Response to yohimbine was not dependent on patient age. Patients who showed a positive response had fewer medical risk factors overall, although the small number of patients was not large enough to provide statistical significance. The positive clinical response was verified subjectively both by the formal questionnaire and by the in-office clinical encounter. The positive response was verified objectively by measuring nocturnal penile tumescence and rigidity with the RigiScan™ home monitor. The trend of the baseline penile erectile response was better in the responders, suggesting that use of yohimbine might be more effective in patients who have less severe erectile dysfunction. Some authors have questioned the effect of yohimbine on penile activity, but either inadequate doses of yohimbine were used or only tumescence was measured,21,32 often in an office setting where anxiety and embarrassment might affect results.
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There have been only a few  well-controlled studies to test the effects of herbal yohimbe (as opposed to medications) on humans. There’s some evidence that yohimbine has potential to enhance the nitric oxide pathway, helping to bring blood flow to the corpus cavernosum tissue of the penis. It may also stimulate the pelvic nerve ganglia and boost adrenaline supply to nerve endings. It seems to have the most effects overall when combined with other treatments or herbal remedies. (6) One study that evaluated the effects of yohimbe on ED found that those taking the herbal remedy experienced slight benefits compared to a control group that was not taking the supplement.


Vitamins and minerals are used in systems all over the body. Everywhere from your cardiovascular to your nervous system. It’s a lot to understand. So to help dispel some of the myths and outlandish claims, we’ll take a look at how five common vitamins and nutrients affect one very specific aspect of men’s health—erections. Turns out, vitamins can do more than just ward off the common cold.
Some medical self-help books make niacin sound like a panacea for health-conscious people with rising cholesterol levels and shrinking budgets. Because this B vitamin is cheap and sold over-the-counter at drug and health food stores, people see no reason to check with the doctor before tossing back a handful of pills. What they may not know is that the high doses (1,500-3,000 mg) needed to lower cholesterol levels can cause serious complications. (As a dietary supplement, 10-20 mg is usually recommended). To add to the confusion, niacin comes in two forms: immediate- and sustained-release preparations.

Twenty-one men were screened. Two were rejected because they had normal results on nocturnal penile study, and one man was excluded from the study because of a protocol violation. Eighteen men completed the study. The mean age of the men was 60.2 y (range, 34–69 y). The mean duration of erectile dysfunction was 3.1 y (range, 1–10 y). All men were in stable heterosexual relationships. The listed medical risk factors for erectile dysfunction were hypertension in nine men, atherosclerotic cardiovascular disease in seven, single offending medication in seven (mostly beta-blockers), multiple medications in five, diabetes mellitus in four (one with neuropathy), venous leakage in two, and peripheral vascular insufficiency in one.

