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14 min read<\/p>\n14 min read<\/p>\n
ON THE NIGHT he hoped to lose his virginity<\/a>, Mark couldn\u2019t get it up<\/a>. The 25-year-old wasn\u2019t necessarily surprised. He was nervous\u2014really nervous. His partner tried to put him at ease and eventually used her hands to bring him to climax. But when the time came for intercourse, Mark says he couldn\u2019t perform. \u201cTo this day, I could not explain why,\u201d he tells me.<\/p>\n He didn\u2019t have a lot of experience talking to women. He wasn\u2019t very social<\/a> in general because he suffered from a lack of confidence. And then there was his porn habit<\/a>. He\u2019d been looking at porn since he was 8 and masturbating since 11. \u201cFourteen years of doing that every day will desensitize you,\u201d he says. As for disappointment over his inability to have sex? Destroyed is the word he uses. \u201cYou feel like a part of yourself is just not complete,\u201d he says. \u201cYou don\u2019t feel like what you are supposed to be. You lose a sense of self.\u201d<\/p>\n After that night, Mark started doing some online research. He had come across Viagra, which was released in 1998 as the first pill to treat erectile dysfunction<\/a>, but he wasn\u2019t sure how he could get some. Then, after making a sex-related joke to a coworker, he learned that his colleague was in possession of some BlueChew, part of a class of newer, direct-to-consumer erectile dysfunction medications sold by telemedicine companies that cropped up almost a decade ago and now market to young men. He bought a BlueChew off his work friend for $5 and took the chewable home to see if it worked.<\/p>\n \u201cIt gave me a feeling I haven\u2019t felt since I was young,\u201d Mark, now 28, says. \u201cIt was magical. I\u2019m like, \u2018I have to get my hands on these.\u2019 \u201d<\/p>\n Luckily for Mark, and a surprising number of American young men who struggle with erectile dysfunction, scoring ED pills has never been easier. Pfizer\u2019s Viagra patent lapsed back in 2020, so the drug\u2019s active ingredient, sildenafil<\/a>, 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\u2019re in the thick of a boner business boom.<\/p>\n There are now roughly 15 direct-to-consumer platforms selling ED treatments, including some you\u2019ve likely heard of\u2014Hims, Ro, BlueChew\u2014and many you probably haven\u2019t. 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 \u201creadiness.\u201d And perhaps most important, all these companies will sell you ED drugs without your ever having to leave the comfort of your home.<\/p>\n To obtain his own stock of BlueChew, Mark went online, answered a short medical questionnaire, had a three-minute meeting with a doctor, and voil\u00e0, 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\u2019d met on a previous trip to the country. They arranged to meet on the day of his 26th birthday. He brought his BlueChew.<\/p>\n Younger models, straightforward language, party vibes\u2014advertising for online, direct-to-consumer ED meds look way different than the couples-in-tubs days of Cialis.<\/p>\n This time, Mark had no trouble getting hard, saying his erection was \u201calmost instantaneous\u201d upon seeing her. He\u2019s unsure how much of that was due to the pill, his attraction<\/a> 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. \u201cBut the fact that we went on so long that night, I think it was the pill,\u201d he says.<\/p>\n Mark\u2019s story is straight off the vision board of BlueChew\u2019s 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\u2014not to mention athletes and Instagram models\u2014whose sex lives are greatly improved when they \u201cchew it and do it.\u201d (Despite repeated attempts, BlueChew did not respond to requests to participate in this article.)<\/p>\n Though other telehealth companies, like Rugiet and Hims, strike a more professional tone, there\u2019s still been a notable across-the-board vibe shift from the days of Bob Dole and \u201cViva Viagra!\u201d These BlueChew alternatives skew more millennial, not Gen Z, masculine\u2014the men giving the testimonials wear beanies, the attractive doctors are straight off the set of The Pitt<\/a>. Rugiet (which is Latin for \u201che will roar\u201d) just finalized a partnership with the UFC, so now the company\u2019s logo will appear on the Octagon, the closest thing we have to a modern-day Colosseum.<\/p>\n \u201cWe\u2019re a lot more direct than I think companies in this space have been in the past,\u201d says Mike Apostal, Rugiet\u2019s CEO. Apostal says that Rugiet\u2019s typical customer is between the ages of 45 and 65, though he\u2019s seeing \u201cyounger and younger folks needing it earlier,\u201d which is why they\u2019re working to remove the stigma around taking a drug for erectile dysfunction. ED \u201cwas shameful,\u201d he says. \u201cNow it\u2019s like, okay, let\u2019s solve it.\u201d<\/p>\n The proposed solution addresses sexual function and also anxiety, like the kind Mark suffered. Rugiet\u2019s 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 \u201cboth the physical and mental aspects of arousal,\u201d Rugiet advertises. BlueChew also now offers, as one of its eight types of pills, a \u201cGold\u201d version that includes tadalafil, sildenafil, apomorphine, and oxytocin, the neurotransmitter that\u2019s activated when we fall in love or are sexually aroused.