What Strut Health Treats for Men: ED Medications via Telehealth

Bottom line: Erectile dysfunction affects an estimated 30 million men in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases — but fewer than 25% of those men are currently being treated, per a 2023 Journal of Sexual Medicine survey. The primary barriers are stigma, inconvenience of in-person appointments, and cost. Telehealth has changed the access equation for all three. Here’s what Strut Health’s men’s sexual health program covers and what the evidence shows.

ED: What’s Actually Happening Physiologically

Erectile dysfunction is primarily a vascular condition. An erection requires increased blood flow to the corpus cavernosum — the paired spongy tissue cylinders in the penis. This process depends on nitric oxide release from endothelial cells, which relaxes smooth muscle and allows blood to fill the tissue.

The most common causes of ED are conditions that impair vascular function: cardiovascular disease, hypertension, type 2 diabetes, atherosclerosis, and obesity. According to the American Urological Association’s 2024 guidelines, more than 70% of ED cases have a predominantly vascular cause. This is clinically important because:

1. ED is often an early marker of cardiovascular disease. A 2023 European Heart Journal meta-analysis found that ED increased cardiovascular event risk by 59% and all-cause mortality by 33% — making it a symptom worth taking seriously as a health indicator, not just a quality-of-life concern.

2. The physiological mechanism makes it highly treatable with medications that work on the same pathway.

Psychological factors — performance anxiety, depression, relationship stress — are either primary causes or significantly worsen vascular ED by reducing sexual arousal signals that trigger nitric oxide release. This is why treatment for ED often benefits from addressing both the physiological and psychological components.

How PDE5 Inhibitors Work

PDE5 inhibitors (sildenafil, tadalafil, avanafil, vardenafil) are the first-line pharmacological treatment for ED, recommended by the American Urological Association, European Association of Urology, and International Society for Sexual Medicine. They work by inhibiting phosphodiesterase type 5, the enzyme that breaks down cyclic GMP — the second messenger that relaxes smooth muscle in response to nitric oxide. Inhibiting PDE5 maintains higher cyclic GMP levels, prolonging the relaxation response and improving blood flow.

The evidence is robust: A 2021 Cochrane Database of Systematic Reviews meta-analysis of 130 RCTs including 40,000+ men found that PDE5 inhibitors improved the ability to achieve and maintain erections sufficient for intercourse in 60–70% of men with ED, across all major etiologies. Response rates were highest for vascular ED (68%), moderate for mixed vascular/psychological (62%), and still meaningful for psychological ED (44%).

Differences between drugs:

Medication	Onset	Duration	Notes
Sildenafil (Viagra)	30–60 min	4–6 hr	Food can reduce absorption; avoid with large fatty meals
Tadalafil (Cialis)	30 min	36 hr	Food doesn’t affect it; also available as daily 5mg dose
Avanafil (Stendra)	15–30 min	6 hr	Fastest onset; fewer drug interactions
Vardenafil (Levitra)	30–60 min	4–5 hr	May work better in diabetics per some trial data

Generic sildenafil and tadalafil are now available at costs that have dropped dramatically since patent expiration — in some cases under $1 per dose through GoodRx or equivalent programs. For most men, the medication cost is no longer the primary barrier to treatment.

What Strut Health Adds Beyond a Prescription

Standard generic prescriptions are available at minimal cost through GoodRx or discount pharmacy programs. Strut’s value proposition is the physician evaluation and the access to compounded formulations that may work better for specific patients.

Compounded formulations. For patients who don’t respond optimally to standard oral tablets, or who experience specific side effects from standard formulations, Strut’s compounding pharmacy access provides alternatives:

• Sublingual (under-tongue) tadalafil. Faster absorption than oral tablets; useful for patients who want a shorter time-to-effect or who have food absorption issues with oral forms.
• Combination formulations. Some patients respond better to combinations — for example, tadalafil plus oxytocin (which addresses the psychological dimension by promoting arousal), or tadalafil plus low-dose apomorphine for patients with primarily dopaminergic dysfunction.
• Cream formulations. For patients who cannot take oral PDE5 inhibitors due to systemic contraindications, transdermal options may provide local effect with reduced systemic exposure.

Compounded formulations are not FDA-approved as finished drug products and require physician determination that standard approved medications are insufficient or inappropriate for the patient.

Physician oversight. The consult is not a rubber stamp. A responsible telehealth ED program screens for cardiovascular risk, current nitrate use (the primary dangerous contraindication), and identifies patients who need in-person evaluation before medication is appropriate. This screening matters — prescribing sildenafil to a man actively taking isosorbide mononitrate causes dangerous hypotension.

The Performance Anxiety Component

For men whose ED has a significant psychological component, medication alone may not fully resolve the issue. The mechanism is direct: anxiety activates the sympathetic nervous system, which constricts blood vessels and counteracts the vasodilation that PDE5 inhibitors promote. High anxiety can prevent PDE5 inhibitors from working effectively.

The cycle is self-reinforcing: a failed erection (even one caused by anxiety rather than physiology) creates anticipatory anxiety about the next attempt, which makes the next attempt more likely to fail. Breaking this cycle typically requires either:

1. A period of reliable medication-supported erections that rebuild confidence and reduce anticipatory anxiety
2. Specific psychological techniques (sensate focus, mindfulness-based approaches, CBT for sexual performance anxiety)
3. In some cases, both

Strut’s physician consultation discusses the psychological component and can recommend additional resources. For men whose primary issue is clearly psychological, an appropriate physician will say so rather than simply prescribing.

How to Start with Strut Health

The intake process covers:

1. Medical history review including current medications, cardiovascular conditions, and prior ED treatments
2. Sexual health history and International Index of Erectile Function (IIEF) questionnaire
3. Physician review and consultation
4. Prescription issued if appropriate, sent to pharmacy for direct shipment

The consultation is not an automatic prescription — physicians do decline to prescribe when the medical history indicates risk or when in-person evaluation is warranted. This is the correct approach, and a telehealth program that prescribes without proper screening is not a program worth using.

When to Seek In-Person Evaluation Instead

Telehealth ED programs are appropriate for the majority of men with mild-to-moderate ED and no major cardiovascular comorbidities. In-person evaluation is warranted when:

• ED onset is sudden and severe (may indicate acute vascular event)
• ED is accompanied by reduced libido and fatigue (possible testosterone deficiency requiring labs)
• Initial PDE5 inhibitor treatment at maximum dose has failed (may need specialist evaluation for alternative treatments: vacuum erection devices, injections, penile implants)
• Known significant cardiovascular disease requiring cardiac clearance before sexual activity

The Strut physician consultation will identify these scenarios and direct patients appropriately.

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For peptide therapy that may complement men’s health optimization, see Sermorelin Peptide Therapy Guide. For men’s weight loss programs that address the metabolic factors underlying ED, see The Honest Math on GLP-1 Alternatives in 2026.