Participants in this study gradually increased their daily intake of niacin from 250 mg to 3,000 mg over 36 weeks. Nine of the 23 people who were taking immediate-release niacin withdrew from the study early because of facial flushing, fatigue, or skin discoloration. Eighteen of the 23 who were taking 3,000 mg daily of sustained-release niacin dropped out due to upset stomachs, fatigue, or abnormal liver function tests. All of these side effects disappeared once the participants stopped taking the vitamin. Additional cause for concern comes from other reports suggesting that high doses of sustained-release niacin can cause jaundice and liver failure.
Scientists have found a consistent link between maintaining a healthy weight and avoiding erectile problems. In one Italian study, researchers followed 110 obese men experiencing ED over the course of two years. Of the participants that lost the most weight, 31% ceased to suffer from ED. In the group that lost the least weight, only 5% of the men saw an improvement.
The group treated with the lower concentration of zinc (1 mg/day) did not show an alteration in any of the observed parameters. However, supplementation with a dose of 5 mg/day per rat caused substantial prolonged ejaculatory latency and increased in number of penile thrusting. The other parameters studied remained unchanged indicating uninterrupted libido, sex vigor and performance. Majority of male rats (75 %) showed the prominent actions of sexual behaviour (mount, intromission and penile thrusting) and did not ejaculate within the 15-minute observation period.
Erectile dysfunction can occur as a side effect of medication taken for another health condition. Common culprits are high blood pressure meds, antidepressants, some diuretics, beta-blockers, heart medication, cholesterol meds, antipsychotic drugs, hormone drugs, corticosteroids, chemotherapy, and medication for male pattern baldness, among others.
One study that evaluated the effects of yohimbine supplementation on body composition (muscle mass, body mass, etc.) and exercise performance in professional soccer players found that body fat percentage/fat mass significantly decreased in the yohimbine group compared to the placebo group. However, supplementation with yohimbine did not significantly alter overall body mass, muscle mass, or performance indicators. (10) Other studies, however, have found that people do tend to experience increases in energy and alertness when taking yohimbe, sometimes even so much that it causes symptoms of anxiety or restlessness (much like caffeine does).

A daily dose of niacin improves erectile function, particularly in men with high cholesterol, according to a 2011 study in The Journal of Sexual Medicine. The vitamin helps increase blood flow and reduce inflammation—one of the underlying causes of both high cholesterol and erectile dysfunction. “Vitamin B3 is also used to make sex hormones and other important chemical-signal molecules,” says Fisch. Like many of the others on our list, this tablet is most powerful when taken in conjunction with others: A cocktail of propionyl, L-carnitine, L-arginine, and niacin taken for three months improved 40% of erections in a study from researchers at Sapienza University of Rome in Italy.
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).
Some studies suggest that alpha 2-antagonists may help improve patients’ response to antidepressant medications. (5) Yohimbe has a chemical structure that is similar to several medications, and even recreational drugs, that are used to manage conditions like like mood-related disorders such as depression or schizophrenia, low libido, dizziness due to low blood pressure, and others. One such medication is called Reserpine, a type of indole alkaloid that is prescribed as an antipsychotic and antihypertensive drug. Another is lysergic acid (also known as LSD), which has much stronger psychological/psychedelic effects. While yohimbine doesn’t actually have psychedelic effects, according to research findings, it impacts neurotransmitters including dopamine, adrenaline and serotonin. It also seems to help some people suffering from symptoms due to mental illness.
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.
Ashwagandha, an Ayurvedic herbal remedy reputed to act as a mild aphrodisiac, or Asian ginseng (Panax ginseng), a good stimulant and sexual energizer. For either, follow the dosage on the package, and give it six or eight weeks to have an effect. Both ashwagandha and Asian ginseng are generally safe (but Asian ginseng can raise blood pressure and cause irritability and insomnia in some people).
There are many different reasons a man’s ability to sustain or maintain an erection may be impaired. Impotence is the most common sexual disorder among men. It is thought that most men should be able to achieve and maintain an erection well into their 80s, but about 25 percent of all men over the age of 50 are thought to experience some form of impotence. By the age of 75, half of all men will be impotent. Impotence may come and go, depending on the state of their physical health as well as their stress levels. One of the number one causes of impotence is cardiovascular disease. Cardiovascular disease may restrict blood flow to the penile tissues, which greatly affects a man’s ability to achieve and maintain an erection during sexual arousal.
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.

Pay attention to your vascular health. High blood pressure, high blood sugar, high cholesterol, and high triglycerides can all damage arteries in the heart (causing heart attack), in the brain (causing stroke), and leading to the penis (causing ED). An expanding waistline also contributes. Check with your doctor to find out whether your vascular system — and thus your heart, brain, and penis — is in good shape or needs a tune-up through lifestyle changes and, if necessary, medications.


