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.


That said, I think that guys like myself who eat a ton of plant foods have to be consider the fact that they may not always be getting all the niacin they could.  Men with lower niacin status can probably give their erectile strength and cardiovascular health a nice boost by consuming more niacin-rich plant foods.  There are many plant foods, such as broccoli and mushrooms that are quite high in niacin.  I actually consume nutritional yeast and BPA-free sardines daily and get a nice amount of niacin this way on top of my regular diet.  Therefore, I feel that I am likely maximizing my erectile strength by combining the best of both worlds, i.e. some NO-boosting plant foods and high niacin foods as well.  (Both  sardines and nutritional yeast also have a decent amount of protein as well, which is important to me since I enjoy lifting weights.)

L-arginine, an amino acid that is naturally present in the body and helps make nitric oxide, supports a successful erection. Nitric oxide is responsible for making the blood vessels relax, which helps sustain an erection for men. A 1999 study, observed the effects of six weeks of high-dose (5 grams/day) orally administered nitric oxide (NO) donor L-arginine on men with organic ED. Thirty-one percent of those who took 5 grams/day of L-arginine experienced significant improvements in sexual function. Burns told Medical Daily, “l-arginine and deer antler velvet” have been the most popular go-to natural treatments for men.

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.
The truth is medication or psychosexual counselling are the first treatments a doctor will suggest because they’ve been proven to work. If a doctor has approved a medication for you then it’s safe. If you would still like to see if herbal supplements work for you, then there is a list below of supplements thought to work for erectile dysfunction. Just before you invest your money in them, remember they aren’t proven to work:
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.
Long considered an aphrodisiac by the Chinese, ginseng may do more than just rev your engine. A 2013 South Korean study found that taking the herb for just a few weeks improved guys’ performance in the bedroom, including helping them last longer before finishing. Meanwhile, a study in Spermatogenesis found that ginseng can also help make for harder, longer-lasting erections and improve testosterone levels, which in turn boosts libido. “Ginseng is a promising herbal therapy for ED because it helps promote relaxation of smooth muscle in the penis, increase dopamine levels in the brain, and increase pressure in the cavernosal nerves of the penis which helps nitric oxide synthesis,” Walker explains.

After two hours of zinc treatment, male rats were individually caged and kept for 15 minutes for adaptation. One estrous (receptive) and one diestrous (nonreceptive) female were introduced to each cage and the duration of physical contact with each female was recorded for 15 minutes. Partner preference index (PPI) was calculated as the difference between the time spent with estrous female and diestrous female. Positive indices indicate their positive sexual interest.[12]
Allow me to explain. We know that cardiovascular disease is the number-one killer of men in the United States. Well, the “vascular” part of cardiovascular disease means that the cause is really blockage of the arteries around the heart, a process called atherosclerosis. It’s proven that over half of heart attacks occur in men with normal cholesterol. And many times, heart disease develops without warnings, causing sudden cardiac arrest.  So any early warning sign can be a life saver — and might compel you to get checked out before the big one hits.
Thirty two male rats were randomly assigned to four groups and submitted to one of the following daily treatment regimens: (a) 1 mg of ZnSO4 dissolved in 1 ml of distilled water. (b) 5 mg of ZnSO4 dissolved in 1 ml of distilled water (c) 10 mg of ZnSO4 dissolved in 1 ml of distilled water. Controls were provided with 1 ml of distilled water. Supplementation was done orally using a feeding tube. These daily regimens were continued for two weeks (daily at 17.00 hours) and housed two per cage.
Your brain runs on procedures, so you need to apply the correct thought and action sequence to specifically address the problem you are facing. For example, Kegels are one of the most commonly recommended treatments for premature ejaculation. While Kegels (PC exercises) are a good exercise to strengthen the muscles which support your penis, when done during sex Kegels can cause a man to ejaculate early. This is because Kegels increase blood flow which leads to an increased awareness of sensation. This is exactly what you don't want if you suffer from premature ejaculation!
If you can achieve erection on your own, but you then are unable to keep it while with your partner, it could be related to anxiety, stress, or any sort of relationship issue. There has been extensive research conducted into all potential contributors to erectile dysfunction, including increased use of Internet pornography, assuming that excessive use of internet pornography can change the way the brain perceives arousal, therefore changing the desired response. Dan Savage also explores this topic on his love and sex advice podcast, the Savage Lovecast. If your dysfunction is related to anxiety, stress, or relationship issues, it may be time to explore therapy with a sex-positive provider, or even meditation.

