Shindel, A. W., Xin, Z.-C., Lin, G., Fandel, T. M., Huang, Y.-C., Banie, L., … Lue, T. F. (2010, February 5). Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. The Journal of Sexual Medicine, 7(4), 1518-1528. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2009.01699.x/full

A number of nonprescription products claim to be herbal forms of Viagra. Some of these products contain unknown amounts of ingredients similar to those in prescription medications, which can cause dangerous side effects. Some actually contain the real drug, which should be given by prescription only. Although the Food and Drug Administration has banned many of these products, some potentially dangerous erectile dysfunction remedies remain on the market.


The Science: Chemicals inside these plants called ginsenosides are thought to ramp up the physiological pathway that makes nitric oxide, the neurotransmitter that gets the blood flowing during penile erection. Some studies support that idea: one found that ginsenoside-rich ginseng berry extracts relaxed smooth muscle inside rabbit erectile tissue. But so far there haven’t been high-quality double-blind and randomized trials of the chemicals’ effect on humans. The jury’s still out on whether ginsenosides have any effect on people at all, or (if they do) whether they work as well as medications like Viagra.
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for intercourse. Because ED can have a strong psychological component, counseling with a psychotherapist or sex therapist often works. However, more often ED is a symptom of cardiovascular disease and diabetes, both of which can impair blood supply to the penis. In addition, many medications interfere with sexual functioning.
Yohimbine is the principal alkaloid of the bark of the West African evergreen P johimbe (formerly known as C johimbe), family Rubiaceae. The main active chemical present in P johimbe bark is yohimbine hydrochloride (an indole alkaloid), which has stimulant and aphrodisiac effects. However, the levels of yohimbine that are present in P johimbe bark extract are variable and often very low. Therefore, although P johimbe bark has traditionally been used to treat ED [38], there is insufficient scientific evidence to form a definitive conclusion in this area. It is an antagonist of α2-receptors and has no direct relation to erection. It acts as a sex motivation stimulant. Yohimbine has been used as both an over-the-counter dietary supplement in the form of an herbal extract, and as a prescription medicine in purified form for the treatment of sexual dysfunction. Yohimbine 20 mg or adjusted dose has been found to be effective in the treatment of orgasmic dysfunction. Yohimbine was recently associated as a treatment for type 2 diabetes mellitus in animal and human models carrying polymorphisms of the alpha-2A adrenergic receptor gene [39]. The National Institutes of Health states that yohimbine hydrochloride is the standardized form of yohimbine that is available as a prescription medicine in the United States, and has been shown in human studies to be effective in the treatment of male impotence. Yohimbine hydrochloride USP has been used to treat ED. Controlled studies suggest that it is not always an effective treatment for impotence, and evidence of increased sex drive (libido) is anecdotal only. It cannot be excluded that orally administered yohimbine can have a beneficial effect in some patients with ED. The conflicting results available may be attributed to differences in drug design, patient selection and definition of positive response. Yohimbine has been shown to be effective in the reversal of sexual satiety and exhaustion in male rats, and has also been shown to increase the volume of ejaculated semen in dogs, with the effect lasting at least 5 h after administration. Yohimbine has also been shown to be effective in the treatment of orgasmic dysfunction in men, and has also been used for the treatment of sexual side effects caused by some antidepressants, and female hyposexual disorder. Yohimbine has significant side effects, such as anxiety reactions. Higher doses of oral yohimbine may create numerous side effects, such as rapid heart rate, high blood pressure, overstimulation, insomnia and/or sleeplessness. More serious adverse effects may include seizures and renal failure. Yohimbine should not be consumed by individuals with liver, kidney or heart disease, or psychological disorders. The therapeutic index of yohimbine is low; the range between an effective dose and a dangerous dose is very narrow. Side effects include gastrointestinal upset, increased blood pressure, headache, agitation, rash, tachycardia and frequent urination [40].
3. Testosterone replacement. Before oral medications like Viagra, testosterone was routinely used to treat erectile dysfunction as it is central in the male sexual response, including the desire for sex and the process of getting an erection. Testosterone can be administered in a number of ways, for example orally, by means of an injection, skin patch, or subcutaneous (under the skin) pellet. 
Your doctor may also choose to lower your dose of certain medications. Or your provider may switch the type of drug you’re taking if it’s interfering with your sex life. Some medicines used for managing blood pressure, insomnia, anxiety, depression, seizures and prostate problems increase the risk for erectile dysfunction. Beta-blockers (for high blood pressure), SSRIs (often used to treat depression) and the class of drugs called benzodiazepines (like Ativan, Xanax, Librium and Valium) are commonly tied to ED. You may want to speak to your doctor about this.
L-arginine: L-arginine is an amino acid present in the proteins of all life forms. Also, referred to as arginine, this amino acid is required to carry out the synthesis of nitric oxide, which relaxes the blood vessels and allows more blood to flow through arteries (13). L-arginine has shown promise in the treatment and prevention of cardiovascular disease and in the treatment of male infertility (13). With its anti-oxidant properties, L-arginine can be an integral part of any sexual wellness supplement.
The phrase “use it before you lose it” can be applied when it comes to helping men with ED regain normal erectile function. Pelvic exercises, more commonly known as kegel exercises, are used to promote urinary continence and sexual health. They help to strengthen the bulbocavernosus muscle, which does three things: allows the penis to engorge with blood during erection, it pumps during ejaculation, and it helps empty the urethra after urination, according to Healthline.
Arginine. The amino acid L-arginine, which occurs naturally in food, boosts the body's production of nitric oxide, a compound that facilitates erections by dilating blood vessels in the penis. Studies examining L-arginine's effectiveness against impotence have yielded mixed results. A 1999 trial published in the online journal BJU International found that high doses of L-arginine can help improve sexual function, but only in men with abnormal nitric oxide metabolism, such as that associated with cardiovascular disease. In another study, published in 2003 in the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED sufferers who took L-arginine along with the pine extract pycnogenol saw major improvements in sexual function with no side effects. Arginine can be helpful, says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. Espinosa says that men with known cardiovascular problems should take it only with a doctor's supervision; L-arginine can interact with some medications.

