All hormone determinations were performed by radioimmunoassay using kits provided by commercial suppliers. All blood samples were drawn between 8 am and 1 pm, quickly spun down, frozen, and then stored. All determinations were performed at the same time after the end of the study. The serum LH kit was obtained from Nichols Institute (now Quest; Tarzana, CA, USA) (normal male range, 1.4–11.1 mIU/ml). The serum free testosterone kit was obtained from Diagnostic Products Corporation (DPC, Los Angeles, USA) (normal male range, 15–40 pg/ml). The serum cortisol kit was bought from DPC (normal morning range, 10–24 mcg/dl; normal afternoon range, 5–12 mcg/dl). The serum dehydroepiandrosterone sulfate kit was obtained from DPC (normal range, 150–350 mcg/dl from adolescence to the peak at age 50 y, with a progressive decrease with advancing years).

The lack of strong scientific proof that vitamin supplementation can improve erectile function doesn’t stop companies from selling vitamins, herbal supplements, and other products with the promise that they will do the job. ED is often treatable with prescription medications or medical procedures, so be careful not to get taken by a manufacturer’s empty promises.

Several studies (15–17) have shown an inverse relationship between physical activity levels and biomarkers of inflammation in both the healthy individuals and subjects with cardiovascular condition. Studies (18–21) have also reported the role of exercise in the management of erectile dysfunction. The majority of these studies are subjective, retrospective case series and non randomized non controlled studies. However, randomized controlled trials (RCTs) are generally accepted as the most valid method for determining the efficacy of a therapeutic intervention, because the biases associated with other experimental designs can be avoided (22). Therefore, the purpose of the present Meta analysis study was to determine the role and effect of aerobic exercise in the management of erectile dysfunction in randomized controlled trials.
Using the protocol of a clinical randomized placebo-controlled parallel-group trial, the study also took place at the University of Hong Kong. One hundred sixty male patients with ED and dyslipidemia were randomized into two groups receiving either up to 1,500 mg of oral niacin daily or placebo for 12 weeks. Using questions from the International Index of Erectile Function (IIEF, particularly questions Q3 and Q4), the primary outcome was improvement in erectile function. Q3 ranked “frequency of penetration,” while Q4 ranked “frequency of maintained erections after penetration.” Other outcome measurements included the total IIEF score, IIEF-erectile function domain, and Sexual Health Inventory for Men (SHIM) score.
The results, published earlier this month, show that the 80 men in the study with moderate or severe erectile dysfunction (ED) and high cholesterol reported an improvement in their ability to maintain an erection after supplementing their diet with niacin. The 80 men who took a placebo pill, who also began the study with only mild ED, did not experience a change in their symptoms, the researchers said.
If you bike a lot and have a very narrow saddle on your bicycle, consider switching to a "no-nose seat" which is wider at the back than a conventional saddle, allowing more of your weight to be distributed to the sitting bones. Make sure the seat is level or angled slightly downward and at a height that allows your knee to be just slightly bent at the bottom of the pedal cycle. Raising the handlebars on your bike so that you're sitting upright may also help.
There’s evidence to show that Yohimbine may have some small effect in helping aid weight loss. In 1991, there was a study of 20 overweight women on diet of 1,000 calories per day. Each was given 20 mg of Yohimbine a day, and lost 3 pounds more than those who weren’t taking any. Any weight loss drug should, however, always be taken alongside a healthy diet and exercise.
Niacin -- with or without the addition of drugs to treat impotence -- poses serious health risks, including stomach ulcers and liver damage. If you have Type 2 diabetes, taking niacin could cause drastic elevations in your blood sugar levels. Less serious side effects include stomach upset and skin flushes -- your face and chest turn red and your skin itches, tingles or burns. You can purchase niacin without a prescription, but some over-the-counter formulas -- no-flush varieties that contain niacinamide -- will unlikely help lower your cholesterol.
Where it comes from: Yohimbe is derived from the bark of a west African evergreen tree. Yohimbine is an active chemical (an alkaloid) found in said bark and is cultivated into supplement form. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States. These terms are all related but are interchangeable.
Talk with your doctor about going to a counselor if psychological or emotional issues are affecting your ED. A counselor can teach you how to lower your anxiety or stress related to sex. Your counselor may suggest that you bring your partner to counseling sessions to learn how to support you. As you work on relieving your anxiety or stress, a doctor can focus on treating the physical causes of ED.
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
Dr. Niket Sonpal is the Associate Program Director of the Internal Medicine Residency at Brookdale Hospital Medical Center in Brooklyn and an Associate Professor at Touro College of Osteopathic Medicine. He's a practicing Gastroenterologist and Hepatologist with a focus on Men's and Women's Health, and a regular contributor to Women's health, Shape and Prevention Magazine.
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Besides that, dyslipidemia (and hypercholesterolemia in particular), remain undertreated in many patients diagnosed with coronary artery disease. High triglycerides, a contributor to cardiovascular dysfunction by many but not all studies, are somewhat treatable with fibrates, yet there are significant limitations for their use. Elevated fasting triglyceride levels have been shown to be a strong risk factor for ischemic heart disease, independent of other known risk factors for atherosclerosis.

