We did a deep dive into five over-the-counter alternatives to Viagra for treating erectile dysfunction to determine whether they work and how to use them.
Erectile dysfunction (ED) affects millions of people around the world. In the United States, about
Symptoms of ED include:
- the inability to get an erection
- the inability to keep an erection
- a reduction in sexual desire
ED is most often treated with lifestyle changes and medications. In
Since then, the FDA has approved other types of medications to treat ED, but they’re available only by prescription.
You need a prescription to get Viagra in the United States, Canada, and most other countries. Viagra is also available in the generic form sildenafil, which requires a prescription as well.
Many medical clinics now offer remote health services that you can use to request a prescription online without visiting a doctor in person.
Many online companies claim to sell Viagra without a prescription, but this is illegal, and many of these sites are actually selling counterfeit Viagra. The manufacturers of counterfeit pills likely have very little critical oversight and may be dishonest about the contents of the pills.
In fact, a
In 2017, the United Kingdom made Viagra available over the counter to make it more accessible for people with ED who may be reluctant to visit a doctor.
Before deciding to try an over-the-counter (OTC) ED treatment, talk with a doctor. This is especially important if you:
- have any health conditions or concerns
- are undergoing treatment for a health issue
- are taking any medications or supplements
The following five OTC supplements may be able to improve ED.
Dehydroepiandrosterone (DHEA)
According to the landmark Massachusetts Male Aging Study from 1994, low levels of DHEA are associated with a higher risk of ED.
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Similarly, a 2020 review noted conflicting research on whether DHEA was helpful for sexual function.
If you do decide to try DHEA, be wary of products that claim to contain “natural” DHEA. The human body cannot naturally produce DHEA by consuming sources that contain it. Any claim that a product can provide your body with “natural” DHEA is false.
Learn more about DHEA supplements.
Pros of DHEA supplements
- DHEA declines with age, and supplements may help increase your DHEA level.
- Some research suggests that DHA may improve ED symptoms.
Cons of DHEA supplements
- Other research suggests that DHEA is not effective for ED.
- Because DHEA affects hormones, it could cause an array of side effects.
- DHEA may interact with some medications.
L-arginine
L-arginine, an amino acid, may help treat ED by improving blood flow to your penis. However, it can cause mild cramping and nausea.
Your body converts L-arginine into a molecule called nitric oxide. Nitric oxide acts as a neurotransmitter and causes the blood vessels in your penis to relax, making it easier to get an erection.
Experts still don’t know how effective L-arginine supplementation is for ED. But limited research seems to suggest that it plays a role in combination with other ED drugs, such as:
- Cialis: A small 120-person
study from 2020 found that pairing tadalafil (Cialis) and L-arginine could significantly increase sexual health and testosterone levels in males over 60 years old, compared with either substance alone. Cialis is available only by prescription in the United States. - Viagra: Another
2020 study found that combining L-arginine and sildenafil (Viagra) worked better for treating ED than sildenafil alone. - Yohimbine: The authors of a
2021 review concluded that yohimbine improved erectile function when combined with certain other supplements. However, they also noted that yohimbine was not effective when taken alone. - French maritime pine bark extract: A 2019 review found that L-arginine paired with pine bark extract was more effective than L-arginine alone.
A 2022 study found that L-arginine could be used successfully as part of hormone level testing. L-arginine
More research and larger studies need to be done before the FDA can approve L-arginine as an ED treatment. According to the 2019 review mentioned above, current studies are few and have very small sample sizes.
Pros of L-arginine supplements
- Since L-arginine may be able to improve blood flow, it could help cases of ED that have a physical cause.
Cons of L-arginine supplements
- L-arginine can cause side effects such as cramping, bloating, nausea, and diarrhea.
- It may interact with certain medications.
- Research on L-arginine for ED is limited.
Ginseng
Alternative medicine advocates have long celebrated ginseng as a powerful aphrodisiac, meaning it’s thought to boost desire and sex drive.
Of particular interest is Korean red ginseng, which is also known as Chinese ginseng or Panax ginseng. Some
Animal research
In an animal study performed on rabbits and rats, a type of ginseng known as tissue-cultured mountain ginseng 100 was found to help relax penile smooth muscle, which leads to better erectile function. Blood testosterone levels also increased.
Human research
In a
One group received a placebo. The other group received 4 ginseng pills per day, with each pill containing 350 milligrams of Korean ginseng berry extract.
The researchers found that taking the Korean ginseng berry extract pills for 4–8 weeks led to improvements in:
- erectile function
- intercourse satisfaction
- orgasmic function
- sexual desire
- overall satisfaction
However, the men who took the placebo also saw their symptoms improve at similar rates.
