Natural Treatments for Impotence
• Erectile Dysfunction
Impotence, or erectile dysfunction, is the inability to achieve an erection. Impotence may occur for any of at least 15 possible causes, including diabetes, drug side effects, pituitary tumors, hardening of the arteries, hormonal imbalances, and psychological factors. A few of these conditions respond to specific treatment. For example, if a blood pressure drug is causing impotence, the best approach is to change drugs. If a pituitary tumor is secreting the hormone prolactin, treating that tumor may result in immediate improvement. However, in most cases, conventional treatment of impotence is nonspecific.
The drugs Viagra and Cialis have revolutionized treatment for erectile dysfunction. These medications work by increasing tissue sensitivity to the blood-vessel-dilating substance nitric oxide (NO) in the penis. Older methods include mechanical devices that utilize a vacuum to produce an erection, drugs for self-injection, and implantation of penile prostheses.
Proposed Treatments for Impotence
Korean Red Ginseng
In the better of the two trials, 45 participants received either placebo or Korean red ginseng at a dose of 900 mg 3 times daily for 8 weeks.
In an analysis combining the results of 6 controlled trials, researchers found some evidence for the benefits of Korean red ginseng. However, the small size and generally low quality of the studies left some doubt about this conclusion.
For more information, including safety issues, see the full
The substance nitric oxide (NO) plays a role in the development of an erection. Dugs like Viagra increase the body's sensitivity to the natural rise in NO that occurs with sexual stimulation. A simpler approach might be to raise NO levels, and one way to accomplish this involves use of the amino acid L-arginine. Oral arginine supplements may increase nitric oxide levels in the penis and elsewhere. Based on this, L-arginine has been advertised as "natural Viagra." However, there is as yet little evidence that it works. Drugs based on raising nitric oxide levels in the penis have not worked out for pharmaceutical developers; the body seems to simply adjust to the higher levels and maintain the same level of response.
The main support for the use of arginine in erectile dysfunction comes from a small double-blind trial in which 50 men with erectile dysfunction received either 5 g of L-arginine or placebo daily for 6 weeks.
A double-blind crossover study of 32 men found no benefit with 1,500 mg of arginine given daily for 17 days;
Arginine has also been evaluated in combination with the drug yohimbine (made from the herb
Note : Do not use the drug yohimbine (or the herb yohimbe) except under physician supervision, as it presents a number of safety risks.
For more information, including dosage and safety issues, see the full
In a 6-month, double-blind trial of 120 men, average age 66, carnitine (propionyl-l-carnitine 2 g/day plus acetyl-l-carnitine 2 g/day) and testosterone (testosterone undecanoate 160 mg/day) were separately compared to placebo.
Another double-blind, placebo-controlled study found that propionyl-l-carnitine at 2 g/day enhanced the effectiveness of sildenafil (Viagra) in 40 men with diabetes who had previously failed to respond to sildenafil on at least eight occasions.
In another double-blind study, a combination of the propionyl and acetyl forms of carnitine enhanced the effectiveness of Viagra in men who suffered from erectile dysfunction caused by prostate surgery.
Carnitine has also shown promise for treating male infertility. For more information, including dosage and safety issues, see the full
A proprietary combination therapy containing arginine along with
, ginseng, and vitamins and minerals has shown some promise in an unpublished study.
In a 3-week, double-blind, placebo-controlled trial, 20 men with erectile dysfunction received either placebo or a special form of
A double-blind, placebo-controlled study enrolled 40 men with difficulty achieving or maintaining an erection who also had low measured levels of
has shown some promise for erectile dysfunction, according to a 3-month randomized, double-blind study performed in Thailand.
Based on exceedingly preliminary evidence, the herb
Many other herbs are also reputed to improve sexual function in men , including
Numerous case reports and uncontrolled studies had indicated that the herb
In a small single-blind study,
Herbs and Supplements to Use Only With Caution
The US Food and Drug Administration (FDA) warned consumers not to purchase or consume a several brands of dietary supplements after samples were found adulterated with the prescription drug tadalafil (Cialis), an analogue of sildenafil (Viagra). The products named in the warning are SIGRA, STAMINA Rx, STAMINA Rx for Women, Y-Y, Spontane ES, and Uroprin (all manufactured by NVE, Inc., and distributed by Hi-Tech). For more information, see the FDA's Public Health Advisory on this subject.
One report claims that both
2. Chen J, Wollman Y, Chernichovsky T, et al. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized placebo-controlled study. BJU Int. 1999;83:269-273.
8. Cohen A. Long-term safety and efficacy of Ginkgo biloba extract in the treatment of antidepressant-induced sexual dysfunction. Priory Medical Journals website. Available at: http://www.priory.com/pharmol/gingko . Accessed 1997.
14. Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002;168:2070-2073.
15. Lebret T, Herve JM, Gorny P, et al. Efficacy and safety of a novel combination of L-arginine glutamate and yohimbine hydrochloride: a new oral therapy for erectile dysfunction. Eur Urol. 2002;41:608-613.
19. Gonzales GF, Cordova A, Vega K, Effect of Lepidium meyenii (Maca), a root with aphrodisiac and fertility-enhancing properties, on serum reproductive hormone levels in adult healthy men. J Endocrinol. 2003;176:163-168.
21. Gardner-Thorpe D, O'Hagen C, Young I, et al. Dietary supplements of soya flour lower serum testosterone concentrations and improve markers of oxidative stress in men. Eur J Clin Nutr. 2003;57:100-106.
22. Cavallini G, Caracciolo S, Vitali G, et al. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology. 2004;63:641-646.
23. Gentile V, Vicini P, Prigiotti G, et al. Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes. Curr Med Res Opin. 2004;20:1377-1384.
25. Durackova Z, Trebaticky B, Novotny V, et al. Lipid metabolism and erectile function improvement by pycnogenol extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction-a pilot study. Nutr Res. 2003;23:1189-1198.
28. Engelhardt PF, Daha LK, Zils T, et al. Acupuncture in the treatment of psychogenic erectile dysfunction: first results of a prospective randomized placebo-controlled study. Int J Impot Res. 2003;15:343-346.
31. Cavallini G, Modenini F, Vitali G, et al. Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology. 2005;66:1080-1085.
32. Ito T, Kawahara K, Das A. A double-blind placebo-controlled study on the effects of ArginMax, a natural nutritional supplement for enhancement of male sexual function. ArginMax website. Available at: http://www.arginmax.com/html/abstract.htm . Accessed October 5, 2005.
34. Gonzales GF, Cordova A, Vega K, et al. Effect of Lepidium meyenii (Maca) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Andrologia. 2002;34:367-95.
36. Forest CP, Padma-Nathan H, Liker HR. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. Int J Impot Res. 2007 Jun 14. [Epub ahead of print]
Last reviewed April 2009 by EBSCO CAM Review Board
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.