Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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:


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.
ED can be caused by a handful of things, but one thing’s for sure: You need a healthy supply of the neurotransmitter nitric oxide (NO) to get and maintain an erection. NO is produced in nerve tissue and helps jolt your Johnson by relaxing the smooth muscle so blood can fill the penis. After the initial release of NO, your body releases a cascade of chemicals—including more of the neurotransmitter—to help keep you hard and happy, according to a study in the Proceedings of the National Academy of Sciences.

The basis of ED herbal therapies is that they are anti-inflammatory, antioxidant and immunomodulatory, and can stimulate testosterone production. On the other hand, the synthetic drugs act via NO. The principal mediator of the relaxation of corporal smooth muscle of the penis has been shown to be NO, which is released mainly from parasympathetic nerves and endothelium [13]. NO is believed to relax the corporal smooth muscle by activating soluble guanylate cyclase to increase cGMP content [14,15]. Penile rigidity depends on maximizing inflow of blood while minimizing outflow [6]. The increased blood flow in the cavernous sinuses puts pressure on the walls of the surrounding veins, causing the lumen of the veins narrow, temporarily interfering with the flow of blood but causing tumescence. Normally, the parasympathetic nerve produces Ach. Ach acts on muscarinic receptors and nicotinic cholinergic receptors. When the parasympathetic nerve is stimulated, preganglionic neurons release Ach at the ganglion, which acts on nicotinic receptors on postganglionic receptors. Postganglionic neurons then release Ach to stimulate muscarinic receptors of the target organs. The muscarinic receptor M3, present in the endothelial cells and smooth muscle, is activated, and the M2 receptor in the heart may also be activated. This may result in the production of Ach, which can cause endothelial cells to produce NO. Ach released from postganglionic parasympathetic nerves acting through G-protein-mediated muscarinic receptors and nicotinic cholinergic receptors helps to release NO. Normally, M1, M2 and M3 receptors are found in secretory glands, heart, smooth muscle and endothelial cells, respectively. M1, M2 and M3 receptors cause activation of phospholipase C and generate inositol trisphosphate and diacylglycerol, which increase calcium. Activation of M4 may inhibit adenylate cyclase, decreasing the messenger cyclic AMP. This mechanism may be involved in the relaxation and contraction of cavernosal smooth muscle cells.
A cold slice of watermelon can do more than just satisfy thirst and hunger during the warm summer months; it can help with bedroom satisfaction. Citrulline, the amino acid found in high concentrations of watermelon, is found to improve blood flow to the penis. A 2011 study revealed men who suffered from mild to moderate ED and took L-citrulline supplementation showed an improvement with their erectile function and were very satisfied. Natural watermelon juice, or “nature’s Viagra,” can also be easier on the stomach, since taking pills like Viagra can cause nausea and diarrhea.
In modern medication of erectile dysfunction, the oral prescription medication of popular Viagra (Sildenafil) is effective, but in some men it is not compatible and Sildenafil works in less than 70% of men with various etiologies and has certain side effects23. The availability of Viagra has brought millions of couples to ED treatment. Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage34. Other drugs such as Yohimbine, papaverine hydrochloride [used under careful medical supervision]5, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. However, this available modern medication for the ED in men is very expensive for most of the rural people in Ugandan and other developing countries. Yet, in traditional medicine, there are several medicinal plants that have been relied on for use in the treatment of ED. This ethnobotanical indigenous knowledge has not been earlier documented and scientifically validated for efficacy and safety, future drug discovery and development.
In this day and age, there is a wide spectrum of innovative drug and other methods of treatment including psychosexual therapy and counseling, topical and systemic drug therapy, device-assisted therapy, electromagnetic stimulation to improve nerve and vascular function of the pelvis and perineal muscles. Electro-ejaculation and the less often done surgical techniques are currently available. The simpler electrovibration can help create or maintain erection or stimulate ejaculation. Although we give so much emphasis on ejaculation, in the Chinese traditional medical teaching, there is reference to improving health by ejaculatory control and abstaining from ejaculating during sexual activity—hence the popular belief that EJACULATING TOO MUCH will lead to WEAKNESS and ILL HEALTH!
In one study, men with a Vitamin D deficiency were nearly 33% more likely to have ED. But you don’t need that much sun exposure to get a healthy amount of Vitamin D. As little as 15–20 minutes a day is enough. Taking Vitamin D is a good idea, especially if you are over 65. Vitamin D can also help if you’re obese or dark-skinned (dark skin limits the amount of Vitamin D you naturally, produce)
Deer antlers (Cervi pantotrichum): the most popular of sexual tonics. In the Chinese medical teaching, kidneys control sexual function; hence foods and herbs such as this can invigorate impotency and infertility increasing semen production as well (5). Best quality are from young bucks with new horn still in velvet with blood visible in the cartilage.

