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 sustain an erection
- reduced sexual desire
ED is most often treated with lifestyle changes and medications. In
Since then, other types of medications have also been FDA approved 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 approved by the FDA. 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 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 counterfeits.
In 2017, the United Kingdom made Viagra available OTC to make it more available for people with ED who may be reluctant to visit their doctor.
The following five supplements are available OTC and may be able to improve ED.
The steroid hormone DHEA is found naturally in some soy products and yams. According to a landmark Massachusetts Male Aging Study from 1994, low levels of DHEA are associated with a higher risk of ED.
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 that claim 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.
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 isn’t effective for ED.
- Since DHEA affects hormones, it could cause an array of side effects.
- DHEA has the potential to interact with some medications.
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 2020found 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. Cialis is only available by prescription in the United States.
- Viagra. Additionally, a
study from 2019found 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.
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.
Of particular interest is Korean red ginseng, which is also known as Chinese ginseng or Panax ginseng. Some
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.
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.
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.
Yohimbe is another supplement that helps treat ED by stimulating penile blood flow.
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.
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 is often used to address blood flow and other issues related to the circulatory system, making it a potential ED remedy.
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.
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 medications.
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.
Traditional ED treatments such as sildenafil (Viagra), vardenafil (Levitra, Staxyn), and tadalafil (Cialis) are often also used to treat pulmonary hypertension.
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 isn’t 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.
|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|
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 aren’t working or you can’t tolerate them well. These injectable medications work by relaxing the blood vessels in your penis.
The main types of medications used are:
Most people start with Trimix, which is a mixture of the three medications:
The Yale School of Medicine reports satisfaction in 70 percent of men treated at their practice who take injectable medications for ED.
The medication alprostadil is also available as a suppository that goes into the tip of your penis.
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.
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 don’t respond to medications. Most people who receive them are satisfied with their results, with several studies reporting a more than
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 for men with traumatic injury to the pelvis.
Improving lifestyle habits may help improve symptoms of ED by improving your circulation and improving psychological factors that may be contributing. These habits include:
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 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 your doctor.
Can you get Viagra without a prescription?
You can’t legally get Viagra in the United States and most other countries without a prescription. The United Kingdom is one notable exception.
If you don’t want to visit a doctor in person, you can get a prescription remotely using a telehealth service 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, the safety and effectiveness of these products aren’t regulated by the FDA.
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
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.