For over a decade, George, 33, has struggled on-and-off with erectile dysfunction (ED), a challenge that he says left him frustrated and embarrassed. “When I was nineteen, the girl I was seeing was polite about it, but it made me feel incredibly insecure and inadequate,” he says. He considered seeking out a prescription at the time, but a friend with medical expertise told him it was probably normal—that he just needed to get comfortable with the person.

Comfort alone, however, didn’t do it. Many years later, George, who spoke with Medium on the condition we not use his last name, finally mustered the courage to ask his doctor about sildenafil, which is better known as the little blue pill Viagra. “I went to the pharmacy to get it and the prescription my doctor wrote would have cost $150 to fill because it wasn’t covered by my insurance,” he says. Then, George read an article about the company Ro, a web-savvy startup selling affordable, generic forms of Viagra via an app, with a price tag closer to $6 per dose.

Erectile dysfunction, which is defined by the American Urological Society as “the inability to attain and/or maintain penile erection sufficient for sexual satisfaction,” becomes more common as men get older. Some research suggests that 40 percent of men experience ED by age 40; about 70 percent are affected at age 70. But the patient base for ED drugs may be changing.

Viagra, the first FDA-approved drug to treat ED, saw instant success when it came barreling into pharmacies and bedrooms in 1998. Viagra has made its manufacturer, Pfizer, tens of billions of dollars in the two decades since, including $1.6 billion globally in 2016 alone. But now that similar drugs are flooding the market, a new kind of pharmaceutical company is targeting a new kind of consumer: young men.

Two companies, Ro and Hims, both launched in late 2017 with advertising campaigns built for the Instagram set. Their ads are hip, clean, full of white space, more reminiscent of Everlane or Airbnb than, say, And while sildenafil is considered safe and effective for most men, experts warn that some young men may use them as Band-Aids for serious underlying problems, from chronic disease to sexual anxiety.

It’s really important to help these guys not feel like they’re the only ones, because they’re not.

Pfizer still owns Viagra’s patent—it expires in April 2020—but in 2013, Pfizer and pharmaceutical company Teva struck a deal allowing Teva to introduce its own version of Viagra in 2017. To keep pace, Pfizer put its own generic version of the classic blue pill on the market for a reduced price of $32.50 per pill. Prices of generic sildenafil have continued to drop since: Ro sells generic sildenafil at $6 per 60-milligram dose, while Hims offers a monthly plan of 10 20-milligram pills at $30. Both require that users connect with a physician online, or via an app, before getting a prescription.

Since the two companies launched, breezy coverage has celebrated their apparent focus on young men, as seen in carefully curated Instagram feeds and winking ads featuring eggplants. But some health and sexuality experts are concerned that the companies are overemphasizing the role of erections in sexual satisfaction, and noting that online care may be less effective than seeing a doctor in person.

Zachariah Reitano, Ro’s 27-year-old CEO and co-founder, pushes back on the perception that Ro is targeting a millennial customer base. “A vast majority of our members are over 40,” he says. Reitano experiences ED as a result of heart medication he takes. “There are younger people on the platform, but statistically, about 25 percent of men under 40 experience ED… It’s just not the majority of our members.”

He adds that young men experience ED for a variety of reasons, including alcohol, stress, smoking, and weight problems. “I don’t think it would be difficult for anyone to say, ‘Do I know a 30-year-old who is drinking too much, stressed, smoking, or overweight?’”

Andrew Dudum, the 30-year-old founder and CEO of Hims, says his brand’s marketing approach is a concerted effort to appeal to younger customers. “When people ask, ‘Why does this look like this is for men in their twenties and thirties and forties?’ I’ll just point them to the studies which say, ‘Because men suffer from this at an overwhelmingly shocking rate in those age ranges, and it’s really important to help these guys not feel like they’re the only ones because they’re not.’”

A 2013 study of 439 patients found that 1 in 4 seeking first-time medical help for new-onset ED were under 40, but it’s hard to capture accurate data about a condition many men are embarrassed to discuss. Evidence suggests that complaints of ED in younger men are on the rise, which experts say may be due to lifestyle issues like smoking and high blood pressure. “If you look at men over the age of 40, over half have some trouble with erections,” says Dr. Michael Eisenberg, an associate professor of urology at the Stanford University Medical Center. “If you look at men under 30, it depends on which studies you’re looking at, but it can be 10 percent or 20 percent.”

Erectile dysfunction, he adds, is often one piece of a larger health puzzle. Medications for depression, anxiety, pain, and high blood pressure can lead to ED, or the condition may be a sign of underlying problems like heart disease, high blood pressure, diabetes, high cholesterol, or obesity. Obesity, for example, appears to damage the inner lining of blood cells, which in turn can limit blood flow to the penis and hamper erections.

While sildenafil and related medications are considered relatively safe, they are not without side effects, including erections that last a very long time, low blood pressure, and interactions with other medications.

Jamin Brahmbhatt, an assistant professor of urology at the University of Central Florida College of Medicine, says ED meds shouldn’t be prescribed without a medical evaluation. “Issues in the bedroom may improve with these medications,” he says. “But what if there is another underlying problem like relationship issues, low testosterone, low thyroid, a heart blockage? These are all the things we screen for when a new patient [sees] us in the office.”

On the whole, Stanford’s Eisenberg is in favor of both companies’ approaches. “It takes a lot to get men to the doctor,” he says. “Here’s this whole segment of the population that’s really underrepresented and undercared for, and so by increasing access for them, I think that could do a lot.”

They’re not that silver bullet solution that’s going to fix everyone.

Vanessa Marin, a Los-Angeles-based psychotherapist specializing in sex, says she’s seeing more younger men with erectile issues and that performance anxiety is a recurring complaint among her clients. She maintains that where ED has psychological or interpersonal roots, medication shouldn’t be the only answer. “These drugs can be game changers, [but] I’ve worked with a lot of men who, when their penis wasn’t doing what they wanted it to do, went to the doctor and got a quick prescription or used one of these services where you can do it online,” she says. Often the Viagra or the Cialis would work one or two times, “but then they very quickly got right back to where they started.”

This cycle can lead to even more stress, when men who think ED meds are a foolproof solution feel like hopeless cases. Often, Marin says, the culprit lies in their attitudes toward sex. Younger people in particular “are developing this idea that you can be ‘perfect’ at sex,” she says. “They feel like every single moment needs to flow nicely and go perfectly—no communication necessary, no speed bumps. Everything’s just got to go as if it were porn.”

Just as a doctor might stress that sildenafil can’t fix an underlying condition such as heart disease, a therapist might emphasize that it can’t cure sexual perfectionism, and a partner might attest that it can’t replace communication in a relationship. What it can do is increase blood flow to the penis when taken as prescribed. Ascribing ED medication more powers than that could put people’s physical or emotional health at risk. Even as the companies that supply them “are opening up more conversations about sexual issues,” Marin says, she hopes customers remember: They’re not “that silver bullet solution that’s going to fix everyone.”

George’s wife, he says, has been “perfectly supportive” of the medication, although since a pill takes 30 to 60 minutes to kick in, it requires some planning to use. “That caused some tension at first because it seemed to threaten the idea of having romantic sex with spontaneity,” George says. But even when he doesn’t use medication, guaranteed access is its own form of reassurance: “I haven’t even used the full order yet. It’s really nice to know it’s there though.”