We have presented objective evidence that yohimbine has a positive effect in men with organic erectile dysfunction. This is contrary to the blanket statement of the American Urological Association in their clinical guidelines for erectile dysfunction, which states: ‘Based on the data to date, yohimbine does not appear to be effective for erectile dysfunction and, thus, it should not be recommended as treatment for the standard patient.’17 Our data strongly suggest that yohimbine treatment should be revisited. Our study was observational with dose-escalation just to see if there was any rationale to expect any effect in men with organic erectile dysfunction, especially in men who do not have the risk factor of tobacco abuse. The next step would be a double-blind, placebo-controlled study using yohimbine in smokers vs non-smokers to verify the current observation. We believe that our data justify such a trial. Yohimbine will never be a first-line drug for erectile dysfunction, but may be useful in subsets of men with mild disease or few risk factors. Yohimbine might also be useful in combination therapy with other treatment modalities such as sildenafil and intraurethral alprostadil, when they do not produce adequate effects alone, as has already been shown with naloxone39 or trazedone.40
Those consuming yohimbine lost nearly 30% more fat and experienced 31% greater reductions in body fat percentage compared to those in the placebo group. Neither group reported negative side effects from a twice-daily dosing of 10mg of Yohimbine HCL. These findings indicate that the powerful fat loss effects of yohimbine apply to even the most seasoned athletes with already low levels of body fat.
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.
For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.
Usually there will not be a specific treatment that will lead to the improvement of erectile dysfunction. However, there are treatments that will allow erections to happen and can be used to allow sexual activity to take place. There are three main types of treatments: non-invasive treatments such as tablet medicines and external devices (e.g. vacuum device); penile injections; or for men who have not had success with other treatments, surgery may be an option.
Clinical trials were included if they met all of the following inclusion criteria: study population defined; Men with arteriogenic ED were considered; the present review was concerned with studies that used aerobic exercise on ED; only randomized controlled trials on this topic were selected for review; The main outcome measure was satisfactory intercourse without additional therapy using the International Index of Erectile Dysfunction (IIED) scores. The present review utilized studies that had successfully undergone rigorous peer review (i.e., published peerreviewed journals), were included.

Many men experience E.D. According to UW Health, “Mild and moderate erectile dysfunction affects approximately 10 percent of men per decade of life (i.e., 50 percent of men in their 50s, 60 percent of men in their 60s).” And if you think erectile dysfunction is only a problem for older men, think again. As reported by The Greatist, a 2014 study found a quarter of patients newly diagnosed with E.D. were under 40. Of these men, almost half were experiencing severe E.D., meaning they were unable to get or maintain an erection during sex. If this is happening to you, before ordering Viagra online, check in with your primary care practitioner. It could be an early warning sign of atherosclerosis, so it’s worth getting a full evaluation before simply throwing medications at the problem.
There is no evidence that mild or even moderate alcohol consumption is bad for erectile function, says Ira Sharlip, MD, a urology professor at the University of California San Francisco School of Medicine. But chronic heavy drinking can cause liver damage, nerve damage, and other conditions -- such as interfering with the normal balance of male sex hormone levels -- that can lead to ED.
A 2011 study of 160 men with moderate or severe erectile dysfunction divided the group in two—80 men were given niacin supplements, and 80 a placebo. The group given niacin reported improved ability to “maintain an erection versus the control group.” It’s not exhaustive research, but still promising. The best part about niacin is that it’s naturally found in foods like turkey, avocado, and peanuts (yum). If you’re not a turkey sandwich fan, you can supplement with a vitamin B complex.
Usually there will not be a specific treatment that will lead to the improvement of erectile dysfunction. However, there are treatments that will allow erections to happen and can be used to allow sexual activity to take place. There are three main types of treatments: non-invasive treatments such as tablet medicines and external devices (e.g. vacuum device); penile injections; or for men who have not had success with other treatments, surgery may be an option.
Dealing with erection problems can be a challenge. However, there are lots of treatments and lifestyle changes which can help. While medications such as Viagra improve symptoms in the short term, pelvic floor exercises can help you improve your sexual function in the long term. Find out why pelvic floor, also known as Kegel exercises, can be used to treat ED and how to perform the exercises correctly.

Thank you for posting this. The exact same thing happened to me, My Dr. recommended Niacin to reduce LDL and increase HDL. Trouble is I noticed my sex life really dropped quickly. Very rare to get and maintain an erection. I couldn't quite tell but it seemed to me the problems started a couple of weeks after I began the Niacin. Out of desperation I quit Niacin to see what would happen and suddenly the full and regular erectiions came back. Everything I read says the effect should be the opposite. Now I have to decide do a die earlier of heart disease and have more sex or better cholesterol control with a diminished and almost non-existent sex life. Pretty sure I'm gonna favor the sex life!


