What are natural treatments for sexual dysfunction in men?

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Treatment of erectile dysfunction and other male sexual disorders.
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Introduction

Impotence, or erectile dysfunction, is the inability to achieve an erection. Impotence has a minimum of fifteen possible causes, including diabetes, drug side-effects, pituitary tumors, hardening of the arteries, hormonal imbalances, and psychological factors. A few of these conditions respond to specific treatment. For example, if a blood pressure drug is causing impotence, the best approach is to change drugs. If a pituitary tumor is secreting the hormone prolactin, treating that tumor may result in immediate improvement. However, in most cases, conventional treatment of impotence is nonspecific.

The drugs Viagra and Cialis have revolutionized treatment for erectile dysfunction. These medications work by increasing tissue sensitivity to the blood-vessel-dilating substance nitric oxide (NO) in the penis. Older methods include mechanical devices that utilize a vacuum to produce an erection, drugs for self-injection, and implantation of penile prostheses.

Proposed Natural Treatments

Korean red ginseng. Two double-blind, placebo-controlled trials, involving about 135 people, found evidence that Korean red ginseng may improve erectile function. In the better of the two trials, 45 participants received either placebo or Korean red ginseng at a dose of 900 milligrams (mg) three times daily for eight weeks. After a one-week period of no treatment, the two groups were switched. The results indicate that while using Korean red ginseng, men experienced significantly better sexual function than while they were taking placebo.

In an analysis combining the results of six controlled trials, researchers found some evidence for the benefits of Korean red ginseng. However, the small size and generally low quality of the studies left some doubt about this conclusion.

L-arginine. Nitric oxide (NO) plays a role in the development of an erection. Drugs such as Viagra increase the body’s sensitivity to the natural rise in NO that occurs with sexual stimulation. A simpler approach might be to raise NO levels, and one way to accomplish this involves the use of the amino acid L-arginine. Oral arginine supplements may increase nitric oxide levels in the penis and elsewhere. Based on this, L-arginine has been advertised as “natural Viagra.” However, there is little evidence that arginine works. Drugs based on raising NO levels in the penis have not worked for pharmaceutical developers; the body seems to simply adjust to the higher levels and maintain the same level of response.

The main support for the use of arginine in erectile dysfunction comes from a small double-blind trial in which fifty men with erectile dysfunction received either 5 grams (g) of L-arginine or placebo daily for six weeks. More men in the treated group experienced improvement in sexual performance than in the placebo group.

A double-blind crossover study of thirty-two men found no benefit with 1,500 mg of arginine given daily for seventeen days; the much smaller dose and shorter course of treatment may explain the discrepancy between these two trials.

Arginine has also been evaluated with the drug yohimbine (made from the herb yohimbe). A double-blind, placebo-controlled trial of forty-five men found that one-time use of this combination therapy one or two hours before intercourse improved erectile function, especially in those with only moderate erectile dysfunction scores. Arginine and yohimbine were both taken at a dose of 6 g. One should not use the drug yohimbine (or the herb yohimbe) except under physician supervision, as it presents a number of safety risks.

Carnitine . In a six-month double-blind trial of 120 men with an average age of sixty-six, carnitine (propionyl-L-carnitine, 2 g per day, plus acetyl-L-carnitine, 2 g per day) and testosterone (testosterone undecanoate, 160 mg per day) were separately compared with placebo. The results indicated that both carnitine and testosterone improve erectile function; however, while testosterone significantly increased prostate volume, carnitine did not.

Another double-blind, placebo-controlled study found that propionyl-L-carnitine at 2 g per day enhanced the effectiveness of sildenafil (Viagra) in forty men with diabetes who had previously failed to respond to sildenafil a minimum of eight times. In another double-blind study, a combination of the propionyl and acetyl forms of carnitine enhanced the effectiveness of Viagra in men who had erectile dysfunction caused by prostate surgery. Carnitine has also shown promise for treating male infertility.

Other treatments. A proprietary combination therapy containing arginine and Ginkgo biloba, ginseng, and vitamins and minerals has shown some promise in an unpublished study. Also, in a three-week, double-blind, placebo-controlled trial, twenty men with erectile dysfunction received either placebo or a special form of magnet therapy called pulsed electromagnetic field therapy (PEMF). PEMF was administered by means of a small box worn near the genital area and kept in place as long as possible during the study period; neither participants nor observers knew whether the device was actually activated or not. The results showed that the use of PEMF significantly improved sexual function compared with placebo.

A double-blind, placebo-controlled study enrolled forty men with difficulty achieving or maintaining an erection who also had low measured levels of dehydroepiandrosterone (DHEA). The results showed that DHEA at a dose of 50 mg daily improved sexual performance; however, the authors failed to provide a statistical analysis of the results, making the meaningfulness of this study impossible to determine.

Severe zinc deficiency is known to negatively affect sexual function. Because marginal zinc deficiency is relatively common, it is logical to suppose that supplementation with zinc may be helpful for some men. However, this hypothesis has only been studied in men receiving kidney dialysis. The results were promising.

The herb Butea superba has shown some promise for erectile dysfunction, according to a three-month randomized, double-blind study performed in Thailand. In other studies, weak evidence hints at potential benefit with pomegranate juice, melatonin, and oligomeric proanthocyanidins (alone or with arginine).