A small 2021 study involving 52 people found that a combination of ginseng and vitamin E may help improve ED, especially when compared with a placebo. There were no safety issues or negative effects noted after 6 weeks.
However, the authors of a
Overall, ginseng may have a role in helping to treat ED, but more research is needed to determine appropriate doses and potential side effects.
Pros of ginseng supplements
- Some research suggests that ginseng may improve symptoms of ED.
- Some research also notes that it may improve self-reported ability to have sex.
Cons of ginseng supplements
- Ginseng can
interfere with blood clotting. You should not take it if you take a blood thinner such as warfarin. - It may cause mild side effects such as trouble sleeping.
Yohimbe
Yohimbe is another supplement that helps treat ED by stimulating penile blood flow.
It promotes the production of norepinephrine, a neurotransmitter that’s vital to getting an erection. A
Yohimbe is also known by the name of its most active ingredient, yohimbine.
Yohimbe has been linked with a number of side effects, including:
At very high doses, it can be fatal.
As a result, some medical experts are hesitant to recommend it. Proceed with caution and speak with a doctor before trying yohimbe.
Pros of yohimbe supplements
- Some research suggests that yohimbe may be effective for symptoms of ED.
Cons of yohimbe supplements
- Side effects of yohimbe can be serious. It may even be fatal at very high doses.
Propionyl-L-carnitine
Propionyl-L-carnitine is a chemical that naturally occurs in your body and acts as an
Because propionyl-L-carnitine is often used to address blood flow and other issues related to the circulatory system, it may have potential as an ED remedy.
Older research has shown that propionyl-L-carnitine and L-carnitine also
Pros of propionyl-L-carnitine supplements
- A
2021 review of 44 studies suggests that these supplements may improve symptoms of ED when taken in combination with PDE5 inhibitors.
Cons of propionyl-L-carnitine supplements
- Side effects can include nausea, vomiting, and pain in your stomach and chest.
- These supplements can
cause a “fishy” odor in sweat, breath, and urine.
OTC medications for ED have often sparked controversy in the medical community. Risks include undisclosed ingredients and harmful side effects.
Hidden ingredients
Some OTC treatments for ED may be effective, but they may not be safe.
The FDA does not regulate dietary supplements in the same way as OTC or prescription medications. This means there is no evidence or very little evidence to support the manufacturers’ claims. While supplements may help some people, their overall effectiveness and safety are generally untested.
Some dietary supplements sold online contain ingredients that are not listed on the label, and these ingredients could be dangerous for some people who take them.
The amount of each of these active ingredients that is present in a product may not be consistent, either.
Potentially harmful side effects
The unlisted ingredients may also cause harmful side effects in certain people.
Some herbs that are effective in treating ED in animals may not have been tested in humans and could cause unexpected side effects.
In addition, OTC treatments can have unsafe interactions with medications you may take for ED or for other conditions.
Importantly, taking an OTC drug that contains sildenafil at the same time as a drug that contains nitrates, such as one for heart disease, can cause a dangerous drop in blood pressure.
Traditional ED treatments such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis) are often also used to treat pulmonary hypertension.
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Four types of oral medications are FDA approved to treat ED. These are backed by more data than OTC supplements. They are:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra, Staxyn)
- avanafil (Stendra)
These drugs are all classified as phosphodiesterase type 5 (PDE5) inhibitors and work by increasing blood flow to your penis. If one drug is not effective for you, a doctor may recommend trying a different one to see whether you have better results.
There is some variation in the amount of time these drugs take to work and how long they last.
| Medication | Time to take effect | Duration |
|---|---|---|
| sildenafil | 30 minutes | about 4 hours |
| tadalafil | 30 minutes | up to 36 hours |
| vardenafil | 60 minutes | 4–5 hours |
| avanafil | 15 minutes | 6 hours |
Learn more about the similarities and differences between these medications.
The treatments discussed below may also be helpful in treating ED.
Injectable or suppository drugs
Penile injectable medications are a second-line treatment for ED, which means a doctor may prescribe them if oral medications are not working or you do not tolerate oral medications well. These injectable medications work by relaxing the blood vessels in your penis.
The main types of medications used are:
- Trimix
- Bimix
- papaverine
Most people start with Trimix, which is a mixture of three medications:
- alprostadil
- phentolamine
- papaverine
The medication alprostadil is also available as a suppository that goes into the tip of your penis.
