“[Forty] percent of men by age 40 struggle from not being able to get and maintain an erection,” exclaims the website for Hims, a recently launched telemedicine startup that sells generic versions of popular baldness and erectile dysfunction treatments. Worried you might be in that 40 percent? Hims has a solution: with the help of sildenafil (also known as generic Viagra), you can have “an erection when you want one, not just when your penis says it’s allowed.”
“Nobody wants to go to the doctor,” says Hims founder and CEO Andrew Dudum as we talk on the phone. With a “sensitive and uncomfortable topic” like erectile dysfunction, seeking help can feel especially intimidating. The Hims model allows users to upload photos and chat with a physician remotely. Instead of having a face-to-face conversation with your physician (or a sex therapist), you can submit your info online and sign up for a monthly subscription of erectile dysfunction medications. You don’t even have to worry about whether or not your insurance company will cover your prescription: Hims sells low-priced generic medications directly to consumers, taking insurance out the equation entirely. (At present, Hims exclusively offers sildenafil. Cialis and Levitra are not currently available as generics.)
Yet in their attempt to help men sidestep awkward conversations about erectile embarrassment, Hims is aggressively promoting the idea that a healthy sex life is one where erections occur on demand and last as long as you want. That’s a message some sexual health professionals find disturbing. Hims might help you maintain your erection, but it won’t help you understand your body, your sexuality, or give you a more expansive understanding of pleasure. Destigmatizing men’s erectile woes is a noble mission, but the company’s claim that it’s “weird” to leave a frustratingly flaccid member unmedicated does far more harm than good.
Although many of us assume that instantly hard, long lasting erections are not just desirable, but a sign of healthy, “normal” sexuality, the reality is much more complicated. Chris Donaghue, author of Sex Outside the Lines: Authentic Sexuality in a Sexually Dysfunctional Culture, tells me that much of what we label “dysfunctional” about erectile performance is just a natural part of getting older. “When you’re in your forties, you should expect erectile frustration about 40 percent of the time,” says Donaghue, noting that the figure increases about 10 percent with each passing decade. “That’s healthy. That’s not a disorder. That’s normal.”
Even when erectile dysfunction is an accurate diagnosis, medication is rarely warranted as a first-line treatment, particularly among the young men Hims is targeting, explains Donaghue. Younger men’s erectile issues often have mental and emotional causes, says TT Baum, a San Francisco-based sex educator who does hands-on work with clients who struggle with sexual issues. For those men, Hims’ promise of embarrassment-free treatment could seem particularly appealing: If you’re overwhelmed by the idea of talking about your anxiety-induced erectile dysfunction, a pill you order online can feel like an easy out. But that doesn’t address the underlying anxiety — and in some cases, pills may make it worse, making users feel their sexual fulfillment requires medication. A post on the Hims blog does note that erectile dysfunction can have psychological causes that aren’t readily resolved by popping a pill, but you have to search to find this information. Its impact is somewhat lessened by the coupon code for Hims that appears at the top of the page.
Also, sildenafil is a prescription medication — one that has side effects. Painful, hours-long erections occasionally land users in the hospital (and, in the worst cases, destroy their ability to ever get an erection again). But headaches, loss of vision, indigestion, and diarrhea are also fairly common; rarer side effects include facial swelling, renal problems, laryngitis, and, perversely, an inability to experience orgasm.
Those are just the physical side effects; mental ones can occur, too. Using sildenafil regularly can cause a kind of disconnection, where the erection isn’t tied to the “emotional/psychological arousal state,” but is instead fueled by chemical assistance, Donaghue says. That disconnection can drive an even bigger wedge between men and their emotions, and making users who crave an easy, automatic erection further dependent on medication. Men who see good sex as being synonymous with the presence of an erection — any erection, no matter how emotionally disconnected from it they may be — are especially prone to developing a dependency on erectile dysfunction drugs, says Baum. These medications can promote an attitude of “If I don’t have to do the work, why should I?” Baum says.
While getting younger men hooked on sildenafil might make for a profitable business model, it’s not a great way to promote healthy attitudes toward sex, Baum notes.
“Sex isn’t about performance,” Donaghue tells me. “It’s not about if you’re hard or not, it’s about ‘How does this feel?’” Instead of seeing a disappointing erection as a problem, Donaghue encourages clients to see it as an opportunity to expand their understanding of what sex and intimacy are truly about, moving away from a penis-centric, performance-based model that he sees as “really crappy sex.”
Hims offers a solution to men who feel frustrated with their sexual performance, one that promises on-demand access to erections with none of the embarrassment of seeking help from a doctor. But truly getting in touch with your sexuality means confronting, not avoiding, all the embarrassments and anxieties of being human. Buying a pill online may feel like an easy alternative — but in the long run, it makes accessing authentic sexual pleasure much more difficult.