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Erectile dysfunction (ED) affects millions of people around the world. In the United States, about 30 million men have ED. Men over 75 years old are more likely to have it, but even young mencan experience ED too.

Symptoms of ED include:

  • the inability to get an erection
  • the inability to sustain an erection
  • reduced sexual desire

ED is most often treated with lifestyle changes and medications. In 1998, Viagra became the first medication that the Food and Drug Administration (FDA) approved to treat ED. Viagra works by helping the blood vessels in your penis relax to allow more blood flow.

Since then, the FDA has approved other types of medications to treat ED, but they’re all only available by prescription.

Many over-the-counter (OTC) treatments, including herbal supplements, claim to be able to treat ED, but none of these options are FDA approved. Medical professionals often dissuade people from using these products because they’re not regulated for safety and proper labeling.

Some of these products include:

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

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

Viagra is only available with a prescription in the United States, Canada, and most other countries. Viagra is sold under the generic name sildenafil, which is also only available with a prescription.

Many medical clinics now offer remote health services where you can request a prescription online without visiting a doctor in person.

Many online companies claim to sell Viagra without a prescription, but this is illegal. Many of these sites sell counterfeit Viagra.

In 2017, the United Kingdom made Viagra available over-the-counter to make it more available for people with ED who may be reluctant to visit a doctor.

Learn more about how to get Viagra.

The following five OTC supplements may be able to improve ED.

Dehydroepiandrosterone (DHEA)

According to a landmark Massachusetts Male Aging Study from 1994, low levels of DHEA are associated with a higher risk of ED.

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

Similarly, a 2020 review of literature showed 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 that claim that they contain “natural” DHEA. The human body cannot 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.

Pros of DHEA supplements

  • DHEA declines with age, and supplements may help increase your DHEA.
  • Some research suggests that DHA may improve symptoms of ED.

Cons of DHEA supplements

  • Other research concludes that DHEA is not effective for ED.
  • Since DHEA affects hormones, it could cause an array of side effects.
  • DHEA has the potential to interact with some medications.

L-arginine

L-arginine, an amino acid, may help treat ED by improving blood flow to the 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. 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 males over age 60, compared with either substance alone. Cialis is only available by prescription in the United States.
  • 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 bark extract: A 2019 review published in the Journal of Psychosexual Health 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.

More research and larger studies need to be done before the Food and Drug Administration (FDA) approves it as an ED treatment. According to the review published in the Journal of Psychosexual Health, current studies are few in number 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

  • It can cause side effects like 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 research suggests that it may help treat ED symptoms, but more research is needed to draw definitive conclusions.

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

A 2012 study placed 119 men with mild to moderate ED — and no serious coexisting conditions like 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.

Pros of ginseng supplements

  • Some research suggests 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 blood thinners like warfarin.
  • It may cause mild side effects like 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 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 a doctor before trying yohimbe.

Pros of yohimbe supplements

  • Some research suggests it 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 the body and acts as an antioxidant. 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 sildenafil (Viagra). However, research is still very limited.

Pros of propionyl-L-carnitine supplements

  • Limited research suggests it may improve symptoms of ED when taken with ED medications.

Cons of propionyl-L-carnitine supplements

  • Side effects can include nausea, vomiting, and pain in the stomach and chest.
  • It can cause a “fishy” odor in sweat, breath, and urine.

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 over-the-counter erectile dysfunction treatments may be effective, but they may not be safe.

The FDA does not regulate dietary supplements in the same manner as traditional OTC or prescription medications. This means that there is no evidence or very little evidence to support the manufacturer’s claim. While these supplements may help some people, overall their effectiveness and safety are generally untested.

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 present of each of these active ingredients 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 treating ED and could make 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 like sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis) are often also used to treat pulmonary hypertension.