Some medications are changed and broken down by the liver. Yohimbe might decrease how quickly the liver breaks down some medications. Taking yohimbe along with some medications that are broken down by the liver can increase the effects and side effects of some medications. Before taking yohimbe talk to your healthcare provider if you take any medications that are changed by the liver.
What if we look at erectile dysfunction as something that can be addressed as a condition other than a “pill for every ill”.   What if we actually look at a nutrient level that directly correlates to a medical condition and follow the science to give a directive on its recommendation?  Well it turns out taking a simple zinc supplement won’t help 100% of the time, but it certainly helps some of the time.
Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing some men to function normally. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in men who get normal erections.
Anxiety. There is mixed evidence about the effectiveness of yohimbine, the active ingredient in yohimbe, for treating anxiety related to phobias. Some research suggests that it does not improve anxiety when combined with exposure-based therapy used to reduce fear of flying. However, other research suggests that taking yohimbine along with exposure-based therapy helps treat claustrophobia better than exposure-based therapy alone. The effect of yohimbe bark on anxiety is not clear.
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.
Esposito et al (18), in their randomized study investigated the effect of physical activities on 110 obese subjects. They reported significant effect of physical activities on both body mass index and EF. The physiological rationales underlying this hypothesis are that healthy lifestyle factors are associated with maintenance of good erectile function in men (19); obesity has been positively associated with endothelial dysfunction and increased serum concentrations of vascular inflammatory markers (34, 35); and both endothelial and erectile dysfunction may share some common metabolic and vascular pathways that may be influenced by behavioral-related pathways (19, 36). Obese men with erectile dysfunction had evidence of abnormal endothelial function, which was indicated by reduced blood pressure and platelet aggregation responses to L-arginine and elevated serum concentrations of markers of low-grade inflammation, such as IL-6, IL-8, and CRP. It has been shown that there are significant associations between IEEF score and proxy indicators of elevated body fat, the vascular response to L-arginine, and circulating IL-8 and CRP levels. The association we found between IEEF score and indices of endothelial dysfunction supports the presence of common vascular pathways underlying both conditions in obese men. A disturbance in nitric oxide activity linked to reduced nitric oxide availability could provide a unifying explanation for this association. In particular, in isolated corpus cavernosum strips from patients with erectile dysfunction both neurogenic and endothelium-dependent relaxation is impaired (37).
For many men, stopping smoking is an erectile dysfunction remedy, particularly when ED is the result of vascular disease, which occurs when blood supply to the penis becomes restricted because of blockage or narrowing of the arteries. Smoking and even smokeless tobacco can also cause the narrowing of important blood vessels and have the same negative impact. 

The final study we will be examining in this article took a novel approach to by dosing 16 healthy male subjects with 7.7 milligrams of yohimbine tartrate and 6 grams of L-arginine glutamate and comparing it to a placebo. Depending on their group each subject was randomly assigned to consume the placebo one week and the novel compound the other week.
You may find that using a vacuum device requires some practice or adjustment. Using the device may make your penis feel cold or numb and have a purple color. You also may have bruising on your penis. However, the bruises are most often painless and disappear in a few days. Vacuum devices may weaken ejaculation but, in most cases, the devices do not affect the pleasure of climax, or orgasm.
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.
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.
Much higher doses have been used in certain studies, sometimes up to 100 milligrams daily. However, this is considered a very high dose that is potentially dangerous and likely to cause some side effects. Overall, it’s best to start with small doses while monitoring your reaction. Speak to a doctor or herbal practitioner before increasing your dosage to high levels.
Stimulant drugs speed up the nervous system. By speeding up the nervous system, stimulant medications can make you feel jittery and speed up your heartbeat. Yohimbe might also speed up the nervous system. Taking yohimbe along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with yohimbe.

In addition to getting helpful nutrients from your diet, you can also consider supplementing. Many of these are also on my list of top five supplements to increase sex drive, so they’re helpful for overall sexual health. It’s a good idea to check in with a practitioner, particularly one with knowledge of your individual health issues and medications, before taking anything. Here are some I recommend:

There’s a reason why Casanova developed his reputation: He was alleged to scarf two dozen oysters a day, which is the food highest in zinc. In the modern era, people with higher levels of zinc in their system have been shown to have a higher sex drive than those with lower levels. That’s because the mineral is essential for testosterone production. In one Nutrition study, zinc-deficient men who supplemented with zinc for six months doubled their T levels. And another eight-week trial published results in the Journal of the International Society of Sports Nutrition found that college football players who took a nightly zinc supplement showed increased testosterone levels as well.
When stimulated by the nerves, the spongy tissue arranges itself in such a way that more blood can be stored in the penis. The veins running through the outer sheath of the penis then compress which stops the blood from leaving the penis. As the blood is stopped from flowing out, the penis fills with blood and stretches within the outer casing, giving an erection.
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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