Ginkgo biloba. Ginkgo is an herb that is used in Chinese medicine that’s thought to improve blood flow. "Any ED treatment that improves blood flow may help," explains Dr. Harris. "An erection is just blood in and blood out." However, the evidence that ginkgo can improve blood flow in ED is limited, and most experts say the jury is still out. In addition, ginkgo can increase the risk for bleeding problems if combined with certain medications, such as warfarin (Coumadin).
Various hormone levels were monitored during therapy, and it did not appear that there were major changes in the group as a whole (Table 2). Cortisol levels rose significantly from baseline to the first dose of yohimbine. When the hormone levels were evaluated in responders vs nonresponders (Table 3), slight differences were noted. Free testosterone levels were higher at baseline in the responders but did not increase significantly with the higher doses of yohimbine. Dehydroepiandrosterone sulfate levels were not significantly higher at baseline in the responders, and they did not change with the higher dose of yohimbine. Cortisol levels appeared to increase in both groups with increased doses of yohimbine, significantly more so in responders than in nonresponders (P=0.03).
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

Shape up. ED is often linked with restricted blood flow to the penis. Keep your heart and arteries in good condition by maintaining a healthy weight, and following a diet high in fruits, vegetables and whole grains. Avoid saturated fats and trans-fats. Regular aerobic exercise can improve blood flow to the genitals and reduce the stress that can contribute to ED.


Saw palmetto. Saw palmetto comes from the fruit of a small palm tree. It has been used to treat symptoms in men with an enlarged prostate gland, such as difficulty urinating, and it has been recommended to treat ED caused by an enlarged prostate. However, several recent clinical trials did not show that saw palmetto works any better on an enlarged prostate than a placebo does. "There is no evidence that saw palmetto should be used to treat erectile dysfunction," says Dr. Gilbert. Like ginkgo biloba, saw palmetto can interact with some prescription medications.

A study from 1990 (eight years before Viagra was introduced) found that sedentary but otherwise healthy middle-aged men who started an intense aerobic exercise program reported higher levels of sexual intimacy, and more reliable sexual function. Men in the study who started a walking program also experienced improvements, though not as dramatic. But the bottom line is, improved physical fitness often improves sexual functioning and satisfaction. Here are 5 exercises that can help with erectile dysfunction.
Because the study included only subjects with dyslipidemia, the results may not be applicable to those with ED who have a normal serum lipid profile. Furthermore, patients using aspirin or NSAIDs were excluded to avoid the effect of these drugs in inhibiting prostaglandin D production, which may be one of the potential mechanisms for the effects of niacin on ED. It should be noted that it is quite common for ED patients to have coexisting cardiovascular disease that requires the use of aspirin. Therefore, further study on the interaction of aspirin and niacin in ED patients may be needed to establish the role of niacin in clinical usage.

