A common customer at the drugstore counter asks where the male enhancement products are. He lowers his voice to ask, “What you got that actually works?”
A good question. A hard one to answer.
The purported benefits of male performance products have been greatly exaggerated. Some of the individual ingredients have shown promise in isolated trials. However, even the most effective of them are not nearly as reliable or powerful as the prescription drugs like Viagra or Cialis. The vitamins described below are also largely ineffective: they may help if a particular hormone or mineral is depleted, but they are unlikely to provide an additional stimulation to a healthy man.
Below are the ingredients that may be beneficial, along with a few notes on the ones that are not.
1. L-arginine
Out of all the products described below, L-arginine may be the only one with a plausible mechanism of action. The amino acid is partially metabolized in the body to produce nitric oxide, a signaling molecule that causes blood vessels to dilate.
This effect is partly responsible for the action of Viagra and Cialis, although those drugs have a much stronger and more reliable effect. There is tentative evidence that daily supplementation of L-arginine can improve mild to moderate erectile dysfunction.
However, the doses in the studies were usually measured in grams – not in the tiny amounts found in the proprietary blends. Do not be surprised if an hour or two after ingestion nothing noteworthy has happened – L-arginine is not an immediate erection enhancer.
The amino acid can cause gastrointestinal side effects and bloating. It may also lower blood pressure, so that it is incompatible with blood pressure medications, nitrates, Viagra, Cialis, or other vasodilating drugs.
2. L-citrulline
This amino acid is sometimes referred to as the watermelon ingredient, due to its association with the fruit. Eating watermelon is healthy, but the amount of citrulline needed for an erection is significantly higher than what can be ingested through diet.
L-citrulline is converted in the body to L-arginine, which can then be used to produce nitric oxide. In some cases, citrulline may help supplement the effects of L-arginine and have a beneficial effect on the circulatory system. This amino acid is generally milder on the digestive tract than arginine, so it may be better tolerated.
The evidence for its effect on the human male anatomy is largely anecdotal. One small study found that men with mild to moderate erectile dysfunction could achieve somewhat better erections with citrulline. However, this is not nearly enough for a definitive endorsement.
Like L-arginine, L-citrulline may enhance the effect of blood pressure medications.
3. Panax ginseng
This popular “tonic herb” supposedly improves almost everything it touches, except possibly broken bones. Panax ginseng has a bit more credibility when it comes to sexual function, as several small studies have found that it can modestly improve libido and sexual performance in men.
Ginseng’s effect on the male anatomy is largely positive but mild. It is important to note that most of the studies used Panax ginseng or Korean ginseng – there may be less potent substances in other ginseng preparations or “blends.”
Panax ginseng can cause insomnia, headache, and indigestion if taken in large dosages. It may also interfere with blood sugar regulation and interact with the blood-thinning medication warfarin. In general, it is prudent to buy Panax ginseng from a reputable supplier – not the “Korean Ginseng Blend” with the dragon on the label.
4. Pycnogenol
Pycnogenol is an extract from the bark of the French maritime pine tree that supposedly improves the function of the endothelium, the deepest layer of tissues in blood vessels. This is a desirable effect for men with erectile dysfunction, as their endothelium is often defective.
Several small studies indeed found that Pycnogenol can improve erectile function. However, they also found that combining it with L-arginine produces better results. Therefore, if a man decides to use Pycnogenol for erectile dysfunction, it should be noted that the results may not be better than standard medications.
It is probably a good idea to avoid the simultaneous use of Pycnogenol with antiplatelet drugs, antidiabetic agents, and multiple blood pressure medications. The extract can interfere with normal blood clotting, glucose metabolism, and blood pressure regulation.
5. Saffron
Saffron has the virtue of being a rare and valuable spice – one that is used to add flavor and color to food. It also has scientific backing: a few small studies have found that saffron can modestly improve erectile function and sexual satisfaction. Saffron has also been tested on people whose sexual function declined after beginning antidepressants.
However, the scientific consensus on saffron and male sexuality is still tentative. The studies were small and did not include a control group. Saffron is not the magic pill that will improve sexual performance beyond reason – a few sprinkles on top of the meal will not do that either.
Highly concentrated saffron supplements can cause nausea, headache, and vertigo, and they can also interfere with blood pressure. It is important not to exceed the recommended dosage, as saffron can also be toxic in large quantities.
6. Vitamin D
Low vitamin D levels often coincide with erectile dysfunction. This has led to the appearance of various myths about vitamin D and its effects on the human anatomy. In particular, it has been claimed that low vitamin D causes erectile dysfunction and that high levels of the vitamin help men achieve harder and longer-lasting erections.
Large randomized trials have shown that this theory is not supported by evidence: vitamin D is no better than a placebo in treating erectile dysfunction. There is an obvious explanation for the association between vitamin D and erectile dysfunction: men with low levels of vitamin D are also more likely to be sedentary, obese, have diabetes, or suffer from cardiovascular diseases. All of these conditions are independently linked with erectile dysfunction.
If a blood test confirms that vitamin D levels are indeed too low, then it should be increased. There are multiple health benefits from normal vitamin D levels, including healthier bones. However, unless there is a documented deficiency, high-dose vitamin D supplements will not improve an erection.
7. Zinc
Zinc is essential for the production of testosterone and male fertility. Low levels of zinc can lead to decreased testosterone, decreased libido, and fertility problems in men. The reverse is generally not true: if a man has normal levels of zinc, extra zinc will not raise testosterone levels.
Supplementing with zinc is not a solution for everyone. It is most useful for people with a zinc deficiency or impaired digestion.
Too much zinc can cause nausea and interfere with copper absorption. Finally, a man who has normal zinc levels may find that zinc supplements do not improve his sex life. It is important to measure hormone levels before initiating zinc supplementation.
A few words about what is not on the list
Yohimbe has some evidence of efficacy against erectile dysfunction. However, it is generally not recommended to use yohimbe supplements because the content of the active substance yohimbine varies from dose to dose and it can be dangerous for the heart. Similarly, Horny Goat Weed has an amazing name but few proven effects. Tribulus and Maca may have a stimulating effect on libido, but increased libido does not always translate into an erection.
There are also products promising immediate results, such as honey packets, chocolates, and “natural” pills. The FDA periodically finds sildenafil or tadalafil in these types of products, so a man who takes nitrates or Viagra should be especially careful when using them. In general, any dietary supplement that makes a man feel better an hour after ingestion most likely contains sildenafil or a similar substance.
Erectile dysfunction is never a single event. There are multiple underlying causes of the condition, including high blood pressure, diabetes, high cholesterol, atherosclerosis, alcohol abuse, and drug use. It can also be caused by anabolic steroids, hypogonadism, sleep apnea, and anxiety. The best treatments for these conditions can be reviewed separately: the most common erectile dysfunction treatments or the best medications for erectile dysfunction.