Female rats were injected subcutaneously estradiol benzoate 12 μg in olive oil and 0.5 mg progesterone (Sigma chemicals, USA) in olive oil, 48 hrs and six hours prior to introduction to the males.[11] A cervical smear was observed under a light microscope and females in their estrous cycle were included in the study. Observations were performed during the dark phase of the day cycle (19.00 hours) under dim red light. After two hours of the last dose, rats were placed individually in transparent observation cages for 15 minutes adaptation period. A stimulus-receptive female was introduced to each male by gently dropping them in to the observation cage.
Though higher doses of zinc reduce libido, supplementation with a medium dose (5 mg/day) has some beneficial effect on the sexual competence of adult male rats. The major significant effects of this dose of zinc are prolongation of ejaculatory latency without disturbing sexual arousability, motivation, penile erection and sex vigor. Also, the partner preference index of the 5 mg/day group was positive and comparable to the controls. A positive partner preference index is indicative of unchanged sexual interest of males.[16] These results confirmed that libido and sexual interest are not affected by zinc supplementation with a 5 mg/day dose. However, mild reduction in percentage of intromission was observed in this group and it is postulated that this may be situational rather than an effect of supplemented zinc. This is based on our observation where mild rejection by the females at the initial phase of the behavior led some males to refrain from sexual activity.
If you’re experiencing psychological ED, you may benefit from talk therapy. Therapy can help you manage your mental health. You’ll likely work with your therapist over several sessions, and your therapist will address things like major stress or anxiety factors, feelings around sex, or subconscious conflicts that could be affecting your sexual well-being.
This study was designed to test the hypothesis that hydrochlorothiazide a diuretic used to treat hypertension depletes body zinc and thereby cause sexual dysfunction. Serum zinc and sexual dysfunction were measured in 39 middle aged hypertensive men who had been taking hydrochlorothiazide in average daily doses of between 25 and 50 mg daily for at least six months, and a control group of 27 unmedicated middle aged normotensive men. The medicated group had a higher incidence of sexual dysfunction (56 pc) as compared to 11 pc in the control group. The use of hydrochlorothiazide did affect serum zinc levels significantly in 20 patients. Sexual dysfunction occurred more often in older and overweight patients (p < 0.004). Three of the normotensive men experienced sexual dysfunction probably related to old age. Twenty two of the 39 on hydrochlorothiazide and experiencing sexual dysfunction were divided into two groups of 11 patients. Bloods were taken from the 27 normotensive and 22 hypertensive men receiving hydrochlorothiazide for the analyses of zinc. Subsequently one group of the patients were supplemented with zinc 500 mg daily for 30 days while the other group was supplemented with magnesium chloride 1 g daily for 30 days. The normotensive men were not treated. After 30 days, bloods were again taken from the three groups of analyses for zinc and magnesium. Serum zinc was significantly decreased (p < 0.05) by hydrochlorothiazide and a non significant decrease in serum magnesium (p = ns) was observed. After supplementation with zinc, the serum zinc levels returned to normal only in eight patients. There was improvement in the symptoms of sexual dysfunction in five patients. Two patients gained weight. Hydrochlorothiazide decreased serum zinc levels (p < 0.05) and was unchanged with magnesium supplementation but the serum magnesium returned to normal values. Improvement of symptoms of sexual dysfunction was positive in one patient. This study shows that low serum zinc levels may be associated with sexual dysfunction but the definitive role of zinc in the pathogenesis of sexual dysfunction will remain controversial.
E.D. may just be that early warning sign. Erections depend on blood flow, and blood flow depends on nice, wide-open arteries. Atherosclerosis doesn’t just affect the arteries around your heart; if you have plaque build-up, you are likely to have it all around the arterial system — and the penile artery is one of the smallest arteries you have (no matter what you claim about your size). So if you have atherosclerosis, then the plaque there will be one of the first places where you would notice a decline in blood flow.
None of the parameters showed a significant difference between controls and the group treated with 1 mg of zinc. The percentage of males who engaged in intromission (% intromitted), was significantly reduced in 10 mg/day zinc group; only three animals showed the particular behavior. Similarly percentage of rats which ended up with ejaculation significantly decreased with the high dose (two out of eight). Libido index of the highest zinc treated group was significantly low compared to controls; (38 % vs. 88 %, P < 0.05). Number of mounts and intromissions was also significantly decreased in the same group; Number of mounts: 1.58 (SEM 3.16) vs. 11.0 (SEM 1.59) and number of intromissions 2.13 (SEM 4.27) vs. 11.0 (SEM 1.59), P < 0.05).
Take note that you may not be able to complete a series of about 10 kegel exercises on your first try. This is just fine. Just do what you can, and gradually work on more kegel exercises until you reach 10 to 20 kegels, up to three times in a day. When performing these exercises, avoid holding your breath, or pushing your stomach, thigh muscles, or buttocks in. It would be helpful if you relax after every count of five. You may also challenge yourself by alternating between long and short squeezes.
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.
Does drinking water improve erectile dysfunction? Erectile dysfunction or ED is a common concern for men. Everyday factors, such as hydration levels, may affect a person's ability to get or maintain an erection. Drinking water may, therefore, help some men with ED. In this article, learn about the link between hydration and ED, and other factors that can cause ED. Read now
Can one of the B vitamins actually improve erectile dysfunction?  The research makes a strong case that Niacin, a.k.a. Vitamin B3, does indeed do just that for a big percentage of men. Of course, this is a inexpensive help to erectile issues, as high niacin foods and supplements are cheap and readily available.  Below I summarize the most prominent human evidence to date that shows which men will likely benefit and why:
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
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).
medicines called alpha-blockers such as Hytrin (terazosin
HCl), Flomax (tamsulosin HCl), Cardura (doxazosin
mesylate), Minipress (prazosin HCl), Uroxatral (alfuzosin HCl),
 Jalyn (dutasteride and tamsulosin HCl), or Rapaflo (silodosin).
Alpha-blockers are sometimes prescribed for prostate
problems or high blood pressure. In some patients, the use
of Sildenafil with alpha-blockers can lead to a drop in blood pressure or to fainting
In the 18th century, Spain embraced the Age of Enlightenment, directing the beacons of thought to all endeavors. But while Spain was not as advanced as France, Britain, Germany, or America, its new political thinking led to the revocation of most of the historical rights and privileges of the sub-kingdoms that comprised the Spanish Crown. Those changes, in turn, allowed for the freedom of inquiry that was so needed for medical discovery, among others.
Minor side effects associated with erectile dysfunction medications include indigestion, runny nose and skin flushes. Sildenafil may cause temporary changes in your vision, and vardenafil may cause muscle aches and back pain. More serious side effects include hearing loss and erections that last longer than four hours. If you have cardiovascular problems, including a history of heart attacks or strokes, high or low blood pressure or vision problems such as retinitis pigmentosa, it may prove unsafe for you to take sildenafil, vardenafil or tadalafil. These medications may also interact poorly with some antibiotics, blood thinners and medications to prevent seizures and heart rhythm disorders.
Three types of medications to treat erectile dysfunction -- sildenafil, vardenafil and tadalafil -- may cause low blood pressure. Niacin, used to treat conditions such as high cholesterol and hardening of the arteries, can also lower your blood pressure. If you take medications to treat male impotence, ask your doctor before combining it with niacin.
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.
Not only will regular exercise burn calories and lower stress, it may lower your risk of ED. Before you start working out, check with your doctor about the best program for you. Think of exercises you're likely to enjoy and will want to continue on a daily basis, whether it's 30 minutes in the morning on a stationary bike while watching the news, a kick-boxing class, or a brisk after-dinner walk around the neighborhood with a friend.

