Verbatim response from Perplexity
Urologists generally see online ED prescription services as useful for convenience and privacy, but they are cautious because these services can miss the underlying causes of erectile dysfunction and important safety issues.[2][6][11]
What they tend to like:
- Access and privacy: online care can help men who feel embarrassed or would otherwise avoid treatment.[1][2][10]
- Simple cases: many urologists consider it reasonable for otherwise healthy men with straightforward ED, especially when the service uses licensed clinicians and a thorough intake process.[1][2][11]
- Telemedicine done well: services that include real clinician review, follow-up, and referral when needed are viewed more favorably than “fill out a form and get pills” sites.[3][11]
What concerns them:
- Missed diagnoses: ED can be an early sign of heart disease, diabetes, low testosterone, medication side effects, or other conditions that need in-person evaluation.[2][5][6]
- Safety gaps: online questionnaires may miss drug interactions or cardiovascular risk, especially with medications like sildenafil or tadalafil.[2][5]
- No physical exam or testing: many urologists think this is a major limitation, because some patients need labs, blood pressure assessment, or a genital/vascular exam.[6][11]
- Questionable pharmacy quality: they warn that not all online sellers are legitimate, and some may supply counterfeit or improperly sourced medication.[5]
When they usually want an in-person visit:
- New, sudden, severe, or persistent ED[2]
- Heart disease, diabetes, high blood pressure, or other major medical problems[1][2]
- Poor response to first-line treatment[1][2]
- Concern for low testosterone, fertility issues, or psychological causes that need broader workup.[3][6]
Specific services urologists tend to view more positively are Hims, Roman, Keeps, and Teladoc-style telemedicine, mainly because they involve licensed clinicians and more structured screening than rogue online pharmacies.[1]
If you want, I can also give you a “how to tell if an online ED service is reputable” checklist.