Supplements for Erectile Dysfunction

Close-up of dry ginseng slices, capsules and roots
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Erectile dysfunction (ED) is a real problem but you may be reluctant to talk to your doctor about it. Ads abound for supplements claiming to treat ED. Some even say they work better than prescription drugs like Viagra (sildenafil).

But many of these claims have no scientific backing. Supplements are often unresearched or under-researched. In the U.S., they're unregulated. That makes it hard to know what's safe and effective.

This article looks at what herbal supplements do have scientific backing for ED, dosages and potential side effects, and what supplements aren't supported by research.

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6 Lifestyle Changes to Treat Erectile Dysfunction

ED Supplement Research

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.

  • No evidence behind them
  • Evidence that showed they didn't work
  • Studies that contradicted each other

But research has turned up some ED supplements that appear to be safe and effective. They include:

  • Ginseng and vitamin E
  • L-arginine
  • Pycnogenol
  • Yohimbe/yohimbine
  • Tribulus terrestris
  • Eurycoma longifolia (tongkat ali)

Ginseng and Vitamin E

Panax ginseng is one of the better researched ED supplements.

A small clinical trial from 2021 looked at the effectiveness of ginseng combined with vitamin E for ED. Both supplements are antioxidants, which have been shown to help with blood flow and erectile function.

Researchers said the supplements improved erectile function significantly more than placebo after six weeks of use. Side effects appeared similar to the placebo group.

While this was a double-blind, placebo-controlled, randomized clinical trial—the best type of research—the authors called for larger and longer trials.

A 2018 meta-analysis, which looked at 24 clinical trials, found evidence behind ginseng "encouraging." A 2021 review in the Arab Journal of Urology listed it first among promising herbal remedies.

Dosage

Daily dosages in the clinical trial were:

  • 107 milligrams (mg) of ginseng
  • 100 IU vitamin E

Dosages of ginseng aren't well established.

The recommended daily allowance (RDA) of vitamin E for adults is 15 mg, well below the ED dosage in studies.

Talk to your doctor before taking these or any supplement. Don't take more than the amount specified by your doctor 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 may be:

  • 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:

But research has turned up some supplements that appear to be safe and effective for ED. They include:

  • Nausea
  • Vomiting
  • Stomach pain
  • Diarrhea

Researchers gave 68% of them a C or D grade. They say those products either had:

Supplement Warnings

Natural doesn't always mean safe. Supplements can cause side effects, including some potentially dangerous or deadly ones. They may also interact negatively with other things you take. Involve your doctor and pharmacist in your decisions about a supplement regimen.

L-Arginine

L-arginine, also called simply arginine, is a vasodilator, meaning it opens blood vessels. That's the same mechanism of action as ED medications.

The Arab Journal review said L-arginine was promising and warranted further study.

A 2019 meta-analysis of L-arginine for ED found enough credible evidence to recommend it for mild to moderate erectile dysfunction.

Researchers said it significantly improved:

  • Erectile function
  • Orgasmic function
  • Intercourse satisfaction
  • Overall satisfaction

They side side effects were rare, experienced by just 8.3% of participants. None was severe.

Dosage

Standard dosages of L-arginine haven't been established. Doses 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.

You can get L-arginine through your diet. It's in:

  • Red meat
  • Poultry
  • Fish
  • Dairy products

Talk to your doctor about whether L-arginine is right for you and at what dosage. Don't take more than recommended amounts on the product label or what your doctor suggests.

Side Effects

Side effects of L-arginine include:

  • Abdominal pain
  • Bloating
  • Diarrhea
  • Gout
  • Allergies
  • Worsened asthma
  • Low blood pressure

Pycnogenol

Pycnogenol is another supplement called "promising" by the Arab review. This bark-based product is an antioxidant. It's believed to improve circulation and athletic performance.

However, in a 2020 meta-analysis, researchers concluded there's not enough evidence to say whether it improves erectile function.

