ED treatment online, state by state

Yes, in every US state and Washington, D.C. You complete a short online intake — the five-question erectile function index clinicians use (the IIEF-5), your heart and blood-pressure history, and every medication you take — and a clinician licensed in your state reviews it. When clinically appropriate, they prescribe sildenafil, tadalafil or vardenafil in the form and dose they judge right for you; nothing is charged unless they do, and your prescription ships free and discreet from a US-licensed pharmacy.

Usually not. 43 of 50 states let a licensed clinician establish care and prescribe by secure message, with no video call. Arkansas, Mississippi, New Mexico, North Dakota, Rhode Island, South Dakota, and West Virginia, plus Washington, D.C., require one live video visit first; after it, care continues by secure message. Your state's page says which applies.

ED treatment through Pallas starts at $60 for six doses of a sildenafil or tadalafil dissolvable tablet; the tadalafil / sildenafil combination starts at $96 for six, a vardenafil troche is $149 for ten, a 5 mg daily tadalafil tablet is $115 for 30, and a compounded injection is $199. Larger supplies cost less per dose. The price includes your US-licensed clinician, check-ins and care-team messaging, and free shipping; each fill renews every 4 weeks until you cancel, is charged only once a clinician prescribes, is cash-pay and not billed to insurance, and costs the same in every state.

No. Sildenafil, tadalafil and vardenafil are prescription medicines everywhere in the US. A legitimate telehealth service can name the licensed clinician who reviewed you and the licensed pharmacy that filled your prescription; a site that sells "sildenafil" with neither is selling unapproved, unverified product — there is no way to know what's in the tablet or how much. Price, reviews and a clinical-looking website don't change that.

Men taking nitrates in any form — nitroglycerin, isosorbide mononitrate or dinitrate — or riociguat: that combination is a contraindication on every PDE5 inhibitor's label because it can cause a dangerous drop in blood pressure. Beyond it, a clinician weighs alpha-blockers and blood-pressure medicines, recent heart events or chest pain with exertion, severe liver or kidney disease, retinitis pigmentosa or a prior episode of sudden vision loss, sickle cell disease, bleeding disorders, and conditions like Peyronie's disease. Those are screening questions, not automatic answers — the clinician decides, and if treatment isn't right for you, you're told plainly and nothing is charged.

No. Some of the forms Pallas offers — the dissolvable tablets, the troche, the injection — are compounded per-patient by state-licensed pharmacies, and compounded ED preparations are not FDA-approved. Which forms are compounded is the filling pharmacy's call per prescription. That is why every prescription starts with a US-licensed clinician who reviews your health history and prescribes only when clinically appropriate.

Yes. Once a clinician prescribes, a US-licensed partner pharmacy fills your prescription and ships it free and discreet, with tracking, typically within two to three business days of filling it (three to five to Alaska and Hawaii).