In the statistical analysis, the difference between the pre-test and post-test values (changed score) for IIEF score was computed. Student t-test was used to compare the mean changed score values of IIEF. All statistical analysis was performed on an IBM compatible micro computer using SPSS for window version 15.0, (Chicago IL, USA). The probability level for all the above tests was set at 0.05 to indicate significance.
Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.
In male rats, main olfactory epithelium (MOE) exerts an important role in regulating sexual behavior. Intranasal irrigation with zinc sulphate has been reported to destroy the MOE and completely abolish the sex behavior.[6] In this study supplementation of zinc was done using a feeding tube and precautions were taken to avoid contacting nasal area. Hence the possibility of reducing sexual performance due to MOE disturbance is ruled out. Some humans experience gastrointestinal irritation with supplementation of zinc.[23] If the same is applicable to animals it may be another possible explanation for the reduction of libido index with elevated doses of zinc. One drawback of our study is that we did not compare the weight of animals before and after treatment.
Antioxidants  boost nitric oxide production and prevent NO breakdown. Ascorbic acid has direct effects on the bioactivity of NO, and augments NO production in a variety of body processes. The effects are actually synergistic with Vitamin E. Both vitamins are not usually measured, and a reasonable dose of Vitamin C is 500 to 1,000 mg daily. Vitamin E supplementation should be limited to <400 IU per day because of potential adverse long-term health effects of higher doses.
Shindel, A. W., Xin, Z.-C., Lin, G., Fandel, T. M., Huang, Y.-C., Banie, L., … Lue, T. F. (2010, February 5). Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. The Journal of Sexual Medicine, 7(4), 1518-1528. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2009.01699.x/full
Most human studies completed thus-far examine the impact of oral yohimbine consumption on erectile dysfunction (ED) in males. A meta-analysis of seven randomized, placebo-controlled trials found that yohimbine is significantly more effective in treating ED compared to placebo. [11] These findings did not compare yohimbine to prescription medications like Viagra®, which are designed to treat ED.
In the 1700s, pellagra was an endemic disease in northern Italy—which had not been known until maize (corn) was introduced from America. Italy gave the disease the name, “pelle agra” (pelle means skin; agra means rough). Casal had observed that patients with pellagra were all poor, subsisted mainly on maize, and rarely ate fresh meat. Because pellagra outbreaks occurred in regions of Europe where maize was a dominant food crop, the belief was that maize either carried a toxic substance or was a carrier of disease. When it was later noted that there were few pellagra outbreaks in Mesoamerica, where maize is a major food crop (and is processed), it was considered that the causes of pellagra may be due to factors other than toxins.

In fact, dyslipidemia is commonly found in ED patients, and studies show that statins can help to improve the response of PDE5 inhibitors in those suffering from ED precisely because they improve atherosclerosis. Consequently, statins can be used as a treatment in patients with an unsatisfactory response to PDE5 inhibitors, yet there are problems with statins too, among them raised liver enzymes and muscle problems, some of which can be quite serious and even deadly (rhabdomylosis).


Kegel exercises benefits a lot of men. In particular, they also help in strengthening the bulbocavernosus muscle. This very important muscle performs three types of roles. One it allows the penis to grow and be engorged with blood during erection. Second, it pumps while ejaculation, and third, it helps in emptying the urethra right after urination.
L-arginine. L-arginine is an important amino acid that the body needs to build proteins. Because L-arginine has been shown to improve blood flow, some alternative practitioners have recommended that the supplements be used to treat ED. The Natural Medicines Comprehensive Database, which is a reliable authority on alternative medicines, says L-arginine is possibly effective for treating erectile dysfunction. But Harris warns that "although this supplement could improve blood flow, side effects can be dangerous." L-arginine can cause an allergic reaction or worsen asthma in some people; it can also lower blood pressure.

But researchers emphasize that immediate-release niacin should remain as a treatment option for high cholesterol. "The point of our study is not that niacin should be avoided, but that the immediate-release preparation is the preferred form, and that medical supervision and evaluation are necessary for people taking this drug," said James McKenney, professor and chairman of the division of clinical pharmacy at the Medical College of Virginia.
Erectile dysfunction supplements and other natural remedies have long been used in Chinese, African and other cultures. But unlike prescription medications for erectile dysfunction, such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), tadalafil (Cialis, Adcirca) and avanafil (Stendra), erectile dysfunction herbs and supplements haven't been well-studied or tested. Some can cause side effects or interact with other medications. And the amount of the active ingredient can vary greatly from product to product.
Move a muscle, but we're not talking about your biceps. A strong pelvic floor enhances rigidity during erections and helps keep blood from leaving the penis by pressing on a key vein. In a British trial, three months of twice-daily sets of Kegel exercises (which strengthen these muscles), combined with biofeedback and advice on lifestyle changes — quitting smoking, losing weight, limiting alcohol — worked far better than just advice on lifestyle changes.

Aids in fat loss: Yohimbe and other alkaloids in the bark extract are said to block specific receptors that actually inhibit fat loss. A three-week study in 1991 observed 20 obese females on 1,000-calorie diets. They were given 20 mg of yohimbe each day and lost three pounds more than the group receiving placebos. Not a drastic weight loss, but enough to give experts hope that yohimbe can help with weight loss. Other studies have found that yohimbe increases the amount of non-esterified fatty acids, a result of fat breaking down. More research is needed. Most other studies in the field are done using the drug yohimbine. Extracted chemicals are not the same as yohimbe bark. Studies with yohimbine are expected to give different results than studies that used the raw plant.


