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10.1038/clpt.1981.154 63 NauckM

Example 7 Male patients diagnosed with erectile dysfunction and marginally responsive to doses of up to 100 mg of sildenafil (responsive for less than about 50% of attempted sexual activity) are orally administered between 50 and 100 mg of sildenafil between about one and two hours prior to desired initiation of sexual activity

It's done under the guidance of a medical team that understands the nuances of metabolic health

doi: 10.1016/0041-008x(88)90369-9

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Beyond that, the free provider visit and absent membership fee mean fewer add-on charges to begin with