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The Lowdown on Uplifting Herbs for Men
By Diane Eicher
Well Journal

Since Viagra emerged as the No. 1 drug for male sexual dysfunction, a host of non-prescription remedies has been offered to the 30 million men seeking to stoke their sexual vigor.

Not surprisingly, the success of Pfizer's little blue pill has stimulated the market for herbal products and nutritional supplements promising to deliver equal or greater vigor than Viagra itself.

The over-the-counter marketplace is filled with products that contain ingredients like yohimbe extract, avena sativa, L-arginine, saw palmetto, tibulus terrestris, ginseng and even the aptly named horny-goat weed.

The question is: Do they actually work?

Difficulty in the bedroom isn't the kind of thing men discuss at business lunches or on the golf course, but personal plumbing problems are a hot topic in the anonymity of certain Internet chat rooms.

"Do the supplements advertised on TV to enhance performance really work?" asked a plaintive participant in a recent online chat.

That question is on the mind of many of the estimated 30 million American men -- nearly a quarter of the adult male population -- who suffer from erectile dysfunction, the inability from time to time to perform satisfactorily in sexual intercourse.

Though the problem of erectile dysfunction is widespread, it remained largely a taboo topic until a bold advertising campaign in 1998 launched Viagra, a little blue pill heralded as a promising panacea for impotence.

Viagra burst on the national scene with a pitchman no less prominent than Robert Dole, the recently defeated Republican candidate for President of the United States. Viagra was an instant hit, becoming the hottest new drug in 1998. Today, it is on a trajectory to deliver $1.5 billion in sales for its manufacturer, Pfizer Inc.

Beyond Viagra

Not surprisingly, Viagra's success has stimulated the market for a host of herbal products and nutritional supplements promising to deliver equal or greater vigor than Viagra itself. The over-the-counter marketplace is filled with products that contain ingredients like yohimbe extract, avena sativa, L-arginine, saw palmetto, tibulus terrestris, ginseng and even the aptly named horny-goat weed.

The question is: Do they actually work?

"The judicious answer is that we don't know," said Dr. Barnaby Barratt, president-elect of the American Association of Sexuality Educators, Counselors and Therapists and director of the Midwest Institute of Sexology, based in Detroit, MI. While he said there is "very good reason to believe that some of these products do work for some people some of the time," there are "far too few scientifically-conducted studies, so we have negligible data." While the jury may be out on the effectiveness of these elixirs of love, there is little doubt that many men are likely to be looking for a pick-me-up as they age.

In a survey conducted by the American Urological Association, erection difficulties were reported by 19% of men in their 50s and 39% of men aged 60 and older. Eighty percent of cases result either from such physical conditions as hormonal imbalances, heart disease, diabetes, neurological disorders, nutritional or lifestyle issues, according to medical research. The balance of cases is attributed to stress, depression, anxiety or relationship problems.

Despite the open atmosphere created by the Viagra phenomenon, the American Foundation for Urologic Disease estimates that fewer than 10% of men are getting treatment.

Although Viagra is the No. 1 prescription taken for erectile dysfunction, it has risks ranging from nosebleeds to death. Its use is discouraged for men who have high blood pressure or heart problems.

For those seeking a non-prescription alternative to their problems, the choices are numerous -- and sometimes bewildering.

There are herbs that "mimic" the response Viagra provides, "but the effect is not as pronounced as Viagra," says Mark Blumenthal, a spokesman for the American Botannical Society, a trade group representing herbal manufacturers. "There's no herb singly that has the same properties" as the prescription drug, "with the possible exception of yohimbe," says Mr. Blumenthal. But Mr. Blumenthal said there haven't been good clinical studies on it, even though it has long enjoyed a reputation as an aphrodisiac.

Mr. Blumenthal says ginseng and yohimbe, which are contained in many products, are known to stimulate the release of nitric oxide in the body, which in turn can increase peripheral blood flow, including to the genitals. The proof of a product's efficacy, says Mr. Blumenthal "would be whether men buy it the second time."

