ED affects 1 in 5 Indian men over 40, but stigma keeps most from ever seeing a doctor. Men buy medications from pharmacies without medical evaluation. Others suffer in silence, blaming themselves. The reality: erectile dysfunction is a treatable medical condition — and now, with telemedicine, it's possible to get a legal, safe prescription online. But the right approach isn't just taking a pill. It's understanding what's causing your ED, getting the bloodwork that reveals it, and getting a prescription from a physician who actually reviews your health.
Erectile dysfunction affects 1 in 5 Indian men over 40. Before prescribing sildenafil or tadalafil, test testosterone, fasting insulin, HbA1c, lipid panel, and thyroid — ED is often the first sign of cardiovascular or metabolic disease. Treatment without diagnosis is a missed opportunity. Legal online prescriptions are available via telemedicine under India's 2020 guidelines, but a physician must review your full medical history before prescribing.
| Cause | Prevalence | Key Tests | Treatment Approach |
|---|---|---|---|
| Vascular | 35-40% | Lipid panel, HbA1c, BP, hs-CRP | PDE5i + cardiovascular risk reduction |
| Hormonal | 30-40% | Total/Free testosterone, prolactin, thyroid | Hormone replacement + PDE5i if needed |
| Metabolic | 25-35% | Fasting insulin, HbA1c, glucose tolerance | Insulin sensitivity + PDE5i |
| Neurological | 10-15% | Full neurological assessment | Condition-specific treatment |
| Psychological | 10-20% | Morning erections present; full bloodwork normal | Therapy + PDE5i for confidence |
| Medication | Onset | Duration | Cost (India) | Best For |
|---|---|---|---|---|
| Sildenafil (Vigore) | 30-60 min | 4-6 hrs | ₹20-50 | On-demand, budget-friendly |
| Tadalafil (Tadacip) | 30-45 min | 24-36 hrs | ₹40-80 | Longer window; daily 5mg |
| Vardenafil | 15-30 min | 8-10 hrs | ₹60-100 | Faster onset; high efficacy |
| Avanafil | 12-15 min | 6-12 hrs | ₹100-150 | Fastest onset; fewer side effects |
Until recently, telemedicine in India had strict limits. The Telemedicine Practice Guidelines 2020 (approved by the Medical Council of India) changed this. For ED medications, the guidelines explicitly allow first-consultation prescriptions via video. A licensed physician must:
This is fundamentally different from buying medications OTC at a pharmacy. A physician is involved. Your medical history is reviewed. The prescription is documented. If something goes wrong, there's accountability.
In practice, this means: a legal online ED prescription from arq. comes from a real physician after a real consultation, not a form-fill or automated system. It's regulated, safe, and legitimate.
Here's what most men don't know: erectile dysfunction is an early warning sign of cardiovascular and metabolic disease. The blood vessels that feed the penis are small — they fail before larger coronary arteries. ED can be the first symptom of diabetes, hypertension, or heart disease.
The statistics are stark: In one major study, 40% of men under 40 with ED had undiagnosed diabetes or prediabetes. Another 30% had undiagnosed hypertension. Many had low testosterone. They came for ED treatment and left with diagnoses that changed their health trajectory.
This is why bloodwork isn't optional — it's diagnostic. Your physician needs to know:
Each requires a different treatment. A man with low testosterone needs hormone replacement, not just a PDE5 inhibitor. A man with undiagnosed diabetes needs glucose control before ED medications will work optimally. A man with psychological ED might benefit from the medication AND therapy.
The arq. approach: test first, treat smart.
How it works: PDE5 inhibitor. Increases blood flow to the penis during sexual stimulation.
Onset: 30-60 minutes (30-45 minutes on empty stomach)
Duration: 4 hours
Best for: Men who want a pill taken close to sexual activity. Fast, predictable.
Common dosage: 50mg or 100mg as needed, no more than once daily
Considerations: Works better on empty stomach. High-fat meals delay onset by 2 hours. Price: ~300-400 INR per tablet.
How it works: PDE5 inhibitor, longer half-life than Sildenafil.
Onset: 15-45 minutes (or 2-3 hours for daily formulation)
Duration: 24-36 hours (much longer than Sildenafil)
Best for: Men with frequent sexual activity (2-3+ times per week) or those who want a daily low-dose option. Once you take Tadalafil, you're "covered" for 24-36 hours. Less planning required.
Common dosage: 10mg or 20mg as needed, OR 5mg daily
Considerations: Allows spontaneity. Unaffected by food. Price: ~600-900 INR per dose (or ~500-700 INR per day for daily 5mg).
How it works: PDE5 inhibitor, similar to Sildenafil.
Onset: 30-60 minutes
Duration: 4-5 hours
Best for: Men who don't respond well to Sildenafil, or those with specific contraindications (e.g., certain foods). Less commonly used in India but available.
Considerations: Similar profile to Sildenafil. Less widely available than Sildenafil or Tadalafil in India.
How it works: PDE5 inhibitor, newer formulation.
Onset: 15-30 minutes (fastest)
Duration: 6 hours
Best for: Men who want the fastest onset and don't mind a 6-hour window. Less affected by food.
Considerations: Emerging option. Less data than Sildenafil or Tadalafil. Availability in India still limited.
