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Erectile dysfunction (ED) is a common condition treated with prescription medication. Medical professionals do not typically recommend over-the-counter (OTC) ED supplements, and most are not approved by the Food and Drug Administration (FDA).

Erectile dysfunction (ED) is a common condition that affects at least 52% of American males aged 40–70. People with ED find it difficult to develop or maintain an erection. Different medical and psychological conditions can work together or independently to cause ED, and the American Urological Association (AUA) has clear treatment guidelines for the condition.

This article looks at various treatment options for ED, including OTC pills, natural remedies, and prescription medications such as Viagra. It also discusses the evidence and risks associated with these options.

Viagra, or sildenafil, is only available by prescription in the United States. OTC viagra refers to any supplement or herb that claims to produce similar effects to Viagra and benefit ED.

In the majority of cases, OTC Viagra products are backed up by limited research suggesting they can benefit sexual function.

OTC Viagra products are not FDA regulated for safety or effectiveness and it cannot test all products marketed for use as sexual enhancers.

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

Medical News Today follows a strict product selection and vetting process. Learn more here.

Although there are many natural ED treatment options available, the FDA does not offer its approval as it classifies them as supplements.

Due to this, ED supplement manufacturers are not legally allowed to state that their products treat ED. Instead, they may market products as sexual enhancers with the aim of helping people achieve or maintain an erection.

The FDA does not recommend using OTC products for ED because they are not regulated for safety and may contain a combination of ingredients or do not specify which ingredients they contain.

The following sections will look at the evidence behind common OTC ingredients marketed for treating ED.

Dehydroepiandrosterone

Spring Valley DHEA 50 mg isolated against a red background.

Dehydroepiandrosterone (DHEA) is an important hormone for sexual function. It helps create sex hormones, including testosterone and estrogen. The adrenal gland naturally produces this hormone.

Levels of DHEA in the body peak in a person’s 20s, then gradually decrease with age.

According to a 2018 review, evidence suggests that low levels of DHEA in the body can increase the chance of ED. However, studies have not convincingly shown that taking DHEA supplements can help ED or improve sexual performance.

In fact, one older 2013 review concluded that DHEA did not significantly improve male sexual function.

DHEA is also a common supplement for boosting energy, enhancing immunity, slowing aging, and improving weight loss. However, there is not enough evidence to suggest that it is effective for any of these uses.

One of its significant drawbacks is that athletes cannot take it. Another is that the lack of studies means there is no information on what is the proper form and dosage for the best results.

Since DHEA is readily available as a supplement, the premise is that people who take it do so for the long term. Unlike viagra, any potential results build up over time rather than producing an immediate erection or sexual benefit.

One DHEA product is from Spring Valley. Each bottle contains 50 tablets of 50 micrograms (mcg) of DHEA. At the time of publishing, it costs $5.94.

L-arginine

Horbaach L-Arginine HCL 4000 mg isolated against a red background.

L-arginine is a common amino acid in men’s health supplements.

The body converts this amino acid into a chemical called nitric oxide. Nitric oxide may help the blood vessels open wider, improving blood flow.

Research from 2017 found that a significant number of people with ED have low levels of L-arginine.

However, the findings of this study are specific to males with poor blood flow through their arteries, which is known as arterial insufficiency. The findings did not apply to males without this condition.

Other 2022 research found that treating mild to moderate ED symptoms with supplements of 1,500–5,000 milligrams (mg) was somewhat effective.

Additionally, a small-scale clinical trial from 2020 reported that taking 2.5 grams (g) of L-arginine improved the symptoms of moderate ED.

That said, a person should be cautious when taking L-arginine or similar supplements, as side effects can include nausea, diarrhea, and slightly lower blood pressure.

As with other ingredients, the supplementation form of L-arginine means that any potential benefits arise from continuous use. However, scientists currently do not know how safe it is to take high dose arginine supplements for over 3 months.

This ingredient is relatively inexpensive. For example, this supplement bottle from Horbaach contains 30 servings of 4,000 mg each. The company writes that the formulation is free of additives or potential allergens, including gluten, wheat, lactose, and soy.

At the time of publishing, it costs $14.98.

Ginseng

Mason Natural Whole Herb Korean Ginseng 1000 mg isolated against a red background.