Sildenafil citrate, tadalafil and vardenafil hydrochloride are contraindicated in patients with a known hypersensitivity to any organic nitrates (oral, sublingual, transdermal or by inhalation) due to the risk of developing potentially life-threatening hypotension. Concomitant use of PDE-5 inhibitors is contraindicated with HIV protease inhihibitors (indinavir, ritinovir, saquinavir) as well as ketoconazole, itraconazole, cimetidine and erythromycin, because these drugs are potent inhibitors of cytochrome P450 3A4 and can raise the plasma levels of PDE-5 inhibitors. Coadministration of PDE-5 inhibitors to patients taking alpha-adrenergic blockers such as alfluzocin or tamsulosin may lead to symptomatic postural hypotension, including dizziness and lighheadedness in some individuals.
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].

The Science: Male rats with damaged penile nerves had better erectile responses after they were given large doses of purified icariin, but as of yet no one has done the experiments to see whether the compound works in humans. Still, as far as the herb goes, it doesn’t really matter: horny goat weed doesn’t contain enough icariin to get even the smallest rise out of a rat.
In modern medication of erectile dysfunction, the oral prescription medication of popular Viagra (Sildenafil) is effective, but in some men it is not compatible and Sildenafil works in less than 70% of men with various etiologies and has certain side effects23. The availability of Viagra has brought millions of couples to ED treatment. Oral testosterone can reduce ED in some men with low levels of natural testosterone, but it is often ineffective and may cause liver damage34. Other drugs such as Yohimbine, papaverine hydrochloride [used under careful medical supervision]5, phentolamine, and alprostadil (marketed as Caverject) widen blood vessels. However, this available modern medication for the ED in men is very expensive for most of the rural people in Ugandan and other developing countries. Yet, in traditional medicine, there are several medicinal plants that have been relied on for use in the treatment of ED. This ethnobotanical indigenous knowledge has not been earlier documented and scientifically validated for efficacy and safety, future drug discovery and development.
There are so many potential reasons a man might develop erectile dysfunction (ED), it's nearly impossible to generalize the best ways to treat it. What works for one man may not work for another simply because they are having problems for different reasons. That said, it may encouraging to hear that there are a variety of options that may be considered, from psychological counseling to lifestyle changes, medications to treatments and devices.

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.

