistleblowers have alleged that some companies actively encouraged them to prescribe medications. Because the risks of negative side effects from sildenafil and tadalafil have been seen as mild relative to other men’s health medications, remote doctors have possibly been especially open-handed in prescribing them.
Remote prescription services continue to increase in reach, and depending on the future of remote prescription regulation, telemedicine services are an increasingly viable option for patients in need of life-improving medication.
To review, the benefits of telemedicine services are:
- Rapid service
- Discreet packaging
- Relative affordability
- Consultation with a licensed doctor
- Confidentiality
The downsides could be:
- Potential for overprescribing
- Unpleasant or dangerous side effects
- Unavailable in certain areas or countries
- Certain non-active ingredients that may not be FDA approved
Telemedicine in the Post-Pandemic World
Telemedicine is the practice of delivering health care services at a distance. Though the term can include services specifically intended to prescribe medication, it also encompasses the use of remote technology by doctor’s offices. While the popularity of telemedicine among general practitioners was relatively low before the COVID-19 pandemic, in the post-pandemic world, it has seen a surge in innovation and popularity.
Today, video conferencing platforms like Zoom and Skype, as well as dedicated medical platforms, have become standard forums for issuing medical guidance. Coincidentally, this increase in traditional telemedicine has enabled doctor’s offices to compete with services like Hims, Rex MD, Bluechew, and Roman in the sexual wellness space. Differences in state requirements make it impossible to prescribe certain medications in certain places, but many doctors have adapted their practices to providing remote care.
Visiting with your primary care physician online is perhaps the best option for treating male wellness concerns during the pandemic. If you’ve visited with your primary physician before, he or she likely knows enough about you to make a safe decision regarding medications and treatments. Of course, under normal conditions, visiting your trusted doctor in person would be preferable, but telemedicine is a perfectly viable alternative. It even has advantages for your wallet, the planet, and your calendar since it limits unnecessary travel.
Distinguishing Legit Viagra Online From Fake Viagra Counterfeits or Supplements
There is an almost dizzying number of options for obtaining Viagra or popular alternatives online. Locating those that are legitimate versus those that are not can be difficult for those who are not well-versed in navigating the world of online medication. Though the most untrustworthy sites, distributors, and products are almost certain to set off alarm bells in the minds of most consumers, many such products still manage to find markets with which to continue their existence. To summarize:
What To Watch Out For
- Unreliable online pharmacies
- Unrealistic promises on packaging or marketing material
- Foreign products
- Products that have not been examined by the FDA
- Dietary supplements manufactured with little oversight
- Doctors with a clear interest in prescribing medication
While watchdog organizations and government lists exist to locate unreliable pharmacies, supplements, and medications, the vast majority of problematic products likely have yet to be discovered.
What to Do
- Do your research
- Use a trusted doctor
- Be open with your doctor
- Look for telemedicine providers that are well-known
- Look for a legitimate verification seal on supplements
- Be honest with yourself
Although it can sometimes feel uncomfortable to discuss sexual performance issues, doing so with a trusted doctor is one of the best ways to safely and successfully handle your problem. If you, like many other men, are dreading the conversation, consider that doctors routinely deal with far more disturbing subjects than erectile dysfunction. Doing so through a virtual process, like most of the big men’s health pharmacies online today, can feel even easier.
Before using any dietary supplement, speak with your doctor. Before attempting to obtain a PDE-5 inhibitor like Viagra, Cialis, or Levitra, do your own research to determine whether there’s anything important you might have neglected to mention to your doctor.