Ginseng, or Panax ginseng, is a popular and widely used herbal remedy. It is available in the form of pills and creams. Manufacturers claim that it can help with fertility and improve sexual function.

Ginseng contains chemicals called ginsenosides. One action of these chemicals is to promote nitric oxide, which may help trigger an erection by relaxing the smooth muscles in areas of the penis.

A review study focusing on Korean literature suggested that ginseng could help with ED and may improve sexual performance. However, the results were mixed — two studies showed positive effects, and two showed no improvement.

The NCCIH writes that the most common side effect of ginseng is interrupted sleep or insomnia.

Other side effects of ginseng may include headaches, breast pain, issues with menstruation, fast heart rate, and changes in blood pressure. It may also affect the stomach. Ginseng can also interact with a variety of medications, such as calcium channel blockers, statins, and certain antidepressants. It is important to talk with a doctor before using ginseng.

Learn more about ginseng and ED.

Mason Natural offers a supplement product containing 60 daily servings of 1,000 mg ginseng. It has minimal inactive ingredients, and the company writes it is soy free. At the time of publishing, it costs $9.98.

Propionyl-L-carnitine

Swanson Propionyl-L-Carnitine with Glycine isolated against a red background.

Propionyl-L-carnitine is one of the commercially available forms of L-carnitine. Key features include playing an essential role in metabolism and protecting the body from oxidative stress and radical damage.

Some people use a supplementation form of this ingredient for these benefits and ED.

However, there is very limited data to suggest that propionyl-L-carnitine can provide the same effects as Viagra.

These two older studies that look at this ingredient in terms of benefit for sexual function only do so to see if it aids the effectiveness of Viagra:

  • A 2004 study found that propionyl-L-carnitine with sildenafil is more effective in treating ED in people with diabetes than sildenafil alone.
  • This 2005 study looked at whether propionyl-L-carnitine with acetyl-L-carnitine and sildenafil work better than sildenafil alone for restoring sexual potency in people after a prostatectomy. It found that the combination of the three had significantly better results.

This means that while this ingredient can be beneficial with prescription Viagra, there is no evidence that propionyl-L-carnitine on its own would have the same beneficial effects.

Moreover, no research goes into how much to take, when to take it, and when it starts to become effective.

However, some people still prefer to add it to their diet to improve bodily function as a supplement.

In fact, a 2012 small study looked at participants taking a 3-month supplementation of propionyl-L-carnitine, l-arginine, and niacin together. 40% of the study participants found they had an improvement in their erections.

Swanson sells a propionyl-L-carnitine and glycine supplement containing 60 vegetarian capsules. Each capsule delivers 515 mg of propionyl-L-carnitine. At the time of publishing, one bottle costs $24.99.

Yohimbe

Yohimbe is an African evergreen tree. Its bark contains a compound called yohimbine, which has traditional uses as an aphrodisiac.

According to the National Center for Complementary and Integrative Health (NCCIH), people also use yohimbe as a natural supplement for ED, weight loss, high blood pressure, and diabetes-related nerve damage.

However, 2022 research states that scientific studies of yohimbine, taken three times daily, show that it is no more effective at controlling ED than a placebo. The NCCIH says there is not enough evidence to support the use of yohimbe for ED or any other medical condition.

The NCCIH also details its risks, which include:

It also states yohimbe is associated with heart attacks and seizures.

A person should speak with a doctor before taking yohimbe.

OTC products marketed for ED often claim to benefit those with ED by increasing the level of certain sex hormones and widening blood vessels to facilitate an erection.

However, there is currently no evidence to suggest that OTC Viagra is safe or effective. A person should exercise caution before trying any OTC Viagra products and speak with a doctor before making a purchase.

A label that suggests the product is a natural or herbal remedy does not make it safe. It is best to speak with a doctor before taking any supplement.

The FDA recommends being cautious with ED pills that:

  • claim to have fast results, such as within 30–40 minutes
  • are available in single servings
  • are labeled as alternatives to prescription drugs
  • are marketed through unsolicited emails
  • have labels in a different language without trusted translation
  • contain warnings and directions that mimic those of prescription products

To date, there is not enough research to confirm that any store-bought supplements or pills are effective or safe for treating ED, and many products that manufacturers claim to be sexual enhancers have not undergone FDA testing or regulation.

