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Ads for supplements claiming to treat erectile dysfunction (ED) are not hard to come by. Some even say these products work better than prescription ED drugs like Viagra (sildenafil).
But this and many of the claims about erectile dysfunction supplements have no or very little supporting research. Supplements are not regulated in the United States, meaning that products you buy may or may not be effective—or safe.
This article looks at which herbal supplements do and don't have scientific backing for treating erectile dysfunction, as well as typical dosages and potential side effects.
6 Lifestyle Changes to Treat Erectile Dysfunction
Which ED Supplements May Help?
ED supplements that appear to be safe and effective, according to studies, include:
- Ginseng and vitamin E
- L-arginine
- Pycnogenol
- Yohimbe/yohimbine
- Tribulus terrestris
- Eurycoma longifolia (tongkat ali)
The following is a review of some of the most notable research on each.
Ginseng and Vitamin E
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Panax ginseng is one of the better researched ED supplements.
A 2018 meta-analysis, which looked at 24 clinical trials, found evidence behind this type of ginseng "encouraging."
A 2021 review in the Arab Journal of Urology listed it first among "promising herbal remedies" for ED.
The combination of Panax ginseng and vitamin E also appears to have an effect. Both supplements are antioxidants, which have been shown to help with blood flow and erectile function.
A small clinical trial from 2021 looked at the effectiveness of the combination for treating erectile dysfunction. Participants were randomly assigned to either a supplement or sham treatment (placebo) group, and neither they nor the researchers knew who got what until the study was over.
Researchers said the supplements improved erectile function significantly more than a sham treatment (placebo) after six weeks of use. Side effects appeared similar in both treatment groups.
The way the study was set up is considered the "gold standard" for conducting research, as it produces results that have minimal bias affecting the results. However, the small study size makes the information difficult to extrapolate to the general population.
The Placebo Effect
In placebo-controlled clinical trials of Viagra, 30% of participants taking the sham treatment reported better erections. People taking herbal supplements for treating ED may experience a similar effect, leading them to believe they work.
Dosage
Daily dosages used in the clinical trial were:
- 107 milligrams (mg) of ginseng
- 100 international units (IU) of vitamin E
Safe and effective dosages of ginseng aren't well established.
The recommended daily allowance (RDA) of vitamin E for adults is 15 mg, well below the dosage used in ED studies.
Talk to your healthcare provider before taking these or any supplements. Don't take more than the amount specified by your healthcare provider or on the product label.
Side Effects
Common side effects of ginseng include:
- Nervousness
- Insomnia
- Increased blood pressure
- Breast pain
- Vomiting
- Diarrhea
- Mania
More serious, but rare side effects include:
- Inflammation of arteries in the brain
- Inflammation of the liver
- Severe skin reactions
- Allergic reactions, including anaphylaxis
Vitamin E side effects, especially at high doses, are:
- Nausea
- Vomiting
- Stomach pain
- Diarrhea
L-Arginine
L-arginine, also called simply arginine, is a vasodilator. That means it opens blood vessels like prescription ED medications do.
The Arab Journal review said L-arginine was promising for treating ED and warranted further study.
A 2019 meta-analysis of L-arginine for ED went one step further, finding enough credible evidence to recommend it for treating mild to moderate erectile dysfunction.
Researchers said it significantly improved:
- Erectile function
- Orgasmic function
- Intercourse satisfaction
- Overall satisfaction
L-arginine is also an antioxidant that may have a benefit for male fertility.
They said side effects were rare, experienced by just 8.3% of participants. None were severe.
Dosage
Safe and effective dosages of L-arginine haven't been established. Doses used in studies ranged from 1,500 mg to 5,000 mg. This is lower than what's been studied for other conditions, including high blood pressure (hypertension).
You can get L-arginine through your diet in:
- Red meat
- Poultry
- Fish
- Dairy products
Talk to your healthcare provider about whether L-arginine supplements are right for you and at what dosage. Don't take more than recommended amounts on the product label or what your healthcare provider suggests.
