When evaluating a treatment for Erectile Dysfunction, there are three important considerations:
- Is it the right treatment for the cause of your ED?
- Is it an effective treatment?
- Is it safe?
Choosing the Right Treatment
There are many different causes for ED, and you can’t choose an effective treatment without understanding your specific problem. To understand how different conditions can affect erections, see our articles, “How Do Erections Work?” and “Causes of Erectile Dysfunction.”
If you intend to try herbal supplements, you should first consult a doctor to understand the underlying cause. This is especially important, because sometimes ED is based on a serious underlying medical condition.
Once you know the cause of your ED, you need to evaluate the effectiveness of the treatments you are considering.
Many herbal supplements are promoted as miracle drugs. If there are claims that a supplement will do everything from curing baldness to preventing heart disease, it’s very likely that the claims are bogus.
There have been some clinical trials of herbal remedies used to treat erectile dysfunction, and in general the results are not impressive. Some supplements have shown small improvements, mostly in men with minor ED. The results are much less significant than those obtained from prescription medications.
A study1conducted by the ED Treatment Information Center in 2018 found that 81% of the men who had tried herbal supplements were either Not at All Satisfied or Not Very Satisfied with the results. 18% were Somewhat Satisfied, and only 1% were Very Satisfied.
Consider this: penicillin, the first successful antibiotic, was derived from molds that inhibit bacterial growth. Scientists had to figure out why the molds slowed bacteria, and refine the active ingredients. Using herbal supplements is somewhat like putting mold on a wound. It might help, a little, but it’s certainly not going to help as much as using penicillin.
Also note that herbal supplements will not cure ED. In order to be effective, even for very mild cases, you will need to take them on a daily basis.
When a doctor prescribes a drug, he makes sure that it won’t cause complications for any medical conditions you have. He also checks it against the other medications you take, to be sure there aren’t dangerous effects when the drugs are combined. When you use herbal supplements, you don’t have these safeguards.
Several of the supplements that are sold as ED treatments actually have side effects that, in some cases, can be severe.
Even more importantly, herbal supplements are not well regulated in the United States. Studies have shown that 40-50% of herbal supplements do not even contain the supposed main ingredient, and many contain substances that are not listed which may have dangerous side effects2. Another study found that over two thirds of the products tested had substituted other plant species for the plants listed on the label, and a third of products also contained other fillers or contaminants3. A study by the New York State Attorney General of herbal products sold at GNC, Target, Walgreens, and Walmart found that four out of every five products didn’t contain the ingredient they claimed! Fourteen US states and territories have petitioned Congress to regulate the herbal supplements industry.
Many products contain undocumented “fillers” that can cause allergic reactions. In recent years, the FDA has found over 300 herbal products that contain hidden, deceptively labeled, or dangerous ingredients4. And since 2015, the FDA has released public warnings on more than 160 ED supplements and “male enhancement” products found to contain dangerous ingredients and contaminants5 . An independent study of FDA data, conducted in 2018, found almost 800 herbal supplements that contained unlisted ingredients6.
Most herbal supplements are produced in 3rd-world countries, and packaged for distribution under various brand names in the United States. Growers often use chemical pesticides, and there is no testing for contamination. So much for “natural.”
Remember the penicillin/mold example, above? If you put mold on a wound, you might get some of the benefits of penicillin… but you might also get toxins and other harmful ingredients that are found in many molds.
No matter how you look at it, using herbal supplements is a risky proposition.
Note that the clinical studies referenced below are based on the use of tested, pharmaceutical grade supplements in controlled dosages. Supplements purchased over-the-counter may not yield the same results.
Ashwagandha (withania somnifera)
Effectiveness: A study using rats found that ashwagandha actually worsened erectile dysfunction and lowered sex drive9. Another study of men with psychogenic erectile dysfunction found that ashwagandha performed no better than a placebo10.
Risks: Large doses can cause upset stomach, diarrhea, and vomiting.
Effectiveness: There is no evidence that CBD cures erectile dysfunction. (See our article on CBD.)
Risks: Generally considered safe with mild side effects; may have harmful interactions with other drugs.
Effectiveness: No evidence of effectiveness in humans. Increases levels of estrogen, and may lower levels of testosterone.
Risks: Appears to be safe at low levels. May cause acne.
Effectiveness: Reputed to increase levels of dopamine and nitric oxide (NO). No evidence of effectiveness for ED in humans.
Risks: May reduce clotting and increase risk of bleeding.
Effectiveness: Stimulates blood flow into the penis by increasing nitric oxide (NO). There is some evidence that Red Ginseng performs better than a placebo in treating ED, but the existing studies are small and not conclusive11.
Risks: A small number of patients experience stomach upset, constipation, headache or insomnia.
