Young Guys Are Popping ED Drugs—But It’s Not for the Reason You Think

“It gave me a feeling I haven’t felt since I was young,” Mark, now 28, says. “It was magical. I’m like, ‘I have to get my hands on these.’ ”

Luckily for Mark, and a surprising number of American young men who struggle with erectile dysfunction, scoring ED pills has never been easier. Pfizer’s Viagra patent lapsed back in 2020, so the drug’s active ingredient, sildenafil, is available generically. Which means any company can make its own version and sell it for about one-tenth the price of Viagra. Combine cheaper prices with relaxed, COVID-era policies that made it easier to buy prescription meds online and you could say that we’re in the thick of a boner business boom.

There are now roughly 15 direct-to-consumer platforms selling ED treatments, including some you’ve likely heard of—Hims, Ro, BlueChew—and many you probably haven’t. Depending on which company guys order from, they can customize the form of the medication (pill, chewable, sublingual), the dosage (daily for those hoping to stay ready, on-demand for specific moments), and even the flavor (wintergreen mint, berry, cinnamon). Most of the meds contain sildenafil, tadalafil, or vardenafil, each active ingredient geared toward time windows of “readiness.” And perhaps most important, all these companies will sell you ED drugs without your ever having to leave the comfort of your home.

To obtain his own stock of BlueChew, Mark went online, answered a short medical questionnaire, had a three-minute meeting with a doctor, and voilà, the pills arrived in a couple days. He already had an opportunity to use them: In the coming weeks, he would be heading to Colombia, where he planned to link up with a woman he’d met on a previous trip to the country. They arranged to meet on the day of his 26th birthday. He brought his BlueChew.

This time, Mark had no trouble getting hard, saying his erection was “almost instantaneous” upon seeing her. He’s unsure how much of that was due to the pill, his attraction to the woman, or the lifestyle changes he had made in the two months between the first attempt to lose his virginity and the second. Mark had started working out, had lost some weight, and was making more money, so he had more confidence and vitality. “But the fact that we went on so long that night, I think it was the pill,” he says.

Mark’s story is straight off the vision board of BlueChew’s marketing department. Its advertisements, from the most reliably horny of the telemedicine companies, show up all over social media, in podcast commercial breaks, and during NFL games. The ad spots often feature young, attractive couples—not to mention athletes and Instagram models—whose sex lives are greatly improved when they “chew it and do it.” (Despite repeated attempts, BlueChew did not respond to requests to participate in this article.)

Though other telehealth companies, like Rugiet and Hims, strike a more professional tone, there’s still been a notable across-the-board vibe shift from the days of Bob Dole and “Viva Viagra!” These BlueChew alternatives skew more millennial, not Gen Z, masculine—the men giving the testimonials wear beanies, the attractive doctors are straight off the set of The Pitt. Rugiet (which is Latin for “he will roar”) just finalized a partnership with the UFC, so now the company’s logo will appear on the Octagon, the closest thing we have to a modern-day Colosseum.

“We’re a lot more direct than I think companies in this space have been in the past,” says Mike Apostal, Rugiet’s CEO. Apostal says that Rugiet’s typical customer is between the ages of 45 and 65, though he’s seeing “younger and younger folks needing it earlier,” which is why they’re working to remove the stigma around taking a drug for erectile dysfunction. ED “was shameful,” he says. “Now it’s like, okay, let’s solve it.”

The proposed solution addresses sexual function and also anxiety, like the kind Mark suffered. Rugiet’s blend consists not only of sildenafil and tadalafil but also apomorphine, which stimulates dopamine receptors and primes the brain for sexual satisfaction. The combo targets “both the physical and mental aspects of arousal,” Rugiet advertises. BlueChew also now offers, as one of its eight types of pills, a “Gold” version that includes tadalafil, sildenafil, apomorphine, and oxytocin, the neurotransmitter that’s activated when we fall in love or are sexually aroused.

