Better sex starts with better care.

ED can have many contributors, including blood flow and cardiovascular health, diabetes and metabolic conditions, medications, hormonal factors, stress and anxiety, alcohol or substance use, neurological factors and other health conditions. Often more than one factor is involved, which is why an evaluation matters.

Occasional difficulty with erections is common, and persistent ED is a common medical concern in adult men. It is not a character flaw. It is a health issue that can be evaluated and, in many cases, treated.

Sildenafil and tadalafil are PDE5 inhibitors. They act on the pathway involved in blood flow to penile tissue during sexual stimulation, supporting the body's natural erectile response. They do not create an erection on their own.

Both are PDE5 inhibitors, but they differ in how long they remain active and how they are typically used. Sildenafil is generally used before anticipated sexual activity, while tadalafil has a longer duration of action and may allow more flexibility around timing. Which one may be appropriate is a clinical decision.

Sildenafil is generally described as shorter-acting and is typically taken before anticipated sexual activity. Duration varies by person, dose and the specific product prescribed. Your physician will review the prescribing information for anything prescribed to you.

Tadalafil is generally described as longer-acting than sildenafil, which is why some patients consider it for flexibility around timing. Actual duration varies by individual, dose and product. Follow the prescribing information and your physician's instructions.

Onset varies by medication, dose, individual physiology and factors such as food intake. There is no universal answer, and faster onset is not automatically better. Your physician can discuss what these differences may mean for you.

Neither medication is universally better. They are different options with different characteristics, considerations and safety information. The right question is which option may be appropriate for you — and that depends on your health history, current medications and preferences.

Taking two PDE5 inhibitors on your own is not appropriate and can increase the risk of side effects. Any treatment that includes more than one active ingredient must be prescribed and directed by a physician who has evaluated you.

It refers to a customized (compounded) formulation containing more than one active ingredient — in this case tadalafil and sildenafil — prepared by a pharmacy for an individual patient when a physician determines it is medically appropriate.

No. Sildenafil and tadalafil are individually FDA-approved as separate prescription drug products. A compounded formulation combining them is not an FDA-approved combination drug product, and compounded medications are not reviewed by the FDA for safety, effectiveness or manufacturing quality in the same way. It is also not established as stronger, safer or better than either medication alone.

Sildenafil and tadalafil are prescription medications with known warnings, contraindications and possible side effects. Whether they are safe for you depends on your health, conditions and other medications, which is why a physician evaluation is required.

ED medication is not appropriate for everyone. People taking nitrates should not take these medications, and certain cardiovascular, liver, kidney, blood pressure and eye conditions — along with some drug interactions — can make treatment inappropriate. Your physician reviews this with you.

No. Combining PDE5 inhibitors with nitrate medications such as nitroglycerin or isosorbide can cause a sudden, dangerous drop in blood pressure. Tell your physician if you take nitrates in any form, including as-needed chest-pain medication.

No. PDE5 inhibitors do not raise testosterone. If hormonal factors may be contributing to your symptoms, that is evaluated separately by your physician.

No. These medications are not aphrodisiacs and do not increase libido. They support the physical erectile response when sexual stimulation is present.

Yes. Sildenafil and tadalafil are prescription medications in the United States and require evaluation by a licensed physician.

Yes. NORBU MD is a physician-led practice. There is no questionnaire-only prescribing and no automatic prescriptions — care starts with a board-certified physician.

The physician visit is $29. That fee covers the medical visit only.

No. Medication, pharmacy and laboratory costs, if applicable, are separate from the $29 visit fee.

No. The $29 visit is paid directly and does not require insurance.

Yes. Your visit and your medical information are handled confidentially as part of your medical record, and care takes place online rather than in a waiting room.

Yes. Sexual health is ongoing care. Your physician can review how treatment is going and adjust your plan when clinically appropriate.