The difference could be long term consequences. Like my uro told me a story that he had to do quite a few cases of the total penis reconstruction to the guys from the former Soviet Union area. There they were using internally approved injection for ED (I bet it is dirt cheap in comparison to the tri-mix

). It was helping for a while (the duck was quacking)... But over time the dick literally was becoming like a shell (the walking duck became a "rubber duck")... non-working and unresponsive to any kind of treatment including VED.
So the country's level of medicine does matter... if you plan to live more than a year or two.
Anyway it is a personal choice. I just wanted to deliver a message that so called "Canadian pharmacies" have absolutely no affiliation with Canada. They are not under Canadian regulation and they are not allowed to sell anything on the Canadian market.