"The problem with alternative treatments for any medical problem, including erectile dysfunction, is that until you have about 20 well-controlled studies over several years, you really don't know what you are working with," cautions Richard Harris, MD, a urologist at Gottlieb Memorial Hospital, part of the Loyola University Health System in Chicago.
However, you might actually be better off going one step back in the chain reaction and taking an L-citrulline supplement. While your body converts L-arginine to nitric oxide, it also metabolizes it too fast when the amino acid is taken in an oral supplement, according to a 2011 study from the University of Foggia in Italy. L-citrulline, which the body converts to L-arginine, is actually a better option to follow the same metabolic pathway and serve as a treatment for ED, the same study found.
ED may occur at any age, but tends to have a greater psychological effect when it occurs in midlife. ED invokes stress related to midlife intimacy and the physiological realities of aging. Although the prevalence of ED increases with age, it is not an inevitable consequence of aging. Rather, ED becomes more prevalent as men grow older because of its relationship with various age-related diseases. Several studies have found that age is an independent risk factor for severe ED, even after adjustment for other age-related diseases. The aging male requires more penile stimulation; it takes longer to get an erection and the erection may not be hard enough for vaginal penetration. Also, it takes more time to reach ejaculation in elderly individuals. Absence of sexual interest in the partners of older men can lead to ED simply by the man not receiving sufficient direct penile stimulation. Testosterone replacement therapy for aging men has become a topic for discussion among health care providers. There are no established norms for testosterone levels in aging men. Studies in healthy men show that testosterone levels, particularly free bioactive testosterone levels, decline with age although there is considerable interindividual variation. The percentage of men who actually become ‘testosterone deficient’ is unknown. The diagnosis of androgen deficiency in aging men is associated with a wider range of symptoms than a mere impact on hormone levels per se. If the patient has no clinical signs of an androgen deficiency, testosterone replacement therapy will have no clinical effect.

Nettle leaf (Urtica dioica): amongst its many properties, nettle leaf has lately shown itself possibly effective for prostate health and prevention of prostate conditions, especially prostatitis, which is an inflammation of the prostate gland (16). There is speculation that nettle leaf may help with male pattern baldness. Prostate health is essential for men, no matter how young or old. Prevention starts when men are young, so as to avoid problems associated with aging. Prostate problems can interfere with a healthy sex life. Nettle is also considered to be an overall restorative for the body, as well as a natural diuretic and anti-inflammatory remedy (16). It is rich in iron, zinc, and chlorophyll.

Feeling fatigued, very stressed, depressed or dealing with another mood-related issue that can lower libido. Sources of stress and diminished quality of life — such as “deteriorating economic position,” unhappiness with one’s job or other aspects that lower emotional health — are believed to be major causes for sexual dysfunction in both men and women


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.
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.
From the conservation point of view, medicinal plants usage will continue to grow in popularity as people seek ways to support health naturally and gently31. So far, over 72% of these medicinal plants used in ED conditions were harvested from the wild. Yet, there is increasing trend in usage of traditional medicine in developed countries30. The dramatic increase in herbal remedies usage will continue to rise since WHO has taken on monitoring of all unconventional medicine according to the traditional medicine strategic plan of 2002 to 200533. Most medicinal plants have proved successful sources or have acted as leads of effective ingredients that today's drug companies often look first to traditional places such as the rain forests, forest animals and traditional healers for clues to guide their drug development efforts. Furthermore, the harvesting of medicinal plants from the wild places such as the forest reserves, national parks in QEBR is a point of concern whereby no viable mechanisms have been put in place to propagate them. The plant parts harvested especially those of wild medicines such as roots and stem, pose threat to the future survival of natural reservoirs if domestication strategies are not adopted in the near future.
Another important natural source of non-essential amino acid, L-Arginine is well studied to support many bodily functions even though its usually present in low quantities, especially as we started to age it is one of the most . One of the biggest benefits to our body is L-arginine or L Citruline (Our body converts L-citrulline to L-arginine, another type of amino acid) is converted into nitric oxide (proven), which causes blood vessels to open wider is its capability to improve blood flow and better circulation for Erectile Dysfunction.
Saw palmetto. Saw palmetto comes from the fruit of a small palm tree. It has been used to treat symptoms in men with an enlarged prostate gland, such as difficulty urinating, and it has been recommended to treat ED caused by an enlarged prostate. However, several recent clinical trials did not show that saw palmetto works any better on an enlarged prostate than a placebo does. "There is no evidence that saw palmetto should be used to treat erectile dysfunction," says Dr. Gilbert. Like ginkgo biloba, saw palmetto can interact with some prescription medications.
Cavallini, G., Modenini, F., Vitali, G., & Koverech, A. (2005, November). Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy. Urology, 66(5), 1080-5. Retrieved from http://www.sciencedirect.com/science/article/pii/S0090429505006515
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. 
The Science: Some studies have implied that feeding maca to domestic cattle increases sperm production, but there is very little data about any sexual effect on humans. One very small randomized double-bind trial of men with erectile dysfunction found that men taking maca extract reported a small increase in their ability to get erections. But so did the control group. As with the fenugreek study, a similar study with a larger group of people is needed to see whether any differences between the controls and the maca-eaters are real.
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.
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].