A significantly older clinical trial, published in 2003, suggested a three-month course of Pycnogenol plus L-arginine restored sexual function.

Pycnogenol is a trademarked name for a patented form of French maritime pine bark extract. It's also called pygnogenol, maritime pine, or pine bark extract.

Dosage

Pycnogelol is considered "possibly safe" in daily doses between 50 mg and 450 mg for up to a year of use.

You can get similar compounds through your diet. They're naturally in:

  • Grapes
  • Red wine
  • Blueberries, cranberries, strawberries, bilberries
  • Red cabbage
  • Apple peel
  • Ginkgo biloba

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 or yohimbine is among the most common supplements marketed for ED. It's sometimes called johimbe. It's also considered an aphrodisiac, meaning it increases sexual desire.

Yohimbe is the name of an African tree. Its bark contains the chemical yohimbine, which is used medicinally. It's marketed under both names but is essentially the same product.

Yohimbe blocks the action of cellular structures called alpha-2 adrenergic receptors. When activated, these receptors prevent you from having an erection.

So blocking the receptors basically removes a roadblock. It may also increase blood flow to the penis by widening blood vessels.

In studies, it's had a consistent but limited effect on ED.

Prescription Form

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

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.

Be certain you talk to your healthcare provider before taking yohimbe supplements and don't take more than 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 (hypertension)

Overdose is possible with yohimbe. It can cause:

  • Low blood pressure (hypotension)
  • Rapid heartbeat
  • Seizures
  • Paralysis
  • Coma
  • Death

Tribulus Terrestris

The IJIR study gave Tribulus terrestris an A grade. The Arab review said it had promising evidence and was among the better-studied options (along with ginseng, L-arginine, and Pycnogenol).

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 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 is sold under the name Tribestan. It comes in 250-mg tablets.

The package recommends taking one or two tablets 3 times a day for at least 90 days. Never take more than the recommended amount.

Check with your doctor on whether this product is safe for you and at what dosage.

Side Effects

The primary reported side effect of Tribulus is stomach irritation. In rare cases, it may cause:

  • Severe liver and kidney problems
  • Neurological toxicity
  • Priapism (a prolonged and painful erection)

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.

Long 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) and other possible effects beneficial in 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

Other Promising Supplements

Several other supplements have been researched but have less evidence overall or mixed results. These include:

Supplements That Don't Work 

Supplements for ED are among the better researched ones. So, if research hasn't shown promising results or if there's no research, you probably shouldn't bother with it.

The IJIR study that assigned letter grades gave these common supplements a C:

  • 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 and may be risky to use are:

  • Ginkgo: May increase risk of excessive bleeding
  • Horny goad week (epimedium): May have a negative impact on your heart or breathing

The Placebo Effect

In placebo-controlled clinical trials of Viagra, 30% of participants taking the placebo reported better erections. People taking herbal supplements for ED may experience a similar effect and lead them to believe the supplement works. That means, even if your friend swears by it, that's not proof of effectiveness.

Summary

ED supplements research suggests are generally safe and effective include:

  • Ginseng and vitamin E
  • L-arginine
  • Pycnogenol
  • Yohimbe/yohimbine
  • Tribulus terrestris
  • Eurycoma longifolia (tongkat ali)

Even so, they can cause side effects and interact negatively with drugs. They may not be safe for everyone. Be sure to ask your healthcare provider what's right for you.

Other supplements with promise are:

  • Macurna pruriens (velvet bean)
  • P. pinaster
  • L. meyenii
  • DHEA

Many more have inadequate research, negative results, or mixed results. Some, including ginkgo and horny goat weed, may be dangerous.

A Word From Verywell

Erectile dysfunction can have a very real impact on your life, mental health, and relationships. Supplements may be a good treatment option, instead of or alongside prescription medications.

Even if you opt for supplements alone, be sure to talk to your healthcare provider about what's safest and most likely to work for you. Your doctor can help you consider your overall health, other conditions, and all the medications you're on.

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