The advent of these new, tailored pills suggests that ED meds are improving. Spend a little time on Reddit (or a lot, as I did for this article) and you’ll find they’re also getting into the hands of younger and younger dudes, who are using them for all types of reasons. Some use them because they struggle to get hard after years of watching porn has left them physically desensitized or too nervous to talk to real-world partners. Some men are interested in, ahem, dickmaxxing and pop BlueChews to look fuller and harder. Some even use them just to get a good pump during a workout. Many young guys believe that ED meds might help them overcome self-consciousness they feel about their bodies, their sexual drive, or being unable to perform during sex. I contacted nearly 100 potential subjects in reporting this story. Only a few agreed to talk to me on the record, and then, like Mark, they requested anonymity.

The issue isn’t whether these pills work or not (they do), but how they’re affecting the landscape of men’s sexual health, and who exactly should be taking them. Gen Z guys might think they need them, but do they, really?

WHAT’S KIND OF wild is that for all the ED med marketing aimed at young guys, researchers aren’t even sure how many men under 30 actually have the condition. Studies put the number below 20 percent. (For men over 40, that number jumps to 50 percent). The big challenge is that younger men tend not to report their ED because of shame. That stigma is a psychological response to a biological fact, and overcoming erectile dysfunction often involves treating a man’s body, his brain, and his penis.

Biologically, when a man can’t maintain an erection, it’s because not enough blood is flowing into the penis. The good news is that there’s a wide range of treatment options available: pills, implants, even shock wave therapy. “I always like to tell men, ‘As long as you have a penis, we can make it hard,’ ” says Michael Eisenberg, MD, a urologic surgeon scientist and professor of urology at Stanford.

Erectile dysfunction pills, specifically, work by blocking an enzyme called PDE5, which allows the muscles in the penis to remain relaxed for longer and increases vasodilation (the widening of blood vessels). When the penis fills with blood, the organ expands lengthwise and radially. The higher the pressure in those chambers, the more expansion.

“[Pills] are often a physiological solution for a psychological problem,” says Nicole Prause, PhD, a neuroscientist who studies sexual behavior. There are, obviously, physiological reasons behind ED. Some involve the cardiovascular system: diabetes, high blood pressure, heart disease. This is also why heavy nicotine use or sucking down five old-fashioneds might also inhibit your ability to achieve whole hog—both habits hit your heart.

But some experts say that most cases of erectile dysfunction, especially among younger men, are psychogenic, the most common reason being performance anxiety, which overactivates the nervous system and floods the body with adrenaline. This is what makes treating erectile dysfunction so tricky. Dr. Eisenberg tells his patients that ED treatments are “not going to take you back to when you were 20.” But many of the men I spoke to described that exact return to glory after taking ED meds.

Evan, 33, first took 20 milligrams of an ED pill about eight years ago for a marathon threesome with two other men. He remembers the drug causing him to “achieve a level of erection I had never previously seen: truly massive, especially in terms of girth.” He still takes vasodilators occasionally and says that sometimes he achieves a “100–105 percent” erection. I asked him to clarify. “One hundred percent is no flop, just a solid steel rod that bounces back like a diving board,” he says. “One hundred and five percent is so hard that you can feel the skin wanting to stretch, and the veins seem to pop out because there is nowhere for them to go. I can stare down at my dick while it’s 105 percent and it will actually be pulsing with my heartbeat.”

Juan, another mid-30s guy, took his first BlueChew roughly four years ago, after hearing it advertised on a comedy podcast. He says he has a good sex life with his wife but figured, why not? “I just thought it could be fun.” After popping the chew, he says, he had sex with his wife four times and masturbated three times—all in a span of eight hours. (Important note: ED drugs do not directly increase sexual desire; research is mixed on if the meds can get you hard again faster after orgasm. Their effect is largely mechanical.) “I don’t think I was getting fully hard until I felt how hard I got on BlueChew,” Juan says. Because of its intensity, he adds, he now takes it only “when my kids are at their grandparents.”