Lifestyle changes
If applicable to you, certain lifestyle changes may help reduce symptoms of ED by improving your circulation and addressing psychological factors that may be contributing. These changes include:
- reducing stress
- eating nutritious foods
- exercising regularly
- getting enough sleep
- managing your weight
- reducing alcohol intake
- quitting smoking
Penis pumps
Penis pumps are cylinders that can be placed around your penis to pump blood until you get an erection. They’re most often recommended when medications don’t work. Most people find that they’re effective at producing an erection.
Penile implants
A penile implant is an inflatable rod that’s inserted into your penis. It comes with a pump hidden in your scrotum. When you press the pump, the implant fills with saline to give you an erection.
Implants are generally reserved for cases of ED that do not respond to medications. Most people who receive them are satisfied with their results, with several studies reporting satisfaction rates of more than
Surgery
A type of surgery called microsurgical penile revascularization can help restore blood flow to the blood vessels of your penis by bypassing blocked arteries. This surgery can be effective, but it’s usually performed only in men with traumatic injury to the pelvis.
Despite the wide research into treatment options, the cause of ED is still relatively unknown. While there is not a conclusive way to prevent ED, there are a few lifestyle habits that can help minimize your risk.
Manage life stressors
The causes of ED are not always physical and can sometimes relate to stressors in your life. Experiencing relationship issues, starting or losing a job, and even moving to a new home can all contribute to ED symptoms.
Whenever possible, try to take the time to manage your stress levels or remove stressors from your daily life to help reduce the risk of developing ED.
Consider your diet
A diet that is low in antioxidants, amino acids such as L-arginine and L-carnitine, or
Talk with your sexual partner
While it may seem like an uncomfortable suggestion, having open lines of communication with your sexual partner can be very important.
Worrying about getting an erection or about disappointing your partner during sex can easily distract you from anticipating, becoming aroused for, and ultimately enjoying sex. All of this could further contribute to difficulties in getting and keeping an erection.
If you’re unable to get an erection or maintain one during sex, consider talking with your partner about trying again later, discussing other sexual activities you can enjoy together, or sharing fantasies or desires that arouse you both to enhance your chances of becoming and staying erect.
It’s not uncommon to sometimes have difficulty keeping an erection during sex or difficulty having a full erection when aroused. These issues can become more common as you age.
However, if you experience these difficulties several times in a week and over a period of 4 or more weeks, talking with a doctor may be helpful to see whether ED may be the cause.
If you receive a diagnosis of ED, your doctor will be able to discuss your possible treatment options and advise you on the effectiveness of natural or OTC treatments.
In general, it’s important to talk with your doctor before adding new supplements to your diet, even if they’re sold over the counter. Some of these supplements could interact with other medications you may be taking and could potentially create other health issues down the road.
There are many causes of ED, including mental, emotional, and physical factors.
Emotional and mental causes can include:
- relationship issues
Possible physical causes include:
- kidney disease
- drug and alcohol use
- prescription medications
ED may have a single cause or several causes, so it’s important to see a doctor for a diagnosis.
If you’re experiencing erections while you sleep, it’s an indication of normal physiological erectile function. If that’s the case, your ED could have an emotional or mental cause rather than a physical one.
If you’re not sure whether you’re experiencing erections at night, consider an erection self-test. It can help you determine whether your ED is due to a physical or mental trigger.
Many OTC treatments, including herbal supplements, claim to be able to treat ED, but none of these options are FDA approved. Medical professionals often do not recommend using these products because they’re not regulated for safety and proper labeling.
Some examples of these products are:
- ginseng
- propionyl-L-carnitine
Combination therapy for ED is possible in certain cases, but it does not apply to every treatment.
In some cases, combining treatments can be unsafe or even dangerous.
Before combining ED treatments, talk with a doctor.
You cannot legally get Viagra in the United States and most other countries without a prescription. The United Kingdom is one notable exception.
If you do not want to visit a doctor in person, you can consider getting a prescription through a telehealth service, which you can access remotely from your home.
You can buy OTC supplements that may help treat ED from most places that sell supplements. However, the FDA does not regulate the safety and effectiveness of these products.
Making lifestyle changes, such as eating a nutrient-dense diet and getting regular exercise, may help improve ED without medication.
Popular FDA-approved medications such as Viagra (sildenafil) and Cialis (tadalafil) require a prescription.
Talk with a doctor before trying an OTC treatment for ED.
It’s important to read the supplement’s label and check to see if an herbal or dietary supplement has been approved or at least tested by a trusted third-party organization such as USP or NSF International.
Some untested treatment options may temporarily resolve your issues, but those temporary benefits do not outweigh the potential health risks.
Proper research and medical consultation are key to finding a successful ED treatment.