ED & PE Medications:
What They Cost, What's Covered, What Works.
Telehealth companies charge $150–300/month for compounded medications your insurance will never cover. This guide breaks down every ED and PE option — what it costs, whether insurance covers it, and how Revive patients save $1,000–2,000/year.
The Gold Standard:
PDE5 Inhibitors
PDE5 inhibitors are the first-line, most proven treatment for erectile dysfunction. All four FDA-approved agents have decades of safety data and are available at your local pharmacy through our ED treatment program.
Sildenafil (Generic Viagra)
FDA-ApprovedBlocks the PDE5 enzyme to increase blood flow to the penis during sexual stimulation. Requires sexual arousal — does not produce erections independently.
- When to take: 30–60 min before activity; avoid high-fat meals
- Duration: 4–6 hours
- Side effects: Headache, flushing, nasal congestion, mild visual changes
- Insurance in WA: Variable — often excluded for ED; covered for PAH
- ⚠ Never take with nitrate medications (nitroglycerin, heart meds)
Tadalafil (Generic Cialis)
FDA-ApprovedSame PDE5 inhibitor class as sildenafil — but with dramatically longer duration and the flexibility of daily dosing. Not affected by food.
- On-demand: 30–60 min before activity, lasts up to 36 hours
- Daily dose: 2.5–5mg daily for continuous readiness
- Duration: Up to 36 hours (the "weekend pill")
- Insurance in WA: Often covered for BPH — important pathway for men with both BPH and ED
- ⚠ Never take with nitrate medications
Vardenafil (Generic Levitra)
FDA-ApprovedPDE5 inhibitor with a profile similar to sildenafil. Slightly more potent on a mg-per-mg basis. Avoid high-fat meals before taking.
- Onset: 25–60 minutes
- Duration: 4–5 hours
- Insurance in WA: Rarely covered for ED — cash pay preferred
- ⚠ Mild QTc prolongation — avoid with certain cardiac rhythm medications
Avanafil (Stendra — Brand Only)
FDA-ApprovedFastest-acting PDE5 inhibitor — works in as little as 15 minutes. Most selective for PDE5 among its class. Shortest nitrate washout period (12 hours).
- Onset: As fast as 15 minutes
- Duration: 4–6 hours
- Insurance: Rarely covered
- Note: Most Revive patients get equivalent results from generic sildenafil or tadalafil at a fraction of the cost.
Beyond PDE5 Inhibitors:
When Standard Treatments Aren't Enough
Revive prescribes all three of these therapies — ask your provider whether one may be right for you.
The therapies described in this section are not FDA-approved for erectile dysfunction in men, are available only through compounding pharmacies, and are not covered by any insurance plan for these indications. These are investigational or off-label uses. Full disclosure and informed consent are required before initiating any of these therapies at Revive. We include this information for educational purposes.
Bremelanotide / PT-141
Off-Label / Investigational for MenPT-141 works in the brain, not the blood vessels. Unlike PDE5 inhibitors that increase blood flow, bremelanotide stimulates melanocortin receptors in the hypothalamus to increase sexual desire and arousal. This makes it potentially effective for men whose ED has a psychological, neurological, or libido-based component — and for men who don't respond to PDE5 inhibitors.
- → Men who don't respond to sildenafil or tadalafil
- → Men with low sexual desire alongside ED
- → As an adjunct to PDE5 inhibitors for enhanced response
Phase II clinical trials showed a 33.5% response rate in sildenafil non-responders (vs 8.5% placebo). Combined with sildenafil, erection duration increased over 5x vs sildenafil alone.
Full PT-141 guide — clinical evidence, dosing & how to get it →
Apomorphine (Compounded Sublingual)
Off-Label / Not FDA-Approved for EDA dopamine receptor agonist that stimulates central arousal pathways — a different mechanism than both PDE5 inhibitors and PT-141. Approved for ED in the EU. Taken as a sublingual tablet dissolved under the tongue 15–20 minutes before activity.
Limitations: Less effective than PDE5 inhibitors overall (~55% vs ~74% for sildenafil in head-to-head trials). Nausea and dizziness are more prominent side effects. Reserved for patients who cannot use PDE5 inhibitors.
Full apomorphine guide — evidence, syncope risk & who it's for →
Oxytocin (Compounded Intranasal)
Off-Label / Very Limited EvidenceOxytocin is a naturally-occurring brain chemical involved in bonding, intimacy, and arousal. Compounded intranasal oxytocin may enhance the psychological and intimacy dimension of sexual activity for some patients.
Evidence level: Very limited — small studies and case reports only. Not a proven standalone ED treatment. Best considered an adjunct for patients with primarily psychological or relational sexual dysfunction.
Full oxytocin guide — evidence, limitations & appropriate use →
Premature Ejaculation Treatments:
What's Available in the US
Note: No medication is FDA-approved specifically for PE in the United States. However, several FDA-approved drugs are used off-label with strong clinical evidence, and compounded dapoxetine offers the most targeted on-demand option available. Off-label prescribing is legal and standard practice for PE globally. Learn more about our PE treatment program →
SSRI Medications (First-Line)
FDA-Approved (Other Dx) | Off-Label for PESSRIs are the most prescribed PE treatment worldwide. They delay ejaculation by increasing serotonin activity, raising the ejaculatory threshold. Used daily or on-demand depending on the agent.
Dapoxetine (Compounded — On-Demand)
Not FDA-Approved in USDapoxetine is the only SSRI specifically engineered for on-demand PE treatment. Unlike daily SSRIs, it's taken 1–3 hours before sexual activity and has a very short half-life — minimizing cumulative side effects.
Approved and widely used in the UK, EU, Canada, Australia, South Korea, and many other countries. Extensive Phase III trial data. In the US, available only through compounding pharmacies.
Topical Anesthetics (First-Line)
FDA-Approved (Other Dx) | Sometimes CoveredReducing sensitivity of the glans penis delays ejaculation by reducing sensory input. Highly effective and well-tolerated. An excellent first option before starting daily medication.
Tramadol (Second-Line)
Schedule IV Controlled SubstanceA controlled substance (Schedule IV) used primarily as a pain medication. Its serotonin/norepinephrine reuptake inhibition has been shown in multiple studies to delay ejaculation when used on demand. NOT combined with SSRIs (serotonin syndrome risk).
What Will Your Treatment
Actually Cost?
Telehealth TRT and ED companies (Hims, Roman, Keeps, etc.) use compounding pharmacies. No commercial insurance covers compounded medications. Revive prescribes FDA-approved generic medications dispensed at your choice of retail pharmacy — meaning insurance may cover your TRT and ED medications, and GoodRx cash prices are dramatically lower than compounding pharmacy rates. Most Revive patients save $100–200/month compared to telehealth alternatives.
Ready to Address ED or PE at the Source?
Our care team will review your complete hormone panel, sexual health history, and treatment goals to build a personalized plan. Most patients leave their first consultation with a clear diagnosis and a prescription in hand.
Schedule Your Consultation →Or call us: (206) 960-4770 · Seattle · Kirkland · Federal Way
Also see: ED Treatment Program · PE Treatment Program
The information on this page is for educational purposes only and does not constitute medical advice. Revive Low T Clinic's licensed providers evaluate each patient individually and prescribe treatments based on clinical assessment, laboratory results, and informed consent. Off-label medications are described with appropriate regulatory disclosures. Contact us at (206) 960-4770 to speak with our care team.