Goji Berry Extract (Lycium chinense)
Effectiveness: A study conducted with rats suffering from age-related ED12 suggests that Goji may have a positive effect by preventing the decrease of serum testosterone levels. The relationship between serum testosterone levels and ED is controversial. Goji extract has not been tested as an ED treatment in humans. There is no direct evidence that Goji improves erectile function.
Risks: Goji berries are generally considered safe for short-term use. They may trigger allergic reactions, and may result in reduced blood pressure.
Horny Goat Weed (epimedium)
Effectiveness: No evidence of effectiveness for ED in humans. Although it is reputed to increase levels of nitric oxide (NO), very little actually makes it into the bloodstream.
Risks: May affect heart function. May cause mood changes.
Effectiveness: Reputed to stimulate blood flow into the penis by increasing nitric oxide (NO). The NO produced by L-Arginine is metabolized in the digestive tract; there is no evidence that improves erectile function13.
There are claims that L-Arginine has some benefit when taken on an ongoing basis with pycnogenol14 or with L-Citrulline15. However, the L-Arginine/pycnogenol study is very suspect. The study consisted of 40 men “without confirmed organic erectile dysfunction.” And there was no control group, to rule out placebo effects.
Risks: Side effects may include nausea, cramps and diarrhea, as well as heart arrhythmia.
Effectiveness: In a small clinical study of 24 men with mild erectile dysfunction16, about half the subjects showed improvement. Researchers concluded that L-Citrulline is more effective than L-Arginine for mild cases of ED, but less effective than PDE5 inhibitors (Viagra, Cialis, Levitra, etc.)
Risks: L-Citrulline may cause harmful interactions with nitrates for heart disease, blood pressure medications, and PDE5 inhibitors. Consult your doctor before taking L-Citrulline. Men with heart disease should not take L-Arginine.
Maca Root (Lepidium Meyenii)
Effectiveness: There is limited evidence that Maca Root may increase sexual desire or erectile function17. However, the total number of trials, the total sample size, and the average methodological quality of the primary studies were too limited to draw firm conclusions.
Risks: Side effects may include mild stomach upset, cramps, and mood swings.
Effectiveness: Pharmaceutical-grade Nattokinase (NK) has been used in Japan for the treatment of cardiovascular disease18. There is no clinical evidence that it is an effective treatment for ED.
Risks: Nattokinase is a blood thinner which may make bleeding disorders worse. It can also increase the risks of surgery. It is generally safe in small dosages.
Pycnogenol (Pine Bark)
Effectiveness: Stimulates blood flow into the penis by increasing nitric oxide (NO)19. May be effective in the treatment of ED when used in combination with L-Arginine (see above).
Risks: Safe in small dosages.
Effectiveness: In an animal-based clinical test, Tribulus was not effective in treating ED20. There is no clinical evidence that it is an effective treatment for ED.
Risks: Might decrease blood sugar levels to dangerous levels for diabetics. Otherwise, probably safe in small dosages.
Effectiveness: There is some evidence that a shortage of certain vitamins (notable B3, C, and D) may be linked to erectile dysfunction. For men with deficiencies, taking vitamin supplements may improve erections. However, vitamins have no effect unless there is a deficiency.
Risks: Safe if taken in recommended dosage.
Effectiveness: Stimulates blood flow into the penis by increasing nitric oxide (NO)21. May also increase libido, but the mechanism is not understood.
Risks: Side effects include increased blood pressure, fast or irregular heartbeat, anxiety, insomnia. May interact with blood pressure medications or anti-depressants. May cause kidney damage. Yohimbe shouldn’t be used without a doctor’s supervision.
Effectiveness: A zinc deficiency can lower testosterone. For men with a zinc deficiency, taking zinc supplements can raise testosterone, increase the libido, and improve erections. However, zinc has no effect unless there is a deficiency.
Risks: Generally safe if taken in recommended dosage. Excess levels of dietary zinc has been linked to prostate cancer22.
Ingesting high levels of zinc can also result in diarrhea, vomiting, and stomach cramps.
There are a many supplements on the market that do not disclose their specific ingredients. It’s impossible to evaluate the effectiveness and safety of these products, and we strongly advise not purchasing them.
Although a change in diet will not cure erectile dysfunction, it can sometimes lessen symptoms and slow the progression… particular in men experiencing vascular and circulatory problems. For more information, read our article on “Diet and Exercise for ED.”
For More Information
- Nicholson, Robert T. “Comprehensive Study on the Impact of Erectile Dysfunction.” ED Treatment Information Center, 21 Mar 2018.
- Newmaster, Steven G.; Grguric, Meghan; Shanmughanandhan, Dhivya; Ramalingam, Sathishkumar; and Ragupathy, Subramanyam. “DNA Barcoding Detects Contamination and Substitution in North American Herbal Products.” BMC Medicine. 11/2013:222.