E longifolia is a medicinal plant (family Simaroubaceae) native to Indonesia, Malaysia, Thailand, Vietnam and Laos. The root extract has been found to be the most powerful herbal aphrodisiac [17]. Tongkat ali extracts contain many alkaloids, quassinoids, phenolic compounds, tannins, high-molecular-weight glycoproteins and mucopolysaccharides. The main bioactive compounds are eurycomaoside, eurycolactone, eurycomalactone, eurycomanone and pasakbumin-B. It is considered to be natural ‘Viagra’. It increases sexual desire, and enhances performance and general well-being [17- 19]. In addition to its aphrodisiac effect, other medicinal effects, such as antimalarial, antibacterial, antipyretic, antiulcer and antitumour effects, have been reported [20,21]. Root decoction has been used as a general tonic (18,22]. Laboratory animal studies show that root extract enhances sexual characteristics and performance in rodents [22-25]. In a study involving a boar model, it was found that E longifolia root extract-treated boars increased sperm counts and semen volume; the effect was attributed to increased level of plasma testosterone [26]. Reports also suggest that E longifolia extract reverses the inhibitory effects of estrogen on testosterone production and spermatogenesis in rats [27]. Oral administration of E longifolia extract to inexperienced castrated male rats produced dose-dependent increases in sexual performance [28]. Zakaria et al [29] found that eurycomanone, a potential bioactive compound in the root extract of E longifolia, induced apoptosis in hepatocarcinoma (Hep G2) cells. Furthermore, their work suggested that eurycomanone was cytotoxic to Hep G2 cells and less toxic to normal Chang’s liver and WLR-68 cells. Tambi and Imran [19] investigated the effects of water-soluble extract of the root of E longifolia Jack and found that the extract increased semen volume, sperm concentration, percent of normal sperm morphology and sperm motility in male partners of subfertile couples with idiopathic infertility. Supplementation with E longifolia elevated the testosterone levels and upregulated osteoprotegerin gene expression in male Sprague-Dawley rats [30].
The medicinal plants used in male-related conditions will be very significant in the present and future generations. From the researchers point of view, the usage of herbal remedies in managing sexual impotence and erectile dysfunction is useful because of long history of utilisation of some herbs that are perceived as effective. Thus, the establishment of rapport between modern health workers through collaborative ventures with traditional healers, relevant NGOs like Rukararwe in Bushenyi by having close supervision and monitoring of herbal treatments in such conditions is noble. Ministry of Health through its research wing in traditional medicine the Natural Chemotherapeutics Research Laboratory in Wandegeya has role to play in advocacy of traditional medicine. In addition, Public-Private Partnership in Health Care Delivery Desk Office in Ministry of Health and distinguished researchers in herbal medicine need to network, collaborate and have policy in place for herbal medicine as an alternative form of health care in Uganda. The traditional herbal medicines, relevant to the needs of ailing Ugandans can be tried out after being licensed by the National Drug Authority. In our view, sexual impotence and erectile dysfunction are real silent conditions affecting Ugandan men. Additionally, further investigations into the safety and efficacy of these traditional herbal remedies used in the treatment of erectile dysfunction and other male-related conditions are recommended in Uganda.
Phytolacca dodecandra leaves and roots are pounded and smeared on ripe banana and then the ripe banana roasted before being eaten for treating erectile dysfunction. However, care has to be taken Phytolacca dodecandra is poisonous. Cola acuminata fruits are mixed with other plants in Benin to treat primary and secondary sterility24. Cola acuminata is also said to be diuretic and laxative when administered orally24. Some Acacia species are regarded as aphrodisiacs in Niger2. Cassia species have high repute as drugs and poisons. For instance, Cassia sieberiana is used urinary problems, impotence and kidney diseases in Mali24. In Burkina Faso, Cassia occidentalis is used as a stimulant24. Flueggea virosa is famous medicine in African cultures. Flueggea virosa used in sterility, aphrodisiacs, stimulant, rheumatism, arthritis, spermatorrhoea, kidney and liver problems among many other diseases treated17,24.

About 70 – 80% of the Ugandan population still rely on traditional healers for day-to-day health care. In some rural areas the percentage is around ninety compared to 80% reported world-wide10,13,14. WHO32 had earlier estimates that the usage of traditional medicine in developing countries is 80 %. This is an indication that herbal medicine is important in primary health care provision in Uganda. There are several reproductive ailments that local communities have been handling and treating for ages such as sexual impotence and erectile dysfunction (ED). The concept of reproductive health care has been focusing mainly on women disregarding men and yet men are part.
Animal testicles: derived from bulls and wild boars, the orchic substance has been used as a way to possibly increase testosterone levels and sperm counts. In Singapore, testis soap was once very popular (Figure 2). It is still sold in parts of China and Japan. The dried Dog testis and penis (canis familiaris) is believed to tonify the kidneys and strengthen the yang II. Kidney deficiency is believed to be the cause of impotency in Chinese literature.
"Just because there is evidence doesn't mean it's good evidence," says Andrew McCullough, MD, associate professor of clinical urology at New York University Langone Medical Center in New York City, and one of the original clinical investigators for the ED drug Viagra (sildenafil). "And before men with ED start down the naturopathic route, it's smart to make sure that there isn't some underlying medical condition that needs to be corrected." Moreover, it is estimated that 30 million American men have erectile dysfunction, and 70% of cases are a result of a potentially deadly condition like atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. Additionally, ED can also be caused by certain medications, surgical injury, and psychological problems.

Cistanche is usually consumed in stem form, which grows in an extremely arid area with intensive sunshine. It contains various chemical constituents that have some bio-activities such as antioxidation, neuroprotection and overall antiaging. It is shown in a study to shorten erectile latency and prolong erectile duration in castrated rats. Cistanche extract also improves sex hormone levels, improving overall sexual health. The constituent known as echinacoside, promotes relaxation of aortic rings through the NO-cGMP pathway, in other words, it relaxes blood vessels in the penis and improves Nitric Oxide flow.

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