Yohimbe is an herbal remedy that comes from the bark of an African tree, Pausinystalia yohimbe. Before Viagra, drugs containing yohimbine hydrochloride, the active ingredient in yohimbe bark extract, were used to treat erectile dysfunction (ED). However, levels of yohimbine in yohimbe bark extract vary considerably and are often very low. Yohimbe bark extract, by itself, never has been shown to work as effectively as drugs containing yohimbine hydrochloride. What’s more, yohimbe can have serious side effects including paralysis, fatigue, stomach disorders, even death. I don’t recommend it, and harvesting of its bark is driving the yohimbe species to extinction.
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.
Yes, niacin is good for erectile dysfunction. Vitamin B3 or Niacin acts as a powerful agent to improve the condition of erectile dysfunction and a research study conducted in a medical center of Hong Kong confirmed that Niacin supplementation has resulted in the increase of blood flow across the pelvic region in men. In addition, researchers have further confirmed that the Vitamin comes with the ability to unclog various harmful fats collected in the artery region.
Studies of mixed organic causes for erectile dysfunction showed varied results;15,16 thus, certain guidelines recommended that it not be used to treat erectile dysfunction.17 Side effects occurred when a high dose was given.18 Patients with organic erectile dysfunction had mixed results, with positive effects in 26,19 33,20 3421 and 43%,22 respectively. The results were better when the dose was doubled.20,21 Several meta-analyses showed a slight positive effect of yohimbine compared with placebo.23,24
Yohimbine significantly increased subjective measurements of sexual desire, sexual satisfaction, frequency of sexual contacts, and erection quality during sexual intercourse. Each subject also underwent a sleep study and researchers found that yohimbine also objectively increased the rigidity of erections while sleeping. [12] Yohimbine appears to alleviate both physical and psychological symptoms associated with ED.
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.
Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), dextromethorphan, donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.
Consequently, this negatively affects sexual function. Finally, if you frequently suffer from stress, then Vitamin B2 deficiency surely takes place. And the symptoms of this deficiency include peeling lips, cracked lips, stomatitis, tongue inflammation, skin lesions resembling eczema, conjunctivitis, photophobia, lacrimation, and decrement in visual acuity.
Depending on dosage, yohimbine can either increase or decrease blood pressure Small doses can increase blood pressure. Higher doses can lead to a potentially dangerous drop in blood pressure. Higher doses of oral yohimbine may have numerous side effects, such as rapid heart rate, overstimulation, unusual blood pressure, cold sweating, and insomnia.
In addition to lowering low-density and total cholesterol along with triglycerides, increasing high-density lipoprotein cholesterol (HDL-C) has become one of the principal objectives for treating hyperlipidemia. Considerable evidence has shown that even a minor improvement in HDL-C levels may significantly reduce cardiovascular risk. For example, it has been found that an increase of 1 mg/dl in HDL-C levels results in a parallel reduction in coronary artery disease risk by 2% in men and 3% in women. Moreover, HDL-C helps to transport oxidized cholesterol from peripheral tissues where it instigates atherosclerosis to the liver for excretion. Furthermore, HDL-C has potential anti-inflammatory, anti-thrombotic and anti-oxidant effects.

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.
If you can't take one of these oral medications, your physician may have you try Caverject (alprostadil for injection), a hormone that you inject into your penis using a fine needle, or Muse (alprostadil urogenital), a tiny suppository that you insert into the tip of the penis. Both of these will bring on an erection within five to 15 minutes without sexual stimulation.
Does diabetes cause erectile dysfunction? Diabetes can lead to lower levels of testosterone, and this can result in erectile dysfunction. Controlling blood sugar levels, maintaining a healthy weight, getting exercise, and reducing stress are all ways of reducing this problem. Hormone therapy, Viagra, and counseling are some ways that medicine can help. Read now
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
However, the case is entirely different for Niacin, as it is not only relatively more convenient, but also it allows men to enjoy sex any time when they want even when they take Niacin for only one time in a day for erectile dysfunction. Niacin formulates in the form of various slow-release pills designed primarily to seep in a slow way within the human bloodstream during the course of one day.
Motivated by philosophers that included John Locke (the most influential of Enlightenment thinkers), Voltaire, Newton, and Leibniz, ruling princes throughout Europe endorsed and fostered the intelligentsia of the Enlightenment. Some of these rulers even attempted to apply the ideas of the enlightenment to government. When grasped by “natural aristocrats,” the Enlightenment was particularly successful in America where it influenced Benjamin Franklin and Thomas Jefferson, among many others, and fueled the fires that led to the American Revolution, the Declaration of Independence, and the creation of the United States.
The positive response in our patients was enhanced with the higher dose of yohimbine, a phenomenon noted previously.20,21 We agree that several weeks of therapy are needed before clinical effects are seen,21,22 and that some responders may be able to take yohimbine only on demand before sexual activity.39 Yohimbine is effective in a subset of men with organic erectile dysfunction, especially nonsmokers, and it deserves a place in our therapeutic armamentarium. When yohimbine is ineffective alone, it may be useful in combination with other treatment modalities, as has been shown with naloxone39 or trazodone.40
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.

There’s much evidence to suggest that Yohimbine does have a positive effect in men who have erectile dysfunction. Initially, it was considered a failure as a treatment because it doesn’t increase levels of testosterone in the body, the hormone needed for erections. However, recent trials have shown that it works well to increase arousal, help blood flow to the penis, and as a general stimulant.

3. Men With Bad Lipid Readings.  One study examined men with both erectile dysfunction and "dyslipidemia."  Dyslipidemia is medical speak for bad HDL, LDL, triglyceride or some combination of the three.  They gave these men 1.5 grams of niacin, which is a megadosed amount, and is a favorite of Dr. Davis.  (See my  Review of Track Your Plaque for Dr. Davis' approach to plaque regression.) Besides the above listed benefits, niacin will also a) lower triglycerides, b) boost HDL, c) increase particle size and d) decrease LDL particle counts.  All of these are very anti-atherosclerosis and great for your arteries. 