Choosing between them: Your lifestyle determines the best option. If you have predictable sexual timing, Sildenafil works. If you want spontaneity and frequent activity, Tadalafil daily is better. If you want speed, Avanafil. Your physician recommends based on your preferences, other medications, and bloodwork findings.
A responsible ED prescription requires testing. Here's why and what matters:
Low testosterone causes ED and is fixable. If your testosterone is low (below 300 ng/dL), the protocol might combine PDE5 inhibitors WITH testosterone replacement. A PDE5 inhibitor alone won't work optimally if your hormone is depleted.
High prolactin suppresses testosterone and causes ED. If elevated, it needs addressing — sometimes it's a pituitary tumor, sometimes it's medication-induced. Your physician investigates.
Undiagnosed diabetes is common in young men with ED. HbA1c shows your 3-month average blood glucose. If elevated (HbA1c >5.7%), you need glucose control — which itself improves ED, sometimes without medication.
Hypothyroidism causes ED, fatigue, and weight gain. A simple test rules it in or out. If your thyroid is low, thyroid replacement often improves ED dramatically.
High cholesterol damages blood vessel function — one mechanism of vascular ED. Your lipid profile tells your physician your cardiovascular risk and whether lipid-lowering therapy is needed.
Your physician reviews your blood pressure, heart rate, and any history of chest pain, heart attack, or stroke. PDE5 inhibitors lower blood pressure slightly — they're contraindicated in men taking nitrates or with unstable angina.
arq.'s approach: get the bloodwork. It reveals the underlying cause. Your ED medication is then part of a comprehensive protocol addressing testosterone, glucose, thyroid, lipids, and cardiovascular risk — not just a symptomatic fix.
One simple question tells your physician a lot: Do you wake with spontaneous erections?
Yes, you wake with erections = ED is likely psychological (performance anxiety, stress, depression, relationship issues). Your nervous system and blood vessels work fine. The problem is between your ears.
No, you don't wake with erections = ED is likely organic (vascular, hormonal, neurological). Something physical isn't working.
This is crude but reliable. It guides your physician's next steps:
The reality: 40% of ED is purely psychological, 40% is purely organic, and 20% is both. Your physician's job is to figure out which category you fit and build a protocol accordingly.
Most online ED services sell you a pill. Responsible physicians screen for red flags:
A physician-led consultation asks these questions and interprets the answers. That's the safety net.
We don't just sell Sildenafil. Here's how we prescribe differently:
The core difference: we treat you as a whole person, not just an ED symptom.
Struggling with ED? Understand what's causing it. Talk to an arq. physician for a diagnosis-driven approach →
Yes, but with caution. Diabetes damages blood vessels (the mechanism of vascular ED), so your ED is likely diabetes-related. PDE5 inhibitors work, but glucose control matters too. Your physician may recommend: glucose management (diet, metformin, other agents) + PDE5 inhibitor. The medication works better if your blood sugar is controlled.
Mostly yes. PDE5 inhibitors lower blood pressure slightly (5-10 mmHg), which is usually beneficial in hypertensive men. However, if you're already on aggressive blood pressure medication and your BP is well-controlled, the extra drop might cause dizziness. Your physician reviews your current medications and blood pressure before prescribing and may adjust your BP medications. If you're taking nitrates (for angina), absolutely no — PDE5 inhibitors + nitrates = dangerous.
These are common causes of ED, especially in younger men. Antidepressants (especially SSRIs) can also cause ED as a side effect. Your physician assesses: is the ED from the depression itself, or from the medication? If it's medication-induced, options include dose adjustment, switching to a different antidepressant, or adding a PDE5 inhibitor (which can counteract the sexual side effect). If it's depression-related, therapy + medication is the approach. PDE5 inhibitors can help, but addressing the depression is foundational.
First-line medications (Sildenafil, Tadalafil, Vardenafil, Avanafil) work within the first dose if you have organic ED. You'll know within 1-2 hours. If you have psychological ED, the medication works physiologically, but the psychological component (anxiety, performance pressure) may take longer to resolve — sometimes weeks of successful use reduces the anxiety. If you have low testosterone, PDE5 inhibitors alone won't solve it — you need hormone replacement too.
Your physician investigates: (1) Are you taking it correctly? (Empty stomach for Sildenafil? 30-60 minutes before sex?) (2) Is your underlying cause being treated? (Testosterone low? Diabetes uncontrolled? Depression untreated?) (3) Do you have a contraindication making the medication ineffective? (Pelvic surgery, spinal cord injury, severe vascular disease?) (4) Is this psychological ED requiring therapy? Options then include switching medications, adding therapy, treating the underlying cause more aggressively, or referral to a urology specialist.
Generally mild. Most common: headache, flushing, nasal congestion, indigestion (especially with Sildenafil). Rare: vision or hearing changes (very rare, reversible). Serious: priapism (erection lasting >4 hours — call a doctor), severe hypotension (if on nitrates). Your physician screens for contraindications and advises you on expected side effects. Most men tolerate these medications well.
No AI chat. No templates. A specialist reads your panel against South Asian-calibrated ranges and writes the protocol on a 15–20 minute video consult — inside 7 days of your home draw.