There is now one FDA-cleared over-the-counter product in the U.S. that directly treats erectile dysfunction: a topical gel called Eroxon. Beyond that, a few supplements have shown modest benefits in clinical trials, but nothing available without a prescription matches the reliability of Viagra or similar medications. Here’s what actually has evidence behind it and what to avoid.
Eroxon Gel: The First OTC Option in the U.S.
Eroxon is a topical gel applied directly to the tip of the penis. It works by creating a physical cooling-then-warming sensation that stimulates blood flow locally, rather than acting through your bloodstream the way Viagra does. The FDA cleared it through a special device classification, meaning it’s regulated as a medical device, not a drug.
In clinical trials, about 63% of men noticed an erection within 10 minutes of applying it, and roughly 56% were able to have penetrative sex within 15 minutes. The overall responder rate was 62%, which the FDA considered clinically meaningful. For context, Viagra’s success rate in studies typically runs higher (around 70 to 85% depending on the population), so Eroxon is a step down in potency. But for men with mild to moderate ED who want something without a prescription or systemic side effects, it fills a real gap.
You can find Eroxon at major pharmacies and online retailers. Each single-use tube is applied right before sex. Because it works locally rather than through your circulatory system, it carries far fewer risks of interactions with heart or blood pressure medications.
Supplements With Some Clinical Evidence
L-Arginine
L-arginine is an amino acid your body uses to produce nitric oxide, the same molecule that Viagra works through. When nitric oxide levels rise in penile tissue, blood vessels relax and blood flow increases. A meta-analysis of clinical trials found that daily doses between 1,500 and 5,000 mg significantly improved erectile function compared to placebo. The side effect rate was low at about 8%, with no severe adverse effects reported. Common complaints include mild digestive discomfort.
The improvement tends to be modest, most noticeable in men with mild ED. It also takes days to weeks of consistent use rather than working on demand like Viagra. You won’t take it 30 minutes before sex and notice a difference that night.
Korean Red Ginseng
Korean red ginseng (Panax ginseng) is the most studied herbal option. It appears to work through multiple pathways, including boosting nitric oxide production in the tissue of the penis and promoting blood vessel relaxation. A double-blind, placebo-controlled crossover study with 45 patients found improvements in erectile function compared to placebo.
The evidence is real but limited. Studies are generally small, and the effect size is modest. Typical study doses range from 900 mg to 3,000 mg daily. Like L-arginine, it requires regular use over several weeks and works best for mild cases.
DHEA
DHEA is a hormone your body naturally produces, and levels decline with age. Some studies have found minor improvements in sexual desire, arousal, and erectile function with supplementation, but results are mixed. Other studies show no effect at all. Doses up to 50 mg per day are generally considered safe for up to two years. This is best thought of as a maybe rather than a proven treatment.
What to Watch Out For
The FDA maintains a long and growing list of “sexual enhancement” supplements that are contaminated with hidden prescription drugs. Many products sold online or at gas stations with names promising instant results actually contain undeclared sildenafil (the active ingredient in Viagra) or similar compounds. The FDA classifies these as medication health fraud. The danger isn’t just that they’re dishonest. If you’re taking heart medication, blood pressure drugs, or nitrates, hidden sildenafil can cause a life-threatening drop in blood pressure.
A reasonable rule: if a supplement promises results comparable to Viagra and works within 30 minutes, it very likely contains an unlabeled pharmaceutical. Legitimate supplements take time to show modest effects. Anything that works like a drug probably is one.
Sildenafil Without a Traditional Prescription
In the UK, sildenafil (the generic form of Viagra) has been available directly from pharmacists since 2018. You don’t need a doctor’s appointment. The pharmacist asks about your health history and current medications to confirm it’s safe, then sells it to you. The U.S. does not currently allow this. Here, sildenafil and tadalafil (Cialis) still require a prescription.
That said, the prescription barrier is lower than it used to be. Several telehealth platforms offer consultations that take 10 to 15 minutes and can result in a prescription the same day. If OTC options don’t give you the results you need, a quick virtual visit is often the fastest path to something more effective.
How These Options Compare
- Eroxon gel: Works in 10 to 15 minutes, available OTC, lower efficacy than prescription options, minimal systemic side effects.
- L-arginine (1,500 to 5,000 mg daily): Requires weeks of daily use, modest improvement in mild ED, well tolerated.
- Korean red ginseng: Requires weeks of daily use, small but real effect in studies, best for mild cases.
- DHEA (up to 50 mg daily): Mixed evidence, may help with age-related decline in sexual function.
- Gas station pills and unregulated supplements: Frequently contaminated with hidden drugs, potentially dangerous, not worth the risk.
For mild ED, Eroxon or a consistent supplement regimen may be enough. For moderate to severe ED, prescription medications remain significantly more effective, and getting one is simpler than most people expect.