Obesity is a state of chronic oxidative stress and inflammation (38). The increased oxidative stress associated with obesity may increase free radical formation, which could quench and deactivate nitric oxide, reducing its availability for target cells. Weight loss programs with dietary modifications and increased physical activity may lead to reduced oxidative stress associated with improved nitric oxide availability (39). As impaired nitric oxide activity appears to play an important role in the pathogenesis of erectile dysfunction (40), improved nitric oxide availability associated with weight loss may be implicated in the amelioration of erectile function in our series of obese men. A reduced CRP level due to sustained lifestyle changes may have contributed to amelioration of erectile function after treatment. Levels of CRP correlate significantly with reduced nitric oxide availability (41) and increasing severity of penile vascular disease as measured by penile Doppler (42). Moreover, consistent findings support a predictive role of CRP and IL-6 for cardiovascular events in different populations (43), while IL-8 is a potent chemoattractant (44).
The HSE recommends that adults should complete 30 minutes of moderate intensity activity such as brisk walking or gentle cycling at least five days a week. If you’re new to exercising this is a good place to start – particularly if you are in poor health or are overweight. The longer you keep up your exercise plan, the more activity you can add to it; just remember not to put too much strain on yourself too early. For more help, here’s our guide to starting out.
We studied the involvement of zinc in the sexual behavioral response of male rats. The study design employed a rat model to predict the human sexual response to elemental zinc supplementation. Rats were used because they are very social and copulate under a variety of circumstances, regardless of the presence of a human experimenter. They are practical (small and easy to handle) and certain tissues and neuroendocrine systems are strikingly similar to humans.[13]
Aside from pelvic floor exercises, it has been found out that aerobic exercises also work in treating erectile dysfunction. This condition is often caused by problems related to blood flow to the penis. Diabetes, obesity, vascular disease as well as high cholesterol may affect blood flow. This results to erectile dysfunction. By adding some aerobic exercises to your routine, you can significantly enhance your overall male sexual health and may even remove the problem totally in the long run.
Size matters, so get slim and stay slim. A trim waistline is one good defense — a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist. Losing weight can help fight erectile dysfunction, so getting to a healthy weight and staying there is another good strategy for avoiding or fixing ED. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat interferes with several hormones that may be part of the problem as well.

Weak erection is one of the most embarrassing problems in this world because i was always shy to meet new partners due to the fact that i already know that i cannot perform at all and even when i did i was so weak. I could only last 45 seconds and this this made me to ask myself many a times if i am a man, four of my girlfriends left me due to this problem. In my search for a cure and a solution i told an old friend all i have been facing and he told me about Dr. MACK how he helped him save his marriage using his very effective ED medicine which restored back his erection. I contacted him and he sent me the medicine and that is one of the best decision i have ever made in my entire life. I think this will help someone out there if you have any ED related problem do not hesitate to contact [email protected] com i know he can help you.
Supplementation of 5 mg of zinc/day for two weeks led to a prolongation of ejaculatory latency; 711.6 sec. (SEM 85.47) vs. 489.50 sec. (SEM 67.66), P < 0.05 and an increase in number of penile thrusting; 52.80 (SEM 11.28) vs. 26.50 (SEM 6.17), P < 0.05, compared to controls. The same group had elevated prolactin (PRL) and testosterone (T) levels compared to controls at the end of treatment period; PRL- 7.22 ng/dl (SEM 3.68) vs. 2.90 ng/dl (SEM 0.34) and T- 8.21 ng/ml (SEM 6.09) vs. 2.39 ng/ml (SEM 1.79), P < 0.05. In contrast, reduction of libido was evident in the same group, but this effect was not statistically significant (P > 0.05). However, partner preference index was positive and 5 mg zinc supplementation did not exert a significant adverse effect on the muscle strength and co-ordination. The subset of rats supplemented with 1 mg/day did not show a difference from the control group while supplementation with 10 mg/day led to a reduction of the libido index, number of mounts and intromissions.
Clinically I have seen these results in doses of just 20 mg twice daily.   It is important to note that prolonged zinc supplementation can lead to lowered copper levels so it is not advisable to continue this therapy unless it is in a cyclical nature.  For those on long term zinc there are combination products with Zinc and Copper.   In cases where some prescriptions that lower zinc are given, like acid lowering meds, thiazide diuretics and ACE inhibitors, or in renal dialysis patients, this chronic monitoring of zinc may lead to longer term supplementation.
Between 2001–2006, one-third of the US population had insufficient amounts of vitamin D, according to the Institute of Medicine. Risk factors for vitamin D deficiency include obesity and high BMI, not enough sun exposure or outdoor activity, having darker skin and suffering from certain from inflammatory conditions like Crohn’s disease. You can get a blood test to find out if you’re vitamin D deficient.
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