<\/p>\n 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\u2019ll find they\u2019re 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<\/a>, 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.<\/p>\n The issue isn\u2019t whether these pills work or not (they do), but how they\u2019re affecting the landscape of men\u2019s sexual health, and who exactly should be taking them. Gen Z guys might think they need them, but do they, really?<\/p>\n WHAT\u2019S KIND OF wild is that for all the ED med marketing aimed at young guys, researchers aren\u2019t 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\u2019s body, his brain, and his penis.<\/p>\n Biologically, when a man can\u2019t maintain an erection, it\u2019s because not enough blood is flowing into the penis. The good news is that there\u2019s a wide range of treatment options available: pills, implants<\/a>, even shock wave therapy<\/a>. \u201cI always like to tell men, \u2018As long as you have a penis, we can make it hard,\u2019 \u201d says Michael Eisenberg, MD<\/a>, a urologic surgeon scientist and professor of urology at Stanford.<\/p>\n 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.<\/p>\n \u201c[Pills] are often a physiological solution for a psychological problem,\u201d says Nicole Prause, PhD<\/a>, a neuroscientist who studies sexual behavior. There are, obviously, physiological reasons behind ED. Some involve the cardiovascular system: diabetes<\/a>, high blood pressure<\/a>, heart disease<\/a>. This is also why heavy nicotine<\/a> use or sucking down five old-fashioneds might also inhibit your ability to achieve whole hog\u2014both habits hit your heart.<\/p>\n \u201cA lot of people either GET DIAGNOSED WITH ERECTILE DYSFUNCTION or they get treated for erectile dysfunction when THAT\u2019S REALLY NOT WHAT\u2019S GOING ON.\u201d<\/p>\n 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 \u201cnot going to take you back to when you were 20.\u201d But many of the men I spoke to described that exact return to glory after taking ED meds.<\/p>\n 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 \u201cachieve a level of erection I had never previously seen: truly massive, especially in terms of girth.\u201d He still takes vasodilators occasionally and says that sometimes he achieves a \u201c100\u2013105 percent\u201d erection. I asked him to clarify. \u201cOne hundred percent is no flop, just a solid steel rod that bounces back like a diving board,\u201d he says. \u201cOne 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\u2019s 105 percent and it will actually be pulsing with my heartbeat.\u201d<\/p>\n 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? \u201cI just thought it could be fun.\u201d After popping the chew, he says, he had sex with his wife four times and masturbated three times\u2014all in a span of eight hours. (Important note: ED drugs do not<\/a> directly increase sexual desire; research is mixed on if the meds can get you hard again faster after orgasm. Their effect is largely mechanical.) \u201cI don\u2019t think I was getting fully hard until I felt how hard I got on BlueChew,\u201d Juan says. Because of its intensity, he adds, he now takes it only \u201cwhen my kids are at their grandparents.\u201d<\/p>\n 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<\/a> erectile dysfunction as the \u201cconsistent or recurrent inability to attain and\/or maintain penile erection sufficient for sexual satisfaction, including satisfactory sexual performance.\u201d Which raises questions: What is the objective metric for \u201csatisfying\u201d? Once you\u2019ve watched your heartbeat in your erection, how do you go back to 85 percent? \u201cThis is a huge subjectivity problem because everyone thinks they could do better, bigger, longer,\u201d says Prause. \u201cTrying to rely on someone\u2019s insecurity to define a disorder is not a great [criterion].\u201d<\/p>\n This is why Peter Stahl, MD<\/a>, senior VP of men\u2019s health at Hims & Hers, says the strategy to navigate a psychological situation like Mark\u2019s 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.<\/p>\n 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\u2014all 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\u2014which includes the popular party drug \u201cpoppers\u201d\u2014can 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.<\/p>\n \u201cOnce people can get an ERECTION WITH MEDICATION, they\u2019re slow to GIVE UP THE MEDICATION.”<\/p>\n \u201cPeople go to physicians, or to some of these websites, and say, \u2018I don\u2019t get an erection,\u2019 and the rest of the story gets lost in the shuffle,\u201d says Marty Klein, PhD<\/a>, a sex therapist with more than 40 years of practice. \u201cA lot of people either get diagnosed with erectile dysfunction or they get treated for erectile dysfunction when that\u2019s really not what\u2019s going on.\u201d<\/p>\n 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\u2019t function: Does it happen when you masturbate<\/a>? Does it happen with all partners or just one partner? How do you feel about the partner you\u2019re having sex with? Do you drink or use drugs when you\u2019re having sex? \u201c If somebody is wanting to be sexual and they have all the typical desirable circumstances covered and then they have an erection problem once,\u201d that\u2019s not ED, says Klein. \u201cIf that occurs over a period of time, yeah, that\u2019s erectile dysfunction.