Another ingredient that often shows up in OTC aphrodisiacs is L-arginine, an amino acid that has been shown to increase blood flow. One company reports that 88% of men in a study conducted by a physician in Hawaii reported "better erections" after taking an L-arginine-based product fortified with ginseng and gingko biloba. The same product also is being tested on women, and preliminary data suggests that three-fourths of those patients reported improved sexual desire, while 52% reported more frequent orgasms.

Ancient aphrodisiacs

Some of the ingredients in today's "male enhancement" potions are herbs that have been used for centuries to improve sexual health and interest, said Dr. Barratt, who has a Ph.D. in psychology and sexology.

He cited avena sativa - also known as wild oats - that has been used by men in some cultures to improve the quality of their erections, and muira puama, a South American herb favored by indigenous people in the Amazon to treat impotence. Horny-goat weed is an ancient Chinese aphrodisiac.

But long-term anecdotal and folk use doesn't prove efficacy, said Dr. Barratt. And there's another factor to consider. "Almost everything has a placebo effect of up to 30%," he noted, so it's possible that nearly a third of the men who try such herbs perceive an improvement in their performance because they think the pill works and not because of anything the pill actually does.

Dr. Barratt suggests that men try another route to sexual satisfaction: instead of opening a bottle of instant amore, try opening up the lines of communication.

"The penis is hard-wired to the heart," he says. "Sexual performance is tightly bound up with feelings, and not that many men are good at discussing their feelings." Relying on a medication or an herb to fix a sagging love life "distracts men" from looking at the anxiety or relationship difficulties that may be at the root of their bedroom troubles, he adds.

Although the U.S. Food and Drug Administration must approve a prescription drug like Viagra before it goes on the market, some critics worry that herbals and dietary supplements go on sale without any prior government review. While it's true that herbal product manufacturers don't have to get FDA approval to sell a dietary supplement, federal laws require manufacturers to make truthful claims on their labels and empower the FDA to act against unsafe products, says Mr. Blumenthal.

Ray Sahelian, a California physician who markets a line of herbal supplements, including Steel Libido for men with sexual problems, vouches for the safety of products containing such ingredients as L-anginine, yohimbe, muira puama and horny goat weed. He cautions against using products with high doses of hormones, such as DHEA and androstene dione.

While some of the OTC products suggest the best results come from usage over three to four months, Dr. Sahelian recommends "intermittent use" of them, adding, "I would use them occasionally to increase interest and drive." Anyone planning to take any supplement always should consult with his health care practitioner, he emphasizes.

Dr. Ira Sherlip, a professor urology at the University of California-San Francisco who is president of the Sexual Medicine Society of North American, is downright skeptical about the benefit of OTC sexual aids. "I don't know if they work, nor does anyone else -- despite manufacturers' claims that they do," he says. "I'd like for these manufacturers to show me the evidence. But there is none."

Dr. Sherlip says nearly every one of his patients who has tried a supplement "said it didn't do anything." If a patient asks Dr. Sherlip whether he should try an OTC aphrodisiac, "I discourage him, but if he wants to waste his money, that's his business."

The judicious use of a supplement may give a troubled man the lift he needs to begin resolving the possible psychological causes of a sexual problem, says Dr. Sahelian. "I don't see why men can't address both components at the same time -- the physical and the psychological," he explains. "Sometimes improving performance can help a man to start addressing those other issues."

Dr. Barratt's advice falls somewhere in the middle. If a patient wants to try an OTC supplement, "I tell them to be careful, take it in moderation, and don't use it frequently," he says. "We don't know anything about the long-term effects of these products."

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* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. This information is nutritional in nature and should not be construed as medical advice. This notice is required by the Federal Food, Drug and Cosmetic Act.

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Last modified: June 28, 2015