Based on preliminary evidence, the herb maca (Lepidium meyenii) has been advertised as an “herbal Viagra.” In one study in rats, the use of maca enhanced male sexual function. There is one published human trial too. In this small, twelve-week, double-blind, placebo-controlled study, the use of maca at 1,500 mg or 3,000 mg increased male libido. The study did not report benefits in male sexual function, just in desire. Because the loss of sexual function is a more common problem in men than loss of sexual desire, these results do not justify the “herbal Viagra” claim. Contrary to some reports, maca does not appear to affect testosterone levels.

Many other herbs are also reputed to improve sexual function in men, including ashwagandha, Avena sativa (oat straw), catuaba, Cordyceps, damiana, diindolylmethane, Eleutherococcus (Siberian ginseng), L-citrulline, Mucuna pruriens, molybdenum, muira puama (potency wood), pygeum, Polypodium vulgare, Rhodiola rosea, saw palmetto, schisandra, suma, traditional Chinese herbal medicine, and Tribulus terrestris. However, there is no real evidence that these herbs offer any benefits.

Numerous case reports and uncontrolled studies had indicated that the herb Ginkgo biloba offers dramatic benefits for male (and female) sexual disorders caused by antidepressants. However, double-blind, placebo-controlled studies are necessary to truly establish efficacy. When studies of this type were performed, it became clear that people had been misled about ginkgo’s efficacy by the power of suggestion: Ginkgo failed to improve sexual function to any greater extent than placebo.

In a small single-blind study, acupuncture proved superior to fake acupuncture for treatment of erectile dysfunction. However, because the treating practitioners administrating the control treatment were aware that they were providing sham acupuncture, it is quite likely that they unconsciously communicated lack of confidence as they provided it; this is an inherent limitation of single-blind studies.

Deer or antelope velvet antler is a popular treatment for sexual dysfunction. However, the one double-blind study performed on the subject failed to find benefit.

Herbs and Supplements to Use with Caution

The U.S. Food and Drug Administration has warned consumers not to purchase or consume several brands of dietary supplements after samples were found adulterated with the prescription drug tadalafil (Cialis), an analogue of sildenafil (Viagra). The products named in the warning are SIGRA, STAMINA Rx, STAMINA Rx for Women, Y-Y, Spontane ES, and Uroprin (all manufactured by NVE and distributed by Hi-Tech).

The herb yohimbe is the source of the drug yohimbine, which has been shown to be modestly better than placebo for impotence. However, because of many drug interactions and other risks, yohimbine is not recommend for use except under the supervision of a physician. Because there is no agency regulating the quality and labeling of herbal products, the herb yohimbe presents even more risks, such as unpredictable yohimbine content.

Soy or soy isoflavones, and the herb licorice, may reduce testosterone levels in men. For this reason, men with impotence, infertility, or decreased libido may want to avoid these natural products.

One report claims that both tea tree oil and lavender oil have estrogenic (estrogen-like) and antiandrogenic (testosterone-blocking) effects. If this were true, men with erectile dysfunction would be advised to avoid use of these herbs. However, a literature search failed to find any other published reports that corroborate this claim.

One case report suggests that a product containing the herb Epimedium grandiflorum (horny goat weed) caused rapid heart rate and symptoms similar to mania. The supplement androstenedione, often taken for male sexual dysfunction in the belief that it increases testosterone levels, actually appears to increase estrogen levels in men and might, therefore, increase problems with erectile function.

Bibliography

Cavallini, G., S. Caracciolo, et al. “Carnitine Versus Androgen Administration in the Treatment of Sexual Dysfunction, Depressed Mood, and Fatigue Associated with Male Aging.” Urology 63 (2004): 641-646.

Cavallini, G., F. Modenini, et al. “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 (2005): 1080-1085.

Cherdshewasart, W., and N. Nimsakul. “Clinical Trial of Butea superba, an Alternative Herbal Treatment for Erectile Dysfunction.” Asian Journal of Andrology 5 (2003): 243-246.

Conaglen, H. M., J. M. Suttie, and J. V. Conaglen. “Effect of Deer Velvet on Sexual Function in Men and Their Partners.” Archives of Sexual Behavior 32 (2003): 271-278.

Engelhardt, P. F., et al. “Acupuncture in the Treatment of Psychogenic Erectile Dysfunction.” International Journal of Impotence Research 15 (2003): 343-346.

Forest, C. P., H. Padma-Nathan, and H. R. Liker. “Efficacy and Safety of Pomegranate Juice on Improvement of Erectile Dysfunction in Male Patients with Mild to Moderate Erectile Dysfunction.” International Journal of Impotence Research 19 (2007): 564-567.

Gentile, V., et al. “Preliminary Observations on the Use of Propionyl-L-Carnitine in Combination with Sildenafil in Patients with Erectile Dysfunction and Diabetes.” Current Medical Research and Opinion 20 (2004): 1377-1384.

Henley, D. V., et al. “Prepubertal Gynecomastia Linked to Lavender and Tea Tree Oils.” New England Journal of Medicine 356 (2007): 479-485.

Jang, D. J., et al. “Red Ginseng for Treating Erectile Dysfunction.” British Journal of Clinical Pharmacology 66 (2008): 444-450.

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