Wild oats: a study in 1986 by the Institute for Advanced Study of Sexuality in San Francisco reported effects like heightened sexual awareness, increased sexual thoughts, more orgasms (36% in men and 29% in women) and some male subjects showed increased levels of testosterone attributed to unbinding of testosterone from TBG. Oats supply steroidal saponins which modulate hormonal balance (5).


No matter what erectile dysfunction treatment or treatments (whether herbal remedies or not) a man ultimately decides upon, experts say it's important to eat healthily and to avoid smoking and heavy drinking. Moreover, adequate exercise, stress reduction, and sleep can improve erectile dysfunction in many. In addition, says Lamm, "A loving, receptive, and responsive partner is a home run. After all, this is still a couple's issue."
Tongkat Ali (Eurycoma longiflora) (Figure 7): this native plant found through SE Asia is used as an Aphrodisiac since 1996 (5). It has to be used regularly and works by enhancing the testosterone and cGMP production. Benefits are felt gradually over a period of time, mainly because it enhances the natural biological synthesis of testosterone. When the level is increased, health and vitality are restored. In studies on Mice, Tongkat Ali increases the number of times and duration of sexual performance of the animals under study (8) with testosterone levels increasing up to 440% in some animals. In a recent study on humans, 62% of subjects showed an increase of the free testosterone index indicating it’s biostimulatory effect on steroidogenesis. It has also been shown to increase sperm concentration and motility and increases energy in the individual by enhancing ATP production by 60% thru oxidative phosphorylation.

^Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. - Author: The Male Clinic, Beverly Hills, CA, USA and David Geffen School of Medicine at University of California, Los Angeles, CA, USA. (14 June 2007)
L-arginine is used by the body to increase and precursor to the production of human growth hormone, prolactin and several amino acids It even increases our sensitivity to insulin, analogously to body when we exercise, by accepting more glucose to enter into our cells and improve better cellular energy therefore less fatigue with much more stamina. L-arginine’s function in supporting our metabolic health are also extremely important for building stronger muscle tissue and potentially to help fight inflammation.

Erectile dysfunction (ED) is defined as the “inability to reach and maintain erection during the intercourse” (1) leading to the victim’s experience of inadequate libido, inefficient orgasm and retarded or premature ejaculation. In Recent times, ED has been labeled as the most common sexual problem among pleasure-seeking males and a complaint of all men irrespective of their age, race and culture but age is the most important risk factor for ED (2). It is reported that nearly 100 million people around the world are living with erectile dysfunction. Yet, only 10% of these 100 million, i.e., 10 million are opting for treatment, despite enormous advancements and treatment facilities in all parts of the world (2). To cite a few countries, in China and Korea only 9% and 30% males voluntarily admit to having ED (2) and in most of the other countries in Asia, it is still considered very sensitive with considerable social stigma and secretly will resort to herbal remedies and tonics before seeking conventional medical help.


If you have symptoms of ED, it’s important to check with your doctor before trying any treatments on your own. This is because ED can be a sign of other health problems. For instance, heart disease or high cholesterol could cause ED symptoms. With a diagnosis, your doctor could recommend a number of steps that would likely improve both your heart health and your ED. These steps include lowering your cholesterol, reducing your weight, or taking medications to unclog your blood vessels.
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