\u201d<\/p>\n 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\u2019t hold a strong erection during about three-quarters of his sexual encounters. \u201cThe first few times I was unable to achieve a full erection or unable to keep it, I became very worried about sex,\u201d he tells me, adding that he still takes vasodilators a few times a month. \u201cI am totally unable to separate the anticipation of sex away from the anxiety and dread about my own performance, which routinely causes dead dick.\u201d<\/p>\n The patterns underlying psychogenic erectile dysfunction are complex, but ED meds can provide a fix. At least temporarily.<\/p>\n 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. \u201cIt was either shame in the field [of women] or shame in front of a 50-year-old man,\u201d he says.<\/p>\n 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\u2019d perform like a porn star\u2014staying rock hard and going at it for hours. As a result, he began taking so many meds that his vision would blur and he\u2019d suffer skull-crushing headaches<\/a>.<\/p>\n Davis has shared publicly that he takes ED meds and that he\u2019s sober. He says he receives way more messages from people struggling with addiction<\/a> than men who have ED. \u201cAs a society, we\u2019ve gotten a lot better at being like, \u2018Oh, [people with addiction] are sick, they need help, and they actually are or can become really good people,\u2019 \u201d he says. \u201cWe don\u2019t have that in the soft-wiener community.\u201d<\/p>\n After his first experience with BlueChew, Mark posted his story on Reddit\u2014and the thread blew up. Almost every message he receives from other guys about ED is tinged with shame: \u201cWhen people are asking about it, it really feels like someone is asking if you have crack. Like, \u2018Hey, let\u2019s go to this dark corner.\u2019 Their choice of wording and their timidness when they speak. It\u2019s like they\u2019re hiding it from themselves, almost.\u201d<\/p>\n Illustration by Eddie Guy<\/p>\n Klein says that in over four decades of practice, he hasn\u2019t seen much change in the way men think about their penises. \u201cI still see, week after week after week, men who wonder, Is my penis big enough<\/a>? Is it hard enough<\/a>? Do I last long enough<\/a>? How do I last longer<\/a>? What happens if I don\u2019t orgasm at all<\/a>?\u201d Which are the same questions I read again and again from guys posting on Reddit about struggling with ED.<\/p>\n Then there\u2019s the reality that basically anyone born after the mid-1990s has had largely unfettered access to the most extreme and varied pornography in history. \u201cThe porn I watch involves men with very well-above-average body features,\u201d Evan tells me. \u201cThe 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\u2019m performing well, that\u2019s total comfort. None of these factors are present when I have sex with a live person.\u201d<\/p>\n 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\u2019re older or younger, has the \u201cporn issue,\u201d he says. (To bring this full circle, there\u2019s now even a niche of online pornography called \u201cBlueChew porn,\u201d where a guy in the video takes an ED med before sex.)<\/p>\n Klein says he\u2019s seen patients who have unrealistic sexual expectations from porn build a dependency on ED drugs. \u201cOnce people can get an erection with medication, they\u2019re slow to give up the medication,\u201d he says. Though the motivations are understandable, Klein compares it to a woman faking an orgasm. \u201cOnce 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?\u201d Klein says. \u201cSo what I would say to a guy is, if you\u2019re gonna take medication, and I can\u2019t talk you out of it, okay, but what\u2019s the exit strategy?\u201d<\/p>\n Davis still takes ED medication, but when I ask him how he moved away from overdoing it, he says he\u2019s come to realize that the mentality matters as much as the meds. \u201cI think it boils down to trust,\u201d he tells me. \u201cYou don\u2019t need to be in a position where you\u2019re acting like a porn star, or you\u2019re like, \u2018I\u2019m here to battle.\u2019 No, dude, you\u2019re here to form an intimate connection with somebody that you enjoy spending time with. Let\u2019s not abuse our bodies in order to pleasure them.\u201d<\/p>\n 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. \u201cThere 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,\u201d 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 \u201cin someone who has ED and is going to have a heart attack<\/a>, usually the ED precedes the major cardiovascular event by three to five years.\u201d Today, erectile dysfunction is being taken more seriously as a first sign of a cardiac or vascular issue.<\/p>\n 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\u2019t replace a visit with an IRL doc. Yes, a lightning-round prequalification might help you dodge some of the shame\u2014from the unrealistic expectations porn sets, from the very nature of ED itself\u2014but is it worth your long-term health?<\/p>\n 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\u2014cutting back on porn, eating better, exercising more\u2014also 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. \u201cYou have to work on your state of mind as well,\u201d Mark said. \u201cThis is a treatment, not a cure.\u201d<\/p>\n Clay Skipper lives in New York City and previously worked for GQ.<\/p>\n","protected":false},"excerpt":{"rendered":"14 min read ON THE NIGHT he hoped to lose his virginity, Mark couldn\u2019t get it up. 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