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

Four types of oral medications are FDA approved to treat ED. These are backed by more data than OTC supplements. They are:

These drugs are all classified as phosphodiesterase type 5 (PDE5) inhibitors and work by increasing blood flow to your penis. If one is not effective for you, a doctor may recommend trying a different one to see if you have better results.

There is some variation in the amount of time it takes for them to act and how long they last.

MedicationTime to take effectDuration
sildenafil30 minutesabout 4 hours
tadalafil30 minutesup to 36 hours
vardenafil60 minutes4–5 hours
avanafil15 minutes6 hours

Learn more about the similarities and differences between these medications here.

Where to get prescription ED medication

If you’re interested in prescription medication for ED, see a doctor or go to a reputable online source, like Hims or Roman.

Other treatments for ED include:

Injectable or suppository drugs

Penile injectable medications are a second-line treatment for ED, meaning a doctor may prescribe them if oral medications are not working or you cannot tolerate them 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 the three medications:

  • alprostadil
  • phentolamine
  • papaverine

The medication alprostadil is also available as a suppository that goes into the tip of your penis.

Lifestyle changes

Improving lifestyle habits may help improve symptoms of ED by improving your circulation and improving psychological factors that may be contributing. These habits include:

Penis pumps

Penis pumps are cylinders that can be placed around your penis to pump blood until you achieve an erection. They’re most often recommended when medications don’t work. Most people find 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 a more than 90% satisfaction rate.

Surgery

A type of surgery called microsurgical penile revascularization can help restore blood flow to the blood vessels of the penis by bypassing blocked arteries. This surgery has the potential to be effective, but it’s usually only performed in men with traumatic injury to the pelvis.

When it comes to erectile dysfunction, despite the wide research into treatment options, what causes it is still relatively unknown. While there is not a conclusive way to prevent ED, there are a few lifestyle changes that you can make to minimize your risk.

Managing life stressors

The causes of ED are not always physical and can sometimes tie back to stressors in your life. Relationship issues, starting or losing a job, or even moving to a new home can all contribute to experiencing ED symptoms.

Whenever possible, try to take the time to manage your stress or remove stressors in your daily life to help reduce the risk of developing ED.

Consider your nutritional diet

A diet that is low in antioxidants, amino acids like L-arginine and L-carnitine, or lacking crucial vitamins like vitamin D, can contribute to ED symptoms. Consider adding foods high in antioxidants and amino acids to your diet and talk with your doctor about possible vitamin supplements that could be added to your nutritional routine.

Talk with your sexual partner

While it may seem like an uncomfortable suggestion, open lines of communication with your sexual partner can be very important. Worrying about becoming erect or disappointing your partner during sex can easily distract you from anticipating, becoming aroused for, and ultimately enjoying sex, which could even further contribute to getting and keeping an erection.

If you’re unable to maintain an erection during sex or cannot become erect, 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 is not uncommon to sometimes have difficulty keeping an erection during a sexual encounter or having a full erection when aroused. It can become more common as a person ages.

However, if these instances occur several times in a week and over a period of 4 or more weeks, talking with a doctor may be helpful to see if erectile dysfunction may be the cause.

If your receive a diagnosis of ED, your doctor will be able to discuss your possible treatment options and give their advice on the effectiveness of natural or over-the-counter treatments.

In general, it’s important to talk with your doctor before adding new supplements to your diet, even if they are sold over the counter. Some of these supplements can interact poorly with other medications you may be taking and could potentially create other health issues down the road.

What causes ED?

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

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 a 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 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.

Is it safe to combine multiple ED treatments?

Combination therapy for ED 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 a doctor.

Can you get Viagra without a prescription?

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 using a telehealth service, which you can remotely access from your home.

How can I get ED treatment without a prescription?

You can buy OTC supplements that may help treat ED from most places that sell supplements. However, it’s important to know that 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.

However, it’s important to note that popular FDA-approved medications like Viagra (sildenafil) and Cialis (tadalafil) require a prescription.

Talk with a 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.

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.