The experiences of both men highlight one of the complications of diagnosing ED: The function part of erectile dysfunction is largely subjective. The American Urological Association defines erectile dysfunction as the “consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.” Which raises questions: What is the objective metric for “satisfying”? Once you’ve watched your heartbeat in your erection, how do you go back to 85 percent? “This is a huge subjectivity problem because everyone thinks they could do better, bigger, longer,” says Prause. “Trying to rely on someone’s insecurity to define a disorder is not a great [criterion].”

This is why Peter Stahl, MD, senior VP of men’s health at Hims & Hers, says the strategy to navigate a psychological situation like Mark’s is confidence restoration. Put patients in a position to succeed over a couple months, give them their mojo back, and then taper off the medication. If they meet a new partner and the nerves come back, they can go back on the meds if need be.

The medical professionals I spoke with were mostly in agreement that PDE5 inhibitors are a very low-risk class of drugs for the majority of men. There can be side effects: blurred vision, runny nose, increased heart rate, facial flushing—all normal bodily responses to widened veins and increased blood flow. But generally speaking, anyone who is aerobically fit enough to have sex is likely healthy enough to take these drugs, with a few rare but very important contraindications. (For instance, combining an ED drug with any kind of nitrate or nitrite—which includes the popular party drug “poppers”—can lead to a dangerous drop in blood pressure.) There was less consensus among the experts I interviewed as to when taking the drugs might be clinically appropriate.

“People go to physicians, or to some of these websites, and say, ‘I don’t get an erection,’ and the rest of the story gets lost in the shuffle,” says Marty Klein, PhD, a sex therapist with more than 40 years of practice. “A lot of people either get diagnosed with erectile dysfunction or they get treated for erectile dysfunction when that’s really not what’s going on.”

Klein says there are a series of questions men can ask themselves to determine if they have clinical erectile dysfunction or just an erection that won’t function: Does it happen when you masturbate? Does it happen with all partners or just one partner? How do you feel about the partner you’re having sex with? Do you drink or use drugs when you’re having sex? “ If somebody is wanting to be sexual and they have all the typical desirable circumstances covered and then they have an erection problem once,” that’s not ED, says Klein. “If that occurs over a period of time, yeah, that’s erectile dysfunction.”

Evan, the 33-year-old of the 105 percent erection, says that after his first experience with ED meds eight years ago, he continued to take them whenever he was partying and using drugs. He noticed over time that he couldn’t hold a strong erection during about three-quarters of his sexual encounters. “The first few times I was unable to achieve a full erection or unable to keep it, I became very worried about sex,” he tells me, adding that he still takes vasodilators a few times a month. “I am totally unable to separate the anticipation of sex away from the anxiety and dread about my own performance, which routinely causes dead dick.”

The patterns underlying psychogenic erectile dysfunction are complex, but ED meds can provide a fix. At least temporarily.

THIS MIGHT SEEM like an odd time to bring in a guy who appeared on the reality show Vanderpump Rules, but hear me out. Shayne Davis (real name), 34, found out he had erectile dysfunction when he was 21, due to nerve damage after being shot at 19. That was before the advent of telemedicine companies. He had no choice but to go see a doctor. “It was either shame in the field [of women] or shame in front of a 50-year-old man,” he says.

Davis says that when he started using ED meds, his porn use had warped his expectations about how to please a woman. If he took more pills than what was recommended, he thought, he’d perform like a porn star—staying rock hard and going at it for hours. As a result, he began taking so many meds that his vision would blur and he’d suffer skull-crushing headaches.

Davis has shared publicly that he takes ED meds and that he’s sober. He says he receives way more messages from people struggling with addiction than men who have ED. “As a society, we’ve gotten a lot better at being like, ‘Oh, [people with addiction] are sick, they need help, and they actually are or can become really good people,’ ” he says. “We don’t have that in the soft-wiener community.”

