Erectile dysfunction (ED) affects millions of people around the world.

In the United States alone, approximately 30 million men have ED. Men over 75 years old are more likely to have it, but even men in their 20s can experience it.

Symptoms of ED include:

  • the inability to get an erection
  • the inability to sustain an erection

Over-the-counter (OTC) treatments, including those made with herbs, may help address this condition. These treatments include:

Before deciding to try an OTC treatment, talk with a doctor. This is especially important if you:

  • have any health conditions or concerns
  • are undergoing treatment for a health problem
  • are taking medications or other supplements

The steroid hormone DHEA is found naturally in some soy products and yams. According to the landmark Massachusetts Male Aging Study from 1994, low levels of DHEA are associated with a higher risk of ED.

A 2018 review found that DHEA declines with age. It noted that this correlates with the decline of various physiological functions, including erectile function. However, the review concludes that it’s unclear whether supplementing with DHEA could help prevent or treat age-related disorders.

Similarly, a 2020 review found conflicting research on whether DHEA was helpful for sexual function. More research is needed to determine whether it’s a safe and effective choice for ED.

If you do decide to try DHEA, be wary of products advertising that they contain “natural” DHEA. The human body can’t naturally produce DHEA by consuming sources that contain it. Any claim that a product can provide the body with “natural” DHEA is false.

Learn more about DHEA supplements.

L-arginine, an amino acid, may help treat ED by improving blood flow to the penis. However, it can cause mild cramping and nausea.

Because of its effect on nitric oxide in the nerves, L-arginine is needed to get and maintain an erection. Experts still don’t know how effective L-arginine supplementation is for ED.

However, limited research seems to suggest 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 men over age 60, compared with either substance alone.
  • Viagra. Additionally, a study from 2019 found that combining L-arginine and sildenafil (Viagra) worked better for treating ED than sildenafil alone.
  • Yohimbine. An older study from 2002 also found that L-arginine combined with yohimbine worked well for treating ED. However, it was a very small study with only 45 participants.
  • French maritime pine back extract. A 2019 review found that L-arginine paired with pine bark extract was more effective than L-arginine alone.

L-arginine has also been used successfully as part of hormone level testing and to treat metabolic alkalosis in children.

However, more research and larger studies need to be done before the Food and Drug Administration (FDA) approves it as an ED treatment.

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. Research has been conducted on its ability to treat ED symptoms, too.

Animal research

In an animal study done 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 improved.

Human research

A 2012 study placed 119 men with mild to moderate ED — and no serious comorbidities such as endocrine system disease — into two groups.

One group received a placebo. The other group received four ginseng pills a day, with each pill containing 350 milligrams (mg) of Korean ginseng berry extract.

Researchers found that taking the Korean ginseng berry extract pills for 4 to 8 weeks led to improvements in:

However, the men who took the placebo also saw their symptoms improve at similar rates.

Another study from 2021 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, a 2021 review of nine studies comparing ginseng to a placebo concluded ginseng has a minimal effect on ED, though it may improve men’s self-reported ability to have intercourse.

Overall, there may be a role for ginseng in helping treat ED, but more research is needed to narrow down appropriate doses and potential side effects.

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 achieving erections. Research from 2013 shows that it can improve orgasmic function and ejaculation in men as well.

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 also be fatal.

As a result, some medical experts are hesitant to recommend it. Proceed with caution and speak with your doctor before trying yohimbe.

Propionyl-L-carnitine is a chemical that occurs naturally in the body. It’s related to the amino acid derivative L-carnitine.

Propionyl-L-carnitine is often used to address blood flow and other issues related to the circulatory system, making it a potential ED remedy.

Older research has shown that propionyl-L-carnitine and L-carnitine also enhance the effects of the popular drug sildenafil (Viagra).

OTC medications for ED have often sparked controversy in the medical community.

The FDA has warned about the potential risks of ED products available online. Risks include undisclosed ingredients and harmful side effects.

Hidden ingredients

Some OTC treatments for ED may be effective, but they may not be safe.

Dietary supplements are not regulated by the FDA in the same manner as traditional OTC or prescription medication.

Some dietary supplements sold online contain ingredients not listed on the label, and these ingredients could be dangerous for some people who take them.

The amount of active ingredients in products containing these supplements may not be consistent either.

Potentially harmful side effects

The unlisted ingredients may also cause harmful side effects in certain users.

Some herbs effective in treating ED in animals may not have been tested on humans, resulting in unexpected side effects.

In addition, OTC treatments can interact with other medications taken for ED, making the supplements unsafe.

Ingredients in these OTC treatments can also cause unsafe interactions with medications taken 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 diabetes or 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.

A 2013 study shows that combining ED treatments containing these medications with nitrates or alpha-blockers can cause problems.

Many treatment options are available for ED management. These are backed by more data than OTC supplements. Your doctor may suggest:

Five prescription medications are available:

What causes ED?

There are many causes of ED, including mental, emotional, and physical.

Emotional and mental causes may include:

Physical causes include:

There may be a single cause of ED or several causes, so it’s important to see your doctor for a diagnosis.

How do you know whether ED is physical or mental?

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 physical.

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 physical or mental.

Is it safe to combine ED treatments?

Combination therapy for erectile dysfunction is possible in certain instances, but it does not apply to every treatment.

In some cases, combining treatments can be unsafe or even dangerous.

Before combining ED treatments, speak with your doctor.

Talk with your doctor before trying an OTC treatment for ED.

Always check to be sure that an herbal or a dietary supplement has been approved or at least tested by a trusted agency, such as the FDA or the National Center for Complementary and Integrative Health (NCCIH).

Some untested treatment options may temporarily resolve your issues, but it’s not worth potential health risks. Proper research or medical consultation are key to finding a successful ED treatment.