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).
Yohimbe is commonly taken to increase sexual excitement and to reduce sexual problems such as symptoms of erectile dysfunction (ED), also called impotence. Research shows that yohimbe may be capable of increasing blood flow to the penis or vagina. It also increases nerve impulses that play a role in orgasm. Due to how yohimbine affects blood vessels, it can cause relaxation of the penile tissue and engorgement of blood. This helps a man to maintain an erection. These effects are beneficial for both sexes when it comes to experiencing sexual satisfaction.
Counselling or sex therapy (58% of people find this works for them) –mind-related causes of erectile dysfunction can affect anyone. They are more likely if you experience erectile dysfunction at a younger age. Talking to a counsellor or therapist can help some people overcome erectile dysfunction related to these problems, possibly for good. They can also help you if your erectile dysfunction is causing you stress, as this can make matters worse.
There’s no bedroom bummer quite like having to fly at half mast, but your penis problems are likely more common than you think: As many as 30 million American men suffer from erectile dysfunction, and one in four who seek treatment for ED are actually under the age of 40, according to a study in The Journal of Sexual Medicine. We all know there’s a little blue pill that can fix the failure to launch—but you don’t necessarily have to fill a ‘script to save your stiffy.
The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of hims, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.
What it’ll do for you: “Yohimbe dilates the blood vessels and can lower blood pressure,” says Dr. Patrick M. Fratellone, an integrated physician with a practice in Manhattan. “So experts figured, if it can do that, it must give you an erection and treat erectile dysfunction.” Some proponents say that yohimbe extracts are powerful antioxidants that can prevent heart attacks, act as a stimulant and an anti-depressant, and an aid to weight loss. Here, a closer look at the key benefits:
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.
Pelvic floor exercises are actually good as they can enhance the strength of the pelvic floor muscles. These exercises are commonly called Kegel exercises. These are the types of exercises that women usually perform in order to regain their muscle tone right after childbirth. They are also known to enhance urinary continence and overall male sexual health.
These results are remarkable, because it appears that not only can niacin improve short term erectile function in many men, but also can likely help to reverse arterial plaque if a comprehensive program is undertaken.  Of course, neither I nor anyone else knows how safe megadosed niacin is long term, but many experts consider it safe when used under the care of a knowledgeable physician.  You'll have to do your own due diligence.
Twenty-one men were screened. Two were rejected because they had normal results on nocturnal penile study, and one man was excluded from the study because of a protocol violation. Eighteen men completed the study. The mean age of the men was 60.2 y (range, 34–69 y). The mean duration of erectile dysfunction was 3.1 y (range, 1–10 y). All men were in stable heterosexual relationships. The listed medical risk factors for erectile dysfunction were hypertension in nine men, atherosclerotic cardiovascular disease in seven, single offending medication in seven (mostly beta-blockers), multiple medications in five, diabetes mellitus in four (one with neuropathy), venous leakage in two, and peripheral vascular insufficiency in one.
However, a recent study that involves yohimbe supplementation to athletes ended with an unsatisfactory result. According to this study, yohimbe did not have any significant effects on body mass, muscle mass and exercise performance even after it was taken for 21 days. Even though it helped burn body fat, it may not be a useful supplement for boosting endurance.9
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.

Erectile Dysfunction is an embarrassing and frustrating condition among many men. There are several reasons behind this. Most of the time, it is caused by certain medical conditions such as diabetes, heart disease, obesity, as well as low testosterone. Other reasons may also include problems in blood flow, psychological issues, nerve damage, as well as hormonal fluctuations.
Lifestyle changes like getting more exercise and adjusting your diet can help. In a study of obese men with E.D. who restricted calories for two years and were advised to be more active, participants not only lost weight but also experienced decreased severity of their E.D. Research also shows aerobic exercise can significantly lower your risk of erectile dysfunction thanks to its ability to boost blood flow and circulation. Eating certain foods can also reduce incidence of E.D.
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