Currently, there are four orally active drugs are available to treat ED. These include: sildenafil citrate (Viagra [Pfizer, USA]), vardenafil hydrochloride (Levitra [Bayer, Germany]), tadalafil (Cialis [Eli Lilly, USA]) and avanafil (Stendra, Spedra [Vivus Inc, USA]). These drugs inhibit the enzyme phosphodiesterase type 5 (PDE-5), which is responsible for the hydrolysis of cGMP. PDE-5 inhibitors and cGMP act as effectors of dilation of smooth muscle of cavernosal bodies. PDE-5 inhibitors are contraindicated in patients taking any kind of nitrate therapy for angina, and may not be appropriate for men with certain health conditions, such as severe heart disease, heart failure, history of stroke or heart attack, uncontrolled high blood pressure or diabetes, and patients with pigmental retinopathy. PDE-5 inhibitors are less effective in men with diabetes and men who have been treated for prostate cancer. PDE-5 inhibitors are also not effective in men with retinitis pigmentosa, a genetic disease involving PDE-5 deficiency. The common side effects of PDE-5 inhibitors include gastrointestinal upset, headache, nasal congestion, back pain and dizziness. The PDE-5 inhibitors may interact with other medications including antihypertension drugs. Nonetheless, the PDE-5 inhibitors are generally safe and effective for most men. The primary mechanism of action of these drugs is through the mediation of NO. NO is one of the key molecules involved in ED. It is a short-lived, highly permeable, pleiotropic, gaseous molecule, secreted from the postganglionic cavernosal parasympathetic nerves, endothelium of the cavernosal blood vessels, platelets in the cavernosal sinuses and phagocytic cells (monocytes, macrophages and neutrophils). NO acts on platelets to inhibit platelets adhesion and aggregation. NO causes relaxation of the smooth muscle of the cavernosal blood vessels of the penis, leading to vasodilation, tumescence and stimulation. Release of NO in the corpus cavernosum of the penis during stimulation activates the enzyme guanylate cyclase, which results in increased levels of cGMP, producing smooth muscle relaxation in the corpus cavernosum and resulting in increased blood flow (5). NO is mainly produced from cavernosal nerves, which are nonadrenergic, noncholinergic nerves within the penis, and acting via its second messenger cGMP. It has been suggested that maintaining normal body weight and mild exercise, as well as dietary supplementation of folic acid, zinc, calcium, vitamin C, vitamin E and L-arginine, a precursor of NO, can support the biochemical pathway leading to NO release [6]. NO is an effector molecule that is involved in a number of intracellular functions such as vasorelaxation, endothelial regeneration, inhibition of leukocyte chemotaxis and platelet adhesion [7]. A small proportion of autonomic nerves do not release either Ach or norepinephrine [8]. For example, the cavernous nerves predominantly release NO in the penis. The exact mechanism is not known, but it is believed to be through increased intracellular calcium. Another gaseous molecule produced in the corpora cavernosa is hydrogen sulphide (H2S), which is also known to be involved in erectile function [9]. H2S activates ATP-sensitive potassium channels in smooth muscle cells. Some reports indicate that NO acts in large vessels and H2S in small vessels. A high level of tumour necrosis factor-alpha has been shown in ED patients [10]. Although current ED therapies using PDE-5 inhibitors are safe and effective, approximately 40% of ED patients do not respond to currently available treatment [11,12]. For these patients, herbal therapy may be useful.

The medicinal plants used such as Citropsis articulata, Cannabis sativa, Cleome gynandra and Cola acuminata are frequently utilized. Some of these plants (Citropsis articulata, Cola acuminate) are already under sale for treating these conditions. Their propagation is on-going in western Uganda in places like Rukararwe Partnership Workshop for Rural Development Centre in Bushenyi District36 and researchers personal experience at Rukararwe. Rukararwe is a non-governmental organisation that is processing herbs, running a famous herbal clinic and with a medicinal plants arboretum and medicinal plants agro-forestry.


Only the few elite (educated) and with money seek modern medical care privately and secretly. The description of impotent men in western Uganda among the Banyankore ethnic grouping is literally translated as the persons having no legs (Kifabigyere, Runyankore Dialect) to imply that the penis is dead (cannot bear children). There are other various terms used to describe such men with sexual impotence and ED like the one trampled by a goat, [Akaribatwa embuzi (empene), Kinyankore dialect]. In other places they called, such men who were unable reproduce as “Ekifera in Kinyankore meaning worthless). The men who were unable to have children were not supposed to be given the positions of responsibility or leadership because they were regarded as abnormal. Socially these men were excluded from society, even on drinking joints for the local brew or beer, they are not expected to talk and if they talked, they are hushed. Even women and children always taunted the suffering individuals. Socio-economically, sexual impotence and ED is demeaning and tortures the sufferers by reducing their self-esteem and worthiness in the society. Culturally, in olden days, the impotent men married wives and entrust their wives to very close friends and or relatives to bear them children. In central Uganda, the men with erectile problems are equalled to car engines that cannot start on their own [non-starters] or cars whose batteries have no or low charge (‘Takuba self’, Luganda dialect).

Red Ginseng — One small randomized trial found evidence that red ginseng may offer modest improvements in ED symptoms (as compared with placebo). A meta-anaylsis published in the British Journal of Clinical Pharmacology states, “Traditionally red ginseng has been used to restore and enhance normal well-being, and is often referred to as an adaptogenic….Possible mechanisms of action of red ginseng include hormonal effects similar to those of testosterone. Others have postulated that red ginseng might induce relaxation of the smooth muscles.”  (5)

Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.
Therefore, this particular study was carried out purposely to document medicinal plants used by traditional medical practitioners to treat ED and sexual impotence and other male erectile related conditions in western Uganda. This manuscript only covers the ethnobotanical documentation of medicinal plants used in the management of erectile dysfunction excluding the socio-cultural aspects. The socio-cultural aspects in details will be presented in the next manuscript covering the broad range of reproductive health ailments management using the indigenous knowledge in western Uganda.
Cordyceps (Dongchongxiacao): this Chinese caterpillar fungus and the carcass of the larvae of various insects are collected in the period of the Summer Solstice (tenth solar term). They are cleaned and dried in the sun or baked and used for treating deficient kidneys manifested as impotence, seminal emissions and soreness and pain in the lower back and knees (17). Cordyceps (Dongchongxiacao) is used with Dogwood fruit (Shanzhuyu), Dioscorea (Shanyao) and Dadder seed (Tusizi). The herb can also be used alone.
For centuries, men have tried all sorts of natural remedies for erectile dysfunction (ED) -- the repeated inability to get or maintain an erection firm enough for sexual intercourse. But do they really work? It is simply not scientifically known at this point. Furthermore, you take these remedies at your own risk, because their safety profiles have not been established. What follows are commentaries by experts and reviews in the field of alternative treatments that are available over the counter for erectile dysfunction and impotence.
Dadder seed (Tusizi): there are 2 species i.e., (I) Cuscuta chinensis Lam and (II) Cuscuta japonica. The ripe seeds are collected in autumn, and then they are dried in the sun or boiled. Used to treat deficient kidneys manifesting as impotence, nocturnal emissions, premature ejaculation; Dadder seed (Tusizi) can be used with Schisandra fruit (Wuweizi), Cnidium fruit (Shechuangzi), Flattened milkvetch seed (Shayuanzi) and Grossy privet fruit (Nuzhenzi) for impotence.
Only the few elite (educated) and with money seek modern medical care privately and secretly. The description of impotent men in western Uganda among the Banyankore ethnic grouping is literally translated as the persons having no legs (Kifabigyere, Runyankore Dialect) to imply that the penis is dead (cannot bear children). There are other various terms used to describe such men with sexual impotence and ED like the one trampled by a goat, [Akaribatwa embuzi (empene), Kinyankore dialect]. In other places they called, such men who were unable reproduce as “Ekifera in Kinyankore meaning worthless). The men who were unable to have children were not supposed to be given the positions of responsibility or leadership because they were regarded as abnormal. Socially these men were excluded from society, even on drinking joints for the local brew or beer, they are not expected to talk and if they talked, they are hushed. Even women and children always taunted the suffering individuals. Socio-economically, sexual impotence and ED is demeaning and tortures the sufferers by reducing their self-esteem and worthiness in the society. Culturally, in olden days, the impotent men married wives and entrust their wives to very close friends and or relatives to bear them children. In central Uganda, the men with erectile problems are equalled to car engines that cannot start on their own [non-starters] or cars whose batteries have no or low charge (‘Takuba self’, Luganda dialect).
Acupuncture. Acupuncture has been used for centuries to treat ED and impotence in China. A recent review of studies on acupuncture for erectile dysfunction was published in the British Journal of Urology International. After reviewing four studies, the authors concluded that there was not sufficient evidence to say that acupuncture worked. However, some experts believe it's worth trying. "Acupuncture can work," says Gilbert. "It probably works best to treat the psychological component of ED. There is very little downside to trying it."
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.
Having your current medication checked – if you are taking medication already, it could be that your erection problems are a side effect. Have a doctor check whether this is the cause of your problems and if it is, you might be able to switch medications and then find that your erectile dysfunction goes away completely – or at least improves. Medications that can cause erection problems include:
Yohimbe. Before Viagra and the other prescription erectile dysfunction drugs became available, doctors sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to their patients suffering from ED. But experts say the medication is not particularly effective, and it can cause jitteriness and other problems. "It's not a great drug," says McCullough. "And I suspect the herb is not as potent as the pharmaceutical version." What's more, evidence shows that yohimbe is associated with high blood pressure, anxiety, headache, and other health problems. Experts discourage its use.
Antioxidants  boost nitric oxide production and prevent NO breakdown. Ascorbic acid has direct effects on the bioactivity of NO, and augments NO production in a variety of body processes. The effects are actually synergistic with Vitamin E. Both vitamins are not usually measured, and a reasonable dose of Vitamin C is 500 to 1,000 mg daily. Vitamin E supplementation should be limited to <400 IU per day because of potential adverse long-term health effects of higher doses.
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