Side Effects
Side effects of L-arginine include:
- Abdominal pain
- Bloating
- Diarrhea
- Gout
- Allergies
- Worsened asthma
- Low blood pressure
Pycnogenol
Pycnogenol is a trademarked name for a patented form of French maritime pine bark extract. It's also called pygnogenol, maritime pine, and pine bark extract.
This product is an antioxidant. It's believed to improve circulation and athletic performance.
Pycnogenol is another supplement called "promising" by the Arab Journal review.
A clinical trial published in 2003 suggested that a three-month course of Pycnogenol plus L-arginine restored sexual function.
However, in a 2020 meta-analysis, researchers concluded there's not enough evidence to say whether it improves erectile function.
Dosage
Pycnogelol is considered "possibly safe" in daily doses between 50 mg and 450 mg for up to a year of use. Less is known about the effective dosage for ED.
You can get similar compounds through your diet in:
- Grapes
- Red wine
- Blueberries, cranberries, strawberries, bilberries
- Red cabbage
- Apple peel
Side Effects
Possible side effects of Pycnogenol include:
- Dizziness
- Stomach upset
- Headache
- Mouth sores
- Bad breath
Pycnogenol may make autoimmune diseases worse by stimulating the immune system. It may also slow blood clotting and lower blood sugar to dangerous levels.
Yohimbe/Yohimbine
Yohimbe (a.k.a. johimbe) is an African tree. Its bark contains the chemical yohimbine, which is used medicinally. It is among the most common supplements marketed for ED. You may see it marketed by either of these names.
When cellular structures called alpha-2 adrenergic receptors are activated, they prevent an erection. Yohimbe works by blocking the action of these receptors.
It may increase blood flow to the penis by widening blood vessels. It's also considered an aphrodisiac, meaning it increases sexual desire.
In studies, it had a consistent but limited effect on ED.
In the U.S., a form of yohimbine (yohimbine hydrochloride) is used in a prescription drug. It's sold as Aphrodyne and Yocon and marketed for impotence and as an aphrodisiac. However, this product is believed to work differently from yohimbe supplements.
Dosage
Safe and effective dosages for yohimine aren't established. The usual recommended dose of yohimbine is between 5 mg and 10 mg, three times a day.
According to the National Center for Complementary and Integrative Health, some products labeled as yohimbe contain very little yohimbine. Many don't include amounts on the label either. That can make it hard for you to know how much you're getting. Also, certain formulations of catuaba, another natural remedy (derived from the bark of trees found in the Brazilian rainforest) have been known to be laced with yohimbine.
Be certain you talk to your healthcare provider before taking yohimbe supplements. Don't take more than is suggested.
Side Effects
Studies have documented several negative reactions to yohimbe.
Possible side effects include:
- Insomnia
- Anxiety
- Fast or irregular heartbeat
- Chest pain
- Sweating
- Blurred vision
- High blood pressure
Overdose is possible with yohimbe. It can cause:
- Low blood pressure (hypotension)
- Rapid heartbeat
- Seizures
- Paralysis
- Coma
- Death
Tribulus Terrestris
Tribulus is an herb from the subtropical regions of Asia, Africa, and southern Europe.
It contains saponins, a type of antioxidant that strengthens small blood vessels (capillaries) in the skin. That's believed to be how it works for ED.
A 2020 review published in the International Journal of Impotence Research (IJIR) looked at evidence behind popular over-the-counter (OTC) supplements for ED and boosting testosterone. It graded them from A (strongest supporting evidence) through D (weakest supporting evidence). Tribulus terrestris got an "A" grade.
The Arab Journal review said it had promising evidence and was among the better-studied options (along with ginseng, L-arginine, and Pycnogenol).
A small clinical trial in 2018 focused on aging men with partial androgen (male hormone) deficiency. Researchers said tribulus had a "robust effect" in raising testosterone and improving sexual function in ED.