Reduction of the libido index was the major disadvantage that we observed with zinc supplementation. Substances that affect libido usually act centrally and may reduce desire by causing sedation or hormonal disturbances.[17] The role of elevated levels of PRL in serum as an inhibitor of sexual drive and gonadal function is well established.[18] This reduction of sex drive may occur through the modification of activity of dopaminergic neurons in the CNS that are regarded as controlling sexual motivation and function.[19] Our study demonstrated a significant increase of serum PRL level (2.9 to 7.22 ng/dl) within two weeks of supplementation of zinc (5 mg/day). This is a possible explanation for the reduced libido with increasing doses of zinc observed in this study.
"The good news is, our study also found that a large proportion of men were naturally overcoming erectile dysfunction issues. The remission rate of those with erectile dysfunction was 29%, which is very high. This shows that many of these factors affecting men are modifiable, offering them an opportunity to do something about their condition," Professor Wittert says.
It’s best to take yohimbe when fasting, first thing in the morning, or between meals. Because it has stimulating effects, don’t combine yohimbe with other stimulants like caffeine or weight loss pills. These may cause reactions like faster heart rate, anxiety, high blood pressure or even cardiovascular complications. If you are planning on having caffeine along wth yohimbe (such as coffee or tea in the morning),  start with a half-dose in order to test your reaction.
This African tree bark extract sends blood flow to the genitals, said herbalist Ed Smith, a founding member of the American Herbalists Guild, who adds a warning that Yohimbe can cause nervousness and raise already-existing high blood pressure (so avoid taking it if you have heart or kidney disease), and can also negatively interact with antidepressants.
There are so many potential reasons a man might develop erectile dysfunction (ED), it's nearly impossible to generalize the best ways to treat it. What works for one man may not work for another simply because they are having problems for different reasons. That said, it may encouraging to hear that there are a variety of options that may be considered, from psychological counseling to lifestyle changes, medications to treatments and devices.

These medications don’t work for everyone but they are easy to use and work for around 60% of people who try them. They work by making it easier to get an erection by reducing the effect of (inhibiting) the chemical PDE-5. This chemical is used in the body to make sure there isn’t too much blood in the penis during an erection, but if you have erectile dysfunction then this chemical ends up over-compensating.
Green vegetables, legumes, seeds, nuts and brown rice are among the best sources of dietary magnesium. Most other foods don’t contain enough of the mineral to contribute to daily recommended levels, which is why many people choose to take a magnesium supplement or a daily multivitamin that contains magnesium. If you’re concerned about your overall magnesium level, particularly as it relates to erectile function, discuss supplement options and dietary changes with your doctor.
So what causes erectile dysfunction?  Sometimes it is a circulation problem.  Sometimes it is a low testosterone issue.  Sometimes it is not.  Testosterone (T) supplementation can help ED and low libido in cases of low T and even if there is a normal T level at baseline, ED can be helped.  In cases where thyroid under or overactivity is causing T levels to be less than optimal.  Aging is also a problem as T levels drop after mid 20’s and as adipose tissue increases and aromatase enzyme conversion of T to Estrogen correspondingly increases.  This causes an unfavorable E:T ratio which equates to low T.
Although not direct proof of cause and effect, the positive results that we report in half of the men in the current study may reinforce our clinical observation with objective RigiScan™ data that use of yohimbine might be associated with better effects in nonsmokers. We30 reported that cessation of smoking may rapidly improve nocturnal erectile activity and found that nicotine was not the noxious agent in our study. We postulated that carbon monoxide might create a hypoxic environment in the penis. This effect probably was mediated through restoration of nitric oxide activity.31
Testosterone levels did not differ statistically in the treatment groups and did not change during treatment with yohimbine. The levels of dehydroepiandrosterone and free testosterone tended to be higher in the responder group, but the levels in both groups were well into the age-adjusted normal ranges. Androgens play a part in peripheral erectile activity, but they are not necessary for the central arousal stimulation of yohimbine,36 in which norepinephrine release acts as an inhibitor antagonist.2 Peripheral sympathetic stimulation also occurs37 but less than its adrenergic antagonistic activity. These peripheral effects are prompting the search for new alpha-2 adrenergic antagonists38
All of these medicines work by relaxing smooth muscles and increasing blood flow in the penis during sexual stimulation. You should not take any of these medicines to treat ED if you are taking nitrates to treat a heart condition. Nitrates widen and relax your blood vessels. The combination can lead to a sudden drop in blood pressure, which may cause you to become faint or dizzy, or fall, leading to possible injuries.
Moreover, it has a positive effect on the nervous system, liver, skin, and mucous membranes, as well as keeps skin, nails, and hair healthy. And of course, what is important for men, erectile dysfunction treatment with vitamin B2 relieves symptoms of the most hateful male disease. Moreover, this vitamin is well-known as a supplier of sexual energy and vitality.
The number of animals ejaculating within 15 minutes was significantly reduced in 5 mg zinc treated group (one out of eight). However, all intromitted rats ejaculated between 20-30 minutes when observation was continued. Ejaculatory latency was significantly high in this group compared to controls; 711.60 Sec (SEM 85.47) vs. 489.50 Sec (SEM 67.66), P < 0.05. Similarly, they showed a significantly higher frequency of penile thrusting compared to controls; 26.50 (SEM 6.17) vs. 52.80 (SEM 11.28), P < 0.05 [Table 1].
The improvements in IIEF-erectile function domain (IIEF-EF) score for moderate and severe ED patients in the niacin group were 3.31 and 5.28 and in the placebo group were 2.74 and 2.65, respectively. In the lower range of mild and mild-to-moderate ED, there was no significant improvement in erectile function. Of the 160 patients in the study, 32 were using statins; 18 in the niacin group and 14 in the placebo group. For patients not receiving statin treatment, there was a significant improvement in IIEF-Q3 scores (0.47) for the niacin group, but not for the placebo group. To summarize, niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia.

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