• Eliminate your bad habits: Bad lifestyle habits may take a toll on your body, making it harder for you to maintain your athletic performance, regulate your weight or treat sexual dysfunction. To keep your body in its best condition, quit your bad habits immediately — eliminate smoking, avoid excessive alcohol intake and cut down your late-night meals.
The researchers reasoned from other studies that when the degree of endothelial dysfunction and atherosclerosis are more severe, the effects of niacin and statins as lipid-lowering agents are also more apparent. Their current study seemed to bear this out. Also, in another study assessing the effect of a PDE5 inhibitor in patients using a statin, patients with higher baseline serum LDL-C had better improvement in erectile function after the use of a PDE5 inhibitor. This supports the researchers’ hypothesis that patients with potentially more serious endothelial dysfunction, such as those with higher LDL-C levels, may have better response to the combination usage of a PDE5 inhibitor and niacin.

Often when we start to look outside of mainstream medicine for alternative protocols to heal our health issues we replace one pill-taking protocol with another. The prescription drugs are replaced with a long list of supplements. Supplements alone, without any other lifestyle changes, will have some impact, but it will be nowhere near what they can achieve when working in a body supported with a healthy way of life.
Yohimbe A number of clinical trials have shown that the primary component of this bark from an African tree can improve sexual dysfunction associated with selective-serotonin reuptake inhibitors (SSRIs) used to treat depression. This herb has been linked to a number of side effects, including increased blood pressure, fast or irregular heartbeat, and anxiety. Yohimbe shouldn't be used without a doctor's supervision.
Just because a product claims to be natural doesn't mean it's safe. Many herbal remedies and dietary supplements can cause side effects and dangerous interactions when taken with certain medications. Talk to your doctor before you try an alternative treatment for erectile dysfunction — especially if you're taking medications or you have a chronic health problem such as heart disease or diabetes.
A double-blind, partial crossover study on the therapeutic effect of yohimbine hydrochloride on erectile dysfunction was done in 82 sexually impotent patients. All patients underwent a multifactorial evaluation, including determination of penile brachial blood pressure index, cavernosography, sacral evoked response, testosterone and prolactin determination, Derogatis sexual dysfunction inventory and daytime arousal test. After 1 month of treatment with a maximum of 42.0 mg. oral yohimbine hydrochloride daily 14 per cent of the patients experienced restoration of full and sustained erections, 20 per cent reported a partial response to the therapy and 65 per cent reported no improvement. Three patients reported a positive placebo effect. Maximum effect takes 2 to 3 weeks to manifest itself. Yohimbine was active in some patients with arterial insufficiency and a unilateral sacral reflex arc lesion, and in 1 with low serum testosterone levels. The 34 per cent response is encouraging, particularly in a Veterans Administration population presenting with a high incidence of diabetes and vascular pathological conditions not found in regular office patients. Only few and benign side effects were recorded, which makes this medication worth an attempt, often as a first line of treatment even at a dose of 8 tablets.