A larger 2017 clinical trial found the supplement significantly improved:
- Erections
- Intercourse satisfaction
- Orgasmic function
- Sexual desire
- Overall satisfaction
Researchers said it was generally well-tolerated.
Dosage
A standardized form of Tribulus terrestris is sold under the name Tribestan. It comes in 250-mg tablets. It's not well established whether this is a safe and effective dosage for ED.
The package recommends taking one or two tablets three times a day for at least 90 days. Never take more than the recommended amount.
Check with your healthcare provider on whether this product is safe for you and at what dosage.
Side Effects
The most commonly reported side effect is stomach irritation.
In rare cases, Tribulus terrestris may cause:
- Severe liver and kidney problems
- Altered nervous system activity (neurological toxicity)
- A prolonged and painful erection (priapism)
Eurycoma Longifolia
Eurycoma longifolia, sometimes called tongkat ali or longjack, also received an "A" from the IJIR study. It comes from the roots of a Southeast Asian shrub and contains several antioxidants.
This herb has long used been used in traditional medicine for enhancing virility. Research suggests it has the same mechanism of action as the ED drugs Viagra, Cialis (tadalafil) and Levitra (vardenafil), as well as other possible effects beneficial for ED.
Dosage
Some studies have reported success with between 200 mg and 300 mg per day of Eurycoma longifolia. One review notes recommendations of up to 400 mg.
However, safe and effective doses aren't established. Little is known about long-term safety. Follow packaging instructions or ask your healthcare provider about the best dosage for you.
Side Effects
So far, studies have not noted any side effects of Eurycoma longifolia.
However, because it may raise testosterone levels, it may not be safe for people with:
- Heart disease
- Hormone-sensitive cancers
- Liver disease
- Kidney disease
- Sleep apnea
What ED Supplements Might Work
Several other supplements have been researched but have less evidence overall or mixed results. These include:
- Velvet bean ( Macurna pruriens )
- Maritime or cluster pine ( Pinus pinaster )
- Maca root ( Lepidium meyenii )
- Dehydroepiandrosterone (DHEA)
Which ED Supplements Don't Work?
The IJIR review also noted supplements that had either:
- No evidence supporting use for ED
- Evidence that showed they didn't work for ED
- Studies that contradicted each other
It assigned a "C" grade to:
- Aspartate
- Boron
- Fenugreek
- L-citrulline
- Vaca root
- Zinc
They gave "D" grades to:
- Cayenne pepper
- Diindolymethane (DIM)
- Magnesium
- Nettle leaf
- Sarsaparilla extract
- Vitamin B6
Two popular herbs that aren't proven to be effective for ED and that may be risky to use are:
- Ginkgo: May increase risk of excessive bleeding.
- Horny goat weed (epimedium), which may have a negative impact on your heart or breathing
Finding Quality Supplements
Supplements aren't regulated by the U.S. Food and Drug Administration (FDA).
To ensure you're getting a quality product that contains what the label says, look for brands that are tested and approved by independent certifying bodies, such as:
- U.S. Pharmacopeia (USP)
- NSF International
- ConsumerLab
This information should be on the product label.
Summary
Research suggests that ginseng plus vitamin E, L-arginine, pycnogenol, yohimbe/yohimbine, Tribulus terrestris, and Eurycoma longifolia (tongkat ali) are generally safe and effective for erectile dysfunction.
Others, like DHEA and velvet bean, show promise. Many more have no research behind them, or studies that produced negative or mixed results. Some, including ginkgo and horny goat weed, may be dangerous.
You should speak to your healthcare provider before taking any supplements for ED. Even if they work, they may not be safe for you depending on your overall health and medication use.
A Word From Verywell
Erectile dysfunction can have a very real impact on your life. Supplements may be a good treatment option, instead of or alongside prescription medications.
It's vital to consult with your healthcare provider. Even if supplements aren't recommended in your case, they may be able to identify other treatment options that can help.
Source: https://www.verywellhealth.com/supplements-for-ed-3300136