After his first experience with BlueChew, Mark posted his story on Reddit—and the thread blew up. Almost every message he receives from other guys about ED is tinged with shame: “When people are asking about it, it really feels like someone is asking if you have crack. Like, ‘Hey, let’s go to this dark corner.’ Their choice of wording and their timidness when they speak. It’s like they’re hiding it from themselves, almost.”

Klein says that in over four decades of practice, he hasn’t seen much change in the way men think about their penises. “I still see, week after week after week, men who wonder, Is my penis big enough? Is it hard enough? Do I last long enough? How do I last longer? What happens if I don’t orgasm at all?” Which are the same questions I read again and again from guys posting on Reddit about struggling with ED.

Then there’s the reality that basically anyone born after the mid-1990s has had largely unfettered access to the most extreme and varied pornography in history. “The porn I watch involves men with very well-above-average body features,” Evan tells me. “The ability to choose what I want to see, and the ability to abandon it instantly in favor of a different channel simply by swiping away, and the privacy to not care what I look like or if I’m performing well, that’s total comfort. None of these factors are present when I have sex with a live person.”

Mark blames his inability to get it up that very first time to his extensive porn viewing, which he says could sometimes reach up to 10 hours a day. Almost everyone who has messaged him on Reddit, whether they’re older or younger, has the “porn issue,” he says. (To bring this full circle, there’s now even a niche of online pornography called “BlueChew porn,” where a guy in the video takes an ED med before sex.)

Klein says he’s seen patients who have unrealistic sexual expectations from porn build a dependency on ED drugs. “Once people can get an erection with medication, they’re slow to give up the medication,” he says. Though the motivations are understandable, Klein compares it to a woman faking an orgasm. “Once she fakes an orgasm with a guy once, then the very next time she has sex with that guy, she has to make a decision: Am I going to fake an orgasm again or not?” Klein says. “So what I would say to a guy is, if you’re gonna take medication, and I can’t talk you out of it, okay, but what’s the exit strategy?”

Davis still takes ED medication, but when I ask him how he moved away from overdoing it, he says he’s come to realize that the mentality matters as much as the meds. “I think it boils down to trust,” he tells me. “You don’t need to be in a position where you’re acting like a porn star, or you’re like, ‘I’m here to battle.’ No, dude, you’re here to form an intimate connection with somebody that you enjoy spending time with. Let’s not abuse our bodies in order to pleasure them.”

THOUGH THE DIRECT-TO-CONSUMER model has brought the benefits of more convenient access to ED meds, the whole situation has also made it even easier for men to avoid seeing an actual doctor. “There are two really important components of treating someone with ED: restoring sexual quality of life and using the opportunity to get men into the door to engage with the health care system,” says Dr. Stahl, who, in addition to working at Hims, has practiced urology in New York for more than 20 years. In fact, he says, erections are so sensitive to changes in the cardiovascular system that “in someone who has ED and is going to have a heart attack, usually the ED precedes the major cardiovascular event by three to five years.” Today, erectile dysfunction is being taken more seriously as a first sign of a cardiac or vascular issue.

And while DTC companies have solved for selling ED meds to Gen Z and millennials, experts say that their quick screener questions and/or telehealth consultations can’t replace a visit with an IRL doc. Yes, a lightning-round prequalification might help you dodge some of the shame—from the unrealistic expectations porn sets, from the very nature of ED itself—but is it worth your long-term health?

All this made me think of something Mark told me. In looking back at his BlueChew experience, he said that using an ED med was the final step in regaining his confidence after his failed virginity-loss attempt. But everything else he did—cutting back on porn, eating better, exercising more—also helped. Mark told me he would counsel someone in his former situation to try to fix everything else before going the BlueChew route: Go to the gym, eat right, get your porn use under control. “You have to work on your state of mind as well,” Mark said. “This is a treatment, not a cure.”

Clay Skipper lives in New York City and previously worked for GQ.