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.
Besides, niacin’s beneficial effects became more evident when the Hong Kong study researchers excluded those already using statin therapy. If there is an overlapping effect of these two groups of lipid-lowering agents on endothelial function, this would make sense. Also, chronic statin use could lessen the effect of niacin on endothelial function and hence affect improvement in erectile function.
While the rationale behind why it would work is airtight, the research on arginine’s actual effect on erectile dysfunction is slim, points out Charles Walker, M.D., assistant professor of urology and cofounder of the Cardiovascular and Sexual Health clinic at Yale University. But given its solid safety profile, minimal side effects, and potential benefit on heart disease, it’s worth a try, he adds, especially when taken in conjunction with other herbs on this list, which studies have shown can be more effective.
In conceiving the potential solutions to issues around erectile dysfunction, it’s really helpful to understand clearly how an erection is achieved and completed. To achieve an erection, there needs to be some form of stimulation, either from touch or some sort of audiovisual stimuli.  Once the stimulation occurs, chemical messengers are released and blood starts to fill into the penis. In terms of the musculature, the bulbospongiosus and ischiocavernosus muscles need to be relaxed so blood can fill the area completely. Then the bulbospongiosus needs to contract to keep the blood in the penis. The erection ‘completes’ with the rhythmic contraction of the bulbospongiosus muscle.
Call this the Marvin Gaye of amino acids: L-arginine converts to nitric oxide (NO), a naturally occuring gas that causes blood vessels to relax and facilitate blood flow, helping you get and stay hard. You can find plenty of the nutrient in oysters, but in supplement form, the Mayo Clinic says that 400-6,000 milligrams is the maximum dose. And these are the best foods for arginine!
Eggs a supplement? Yup. Testosterone is derived from cholesterol, and eggs are the healthiest way to ensure you’re getting enough of the good kind (LDL cholesterol). Plus, eggs are rich in choline, a powerful natural chemical that not only burns fat but can help set your pants afire. Choline triggers the production of nitric oxide (NO), which relaxes arteries in the penis and enables blood flow to do its thing. Choline is a precursor to acetylcholine, a neurotransmitter which controls sexual behavior through its activity in the brain; having a higher level of AcH has been associated with more frequent sex and more intense, longer orgasms. And that’s not all: Check out these things that happen to your body when you eat eggs!
Three of the randomized studies (25–27) that contributed to the present study data indicated the positive role of both interval and continuous aerobic training in the dual management of both ED and cardiovascular disorders (hypertension and ischemic heart disease ,respectively); this is not surprising because of the arterogenic interrelationship between ED and several cardiovascular disorders. The physiological basis for the therapeutic role of continuous exercise in the management of both ED and some cardiovascular disorders as reported in the present study, could be related to the biochemical, neural and hormonal changes in the blood vessel walls that induce an acute and long-term blood vessel relaxation. The blood vessels might relax after each exercise session because of body warming effects; local production of certain chemicals, such lactic acid and NO; decreases in nerve activity; and changes in certain hormones and their receptors (32, 33). Over time, as the exercise is repeated, there appears to be a growing evidence of a prolonged effect. Thus, chronic (regular, longterm) physical training might reduce basal concentrations of inflammatory markers.
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.
Several studies have shown that erectile dysfunction is somehow linked to problems with cardiovascular health — which one comes first has been the question. It makes sense; the penis becomes erect through a complex system of blood vessels and spongy tissue called the corpora cavernosa — this is where the blood gets trapped, causing the erection. When problems arise through this system, whether they’re caused in the brain or through problems with the blood vessels, the penis can’t get erect.
1. Increased Blood Flow in Men with Lower Niacin Levels.  Of course, there is a lot to an erection, but I think just about everyone would agree that the #1 goal is to increase something called endothelial function.  The endothelium is the delicate lining of the arteries that pumps out nitric oxide and relaxes the arteries.  And, of course, a relaxed, i.e. more open artery is one that allows more blood to flow into your arm, your leg or your brain.  And I'm sure I don't need to explain why increased blood flow into your penile arteries is critical for erectile strength.
Aerobic exercises and pelvic floor exercises are two of the best methods to start with. As a matter of fact, you can see improvements on your condition without having to witness the side effects of other male enhancement products. For one, there are certain male enhancement products which should not be taken if you are suffering from other types of medical condition. For instance, if the product contains substances that may react to the male enhancement ingredients of a product, you may suffer from certain consequences.
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.
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.

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


A study in the Journal of Sexual Medicine found that a large percentage of men with ED also have low levels of vitamin D. If you’re experiencing ED, you may want to have your level of vitamin D checked. Other symptoms of a low vitamin D level may be too subtle to notice. However, if you have serious vitamin D deficiency, you may have bone pain or muscle weakness. Vitamin D levels can be checked with a simple blood test and for most people corrected with a supplement.
However, for most men who experience erectile dysfunction, their overall experience can be improved even further through regular exercise. There are many reasons why exercise improves sexual satisfaction. For one thing, regular, sustained exercise can lead to the release of chemicals called endorphins that are responsible for the so-called runner’s high, and which stimulate the release of sex hormones. Exercise also generally improves mood and imparts a sense of calm afterward, with lower heart rate, lower blood pressure, better digestion, and lower levels of stress hormones.
ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.
Alprostadil is injected into the side of penis with a very fine needle. It's of great value to have the first shot in the doctor's office before doing this on your own. Self-injection lessons should be given in your doctor's office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.
Yohimbe is taken by mouth to arouse sexual excitement, for erectile dysfunction (ED), sexual problems caused by medications for depression called selective-serotonin reuptake inhibitors (SSRIs), and general sexual problems in both men and women. It is also used for athletic performance, weight loss, exhaustion, chest pain, high blood pressure, low blood pressure that occurs when standing up, diabetic nerve pain, and for depression along with certain other medications.
Instead of injecting a medicine, some men insert a suppository of alprostadil into the urethra. A suppository is a solid piece of medicine that you insert into your body where it dissolves. A health care professional will prescribe a prefilled applicator for you to insert the pellet about an inch into your urethra. An erection will begin within 8 to 10 minutes and may last 30 to 60 minutes.
Many people experience occasional erectile dysfunction when they're stressed or preoccupied. This is because stress increases levels of the hormone adrenaline, which actually causes blood vessels to contract. As having a firm erection depends upon a strong supply of blood to and within the penis, feeling chronically stressed can lead to repeated bouts of ED.

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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