In conclusion, aerobic training can successfully treat ED in selected patients with arterogenic ED. However, there are very few high-quality randomized trials regarding aerobic training and ED. Practitioners should bear in mind that aerobic training and other risk factors modification is associated with higher rates of ED management success.Since these results are based on small studies, the evidence would be stronger if confirmed by large trials. Effectiveness data were limited; however, the effectiveness of ED is largely determined by the patient health status and associated condition. In addition, work is needed in the standardization of follow-up protocols, evaluation of ED management success and failure, patient selection, and statistical analysis. More randomized studies that compare various exercise techniques are warranted. These studies should evaluate efficacy, complications, quality of life, cost implications, and long-term outcomes of ED management compare to other therapeutic modalities available. Also more database search is also warranted to further broaden the data search on the topic.
In the analysis of the study, the niacin group showed a significant increase in both IIEF-Q3 scores and IIEF-Q4 scores compared to the initial baseline values. While the placebo group also showed a significant increase in IIEF-Q3 scores (high hopes, no doubt), it did not for IIEF-Q4 scores. In other words, the “placebo effect” did not extend to maintaining erections. Also, when patients were stratified according to the baseline severity of ED, the patients with moderate and severe ED who received niacin showed a significant improvement in IIEF-Q3 scores (0.56 and 1.03, respectively) and IIEF-Q4 scores (0.56 and 0.84, respectively) compared with baseline values. These results were not significantly increased for the placebo group.

The Institute of Medicine recommends cumulative daily vitamin D intake of 600 international units (IU) for adults between 18 and 70 years of age , and 800 IU for those over 80. A 3oz serving of salmon contains about 450IU, while an 8oz. glass of milk only has about 100IU. Low vitamin D levels may be an independent, potentially modifiable risk for ED, so it’s worth taking Vitamin D supplements for your “D.” However, keep your daily vitamin D supplement intake below 4,000IU, as too much vitamin D can be toxic.


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Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.
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.

This scenario raises a key concern for us (and should for you as well) about what is recommended to treat erectile dysfunction. I performed a quick Google search on kegels as treatment for the pelvic floor, and found hundreds of websites instructing men to perform kegels to ameliorate erectile dysfunction, have longer and stronger erections – a quick and easy fix. I found a few sites instructing men to perform anywhere from 50-100 repetitions per day (insanity). I discovered a new book called Male Pelvic Fitness, a “user manual to your man parts


Yohimbine's powerful effects on blood flow explain why it's been used in traditional African medicine to increase sexual desire in both genders as well as improve the strength of erections in males. [1] Yohimbine's powerful stimulant properties may also benefit athletic performance on and off the field. The body absorbs and expels yohimbine rapidly.

Have you heard about the famous Kegel exercises women often turn to for help? Well, these exercises are not for women only. You can perform them also and get the same beneficial effects as women. Kegel exercises for men are often recommended by many doctors to be used in the treatment of erectile dysfunction. Kegel exercises will strengthen your pelvic floor muscles. In order to perform these exercises, you will need to locate your pelvic floor muscles (to do that you will need to stop the process of urinating a couple of times) and squeeze them a couple of times. Start performing these exercises a couple of times a day and see the results for yourself.


Niacin, prescribed for more than 50 years, has been successful in treating all three types of lipids in your bloodstream. It can reduce levels of low-density lipoprotein -- LDL, or “bad,” cholesterol -- and triglycerides, as well as elevate your levels of protective high-density lipoprotein -- HDL, or “good,” cholesterol. But other medications, as well as diet and lifestyle changes, can restore your cholesterol to heart-healthy levels. If you currently take niacin and want to start taking medication to treat erectile dysfunction, ask your doctor about switching to a different type of cholesterol medication.

Yohimbine has had questionable effects in men with organic erectile dysfunction. We conducted this study to better define the population of men responsive to yohimbine, because tobacco was thought to affect a regimen of yohimbine more than other risk factors. We measured nocturnal penile tumescence with the RigiScan™ monitor, hormone profiles, answers to the Florida Sexual Health Questionnaire, and clinical responses at baseline and after two different doses of yohimbine in 18 nonsmoking men with erectile dysfunction. Of the 18 men, nine (50%) were successful in completing intercourse in more than 75% of attempts. The yohimbine responders were men with less severe erectile dysfunction as manifested by improved increased rigidity on RigiScan™ testing, higher Florida Sexual Health Questionnaire scores, and slightly higher levels of serum testosterone. Yohimbine is an effective therapy to treat organic erectile dysfunction in some men with erectile dysfunction.


Poor sleep patterns can be a contributing factor for erectile dysfunction, Mucher says. One review published in the journal Brain Research emphasized the intricate relationship between the level of sex hormones like testosterone, sexual function, and sleep, noting that testosterone levels increase with improved sleep, and lower levels are associated with sexual dysfunction. Hormone secretion is controlled by the body’s internal clock, and sleep patterns likely help the body determine when to release certain hormones. 
It promotes the formation of red blood cells, enhances cellular metabolism, supports brain function, improves sexual function in men, and contributes to the healthy sperm production. This is because vitamin B12 is required for the formation and duplication of DNA which, in turn, is responsible for the healthy sperm production. And vitamin B12 deficiency affects genetic material the sperm carries.
Cai, T., Verze, P., Massenio, P., Tiscione, D., Malossini, G., Cormio, L. ... Mirone, V. (2016, August 12). Rhodiola rosea, folic acid, zinc and biotin (EndEP®) is able to improve ejaculatory control in patients affected by lifelong premature ejaculation: Results from a phase I II study. Experimental and Therapeutic Medicine, 12(4), 2083-2087. Retrieved from https://www.spandidos-publications.com/10.3892/etm.2016.3595
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