- Wise, Jaqui. “Herbal products are often contaminated, study finds.” British Medical Journal. Oct 2013. DOI:10.1136/bmj.f6138
- US Food & Drug Administration (FDA). “Beware of Fraudulent Dietary Supplements.” 15 Mar 2011.
- “Tainted Sexual Enhancement Products.”
- “FDA Finds Nearly 800 Supplements with Unapproved Ingredients.”
- Spitz, Aaron. The Penis Book. Rodale Wellness, 2018.
- Mayo Clinic Staff. “Dietary supplements for erectile dysfunction: A natural treatment for ED?” Mayo Foundation for Medical Education and Research, 17 Jan 2016.
- Ilayperuma, I; Ratnasooriya, W D; Weerasooriya, T R. “Effect of Withania somnifera root extract on the sexual behaviour of male rats.” Asian Journal of Andrology. Dec 2002;4(4):295-8.
- Mamidi, Prasad; Thakar, A B. “Efficacy of Ashwagandha (Withania somnifera Dunal. Linn.) in the management of psychogenic erectile dysfunction. Ayu. Jul-Sep 2011, 32(3): 322–328.
- Jang, Dai-Ja; Lee, Myeong Soo; Shin, Byung-Cheul; Lee, Young-Cheoul; Ernst, Edzard. “Red Ginseng for Treating Erectile Dysfunction: a Systematic Review.” Journal of Clinical Pharmacology. Oct 2008. 66(4): 444–450.
- Moon, Hyong Woo; Park, Jung Woo; Lee, Kyu Won; Jeong, Hyun Cheol; Choi, Jin Bong; Choi, Sae Woong; Bae, Woong Jin; Cho, Hyuk Jin; Ha, U-Syn; Hong, Sung Hoo; Geum, Jeong Ho; Hong, Seong Bin; Kim, Sae Woong. “Administration of Goji (Lycium chinense Mill.) Extracts Improves Erectile Function in Old Aged Rat Model” World Journal of Men’s Health. Apr 2017; 35(1): 43–50. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419117/>
- Klotz, T; Mathers, MJ; Braun, M; Bloch, W; Engelmann, U. “Effectiveness of oral L-arginine in first-line treatment of erectile dysfunction in a controlled crossover study.” Urology International. 1999;63(4):220-3.
- Stanislavov, R.; Nikolova, V. “Treatment of erectile dysfunction with pycnogenol and L-arginine.” Journal of Sex & Marital Therapy. May-Jun 2003:207-13.
- Spitz, Aaron. The Penis Book. Rodale Wellness, 2018.
- Cormio, L; De Siati, M; Lorusso, F; Selvaggio, O; Mirabella, L; Sanguedolce, F; Carrieri, G. “Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction.” Urology. Jan 2011;77(1):119-22.
- Shin, Byung-Cheul ; Lee, Myeong Soo; Yang,Eun Jin; Lim, Hyun-Suk, and Ernst, Edzard. “Maca (L. meyenii) for Improving Sexual Function: a Systematic Review.” BMC Complementary and Alternative Medicine. Aug 2010. <https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-10-44>
- Weng, Yunqi; Yao, Jian; Sparks, Sawyer; Wang, Kevin Yueju. “Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease.” International Journal of Molecular Science. Mar 2017; 18(3): 523.
- Rohdewad, P. “A Review of the French Maritime Pine Bark Extract (Pycnogenol), and Herbal Medication with a Diverse Clinical Pharmacology.” International Journal of Clinical Pharmacology and Therapeutics. 2002: 158-68.
- Gauthaman, K1; Ganesan, A. P. “The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction–an evaluation using primates, rabbit and rat.” Actas Urológicas Españolas. Jan 2008;15(1-2):44-54.
- Israel, J.; Laborde, E. “Alternative and Internet Drugs that Affect Sexual Function.” Contemporary Treatment of Erectile Dysfunction. 13 Aug 2016: 137-144.
- Gutiérrez-González, Enrique; Castelló, Adela; Fernández-Navarro, Pablo; Castaño-Vinyals, Gemma; Llorca, Javier; Salas-Trejo, Dolores; Salcedo-Bellido, Inmaculada; Aragonés, Nuria; Fernández-Tardón, Guillermo; Alguacil, Juan; Gracia-Lavedan, Esther; García-Esquinas, Esther; Gómez-Acebo, Inés; Amiano, Pilar; Romaguera, Dora; Kogevinas, Manolis; Pollán, Marina; Pérez-Gómez, Beatriz. “Dietary Zinc and Risk of Prostate Cancer in Spain: MCC-Spain Study.” Nutrients. Jan 2019, 11(1).