An older 2015 FDA publication stated that it found nearly 300 products marketed for ED that contained excessively high doses or undisclosed ingredients.

Importantly, the undisclosed ingredients in these supplements may interact with other medications a person is taking, potentially resulting in harmful consequences.

For example, these products may interact with drugs that contain nitrates, such as:

  • nitroglycerin, which helps treat angina and coronary heart disease
  • isosorbide or nitroprusside, which helps treat high blood pressure
  • amyl nitrate, which helps treat angina

Potential risks of using OTC treatments for ED include:

  • Drug interactions: Some supplements may cause unsafe interactions with other medications or supplements that an individual is taking.
  • Undisclosed ingredients: Inaccurate reporting of ingredients could lead to a person taking medication, or a larger dose of a medication than is expected.
  • Quality control: A lack of quality control and FDA regulation can lead to dangerously different levels of active ingredients in the same product.

A doctor may prescribe a drug that stimulates blood flow to the penis. This can help a person achieve an erection.

These drugs are known as PDE-5 inhibitors. They enhance the effects of nitric oxide, which the body produces to relax muscles in the penis to allow increased blood flow.

The four main FDA-approved oral drugs for ED are:

  • Sildenafil (Viagra): Individuals typically take sildenafil about 1 hour before sex, up to once daily. Side effects include headaches, flushing, and nausea. Hims offers generic Viagra at around $3 per dose. Branded Viagra costs $139 per dose.
  • Avanafil (Stendra): This improves blood flow; people can take up to 15 minutes before sex. Its effects usually last for up to 6 hours. The price makes this medication unsuitable for small budgets, costing $414.33 at Blink Health for six tablets.
  • Tadalafil (Cialis): Depending on the doctor’s instructions, people can take tadalafil every day or as they need around 30 minutes before sex. Hims offers a generic version for around $82 per month.
  • Vardenafil (Levitra): This works by increasing blood flow to the penis to help a person develop an erection. Serious side effects of vardenafil include irregular heartbeat and hive allergic reactions. The generic version costs around $126 at Blink Health for six tablets.

Learn more about which is best out of Viagra, Cialis, Levitra, and Stendra.

Side effects

Different drugs vary in dose, how long they work, and possible side effects. Roughly 40% of those who take PDE-5 inhibitors for ED have side effects, although these symptoms are usually mild.

Some possible side effects include:

Interactions

Sildenafil, the active ingredient in Viagra, can interact with medications for high blood pressure, high cholesterol, diabetes, or heart disease. People with these conditions should consult a physician before taking ED medications, whether prescription or OTC.

Some groups should not take ED medications, as they can be dangerous. This includes people who:

  • take nitrate drugs or have heart problems
  • have very low blood pressure or uncontrolled high blood pressure
  • have liver disease
  • have kidney disease

A person’s doctor can determine which medication is the best fit for them.

Contacting a doctor

Prescription medications can help people manage ED symptoms, but they require a consultation with a physician. The Journal of Sexual Medicine reports that, in general, males are less likely than females to seek medical care for safe and effective treatment.

As an alternative, some businesses offer telehealth services that include ED diagnostic and treatment options. The ability to access evaluation and treatment online can help people save money, time, and preserve anonymity, which may make it more likely that they can get the safe and professional help they need.

Learn more about the benefits of telemedicine.

However, telehealth should not replace in-person exams since ED can be associated with other health issues, such as cardiovascular disease.

Learn more about prescription drugs for ED here.

There are several other treatment options for ED. These include:

  • vacuum devices, which are mechanical pumps that create an erection by drawing blood into the penis
  • ED rings, which are bands that go around the base of the penis to help maintain an erection
  • self-injections, which are medications that the person injects directly into their penis
  • testosterone replacement
  • blood vessel surgery

Learn more about the various treatment options for ED here.

A person should always speak with a doctor before trying a new ED treatment to ensure it is safe.

Certain lifestyle factors can increase a person’s chance of erectile problems. Controlling these factors may help improve their symptoms.

The following may help naturally treat erectile problems and boost the person’s overall health:

Here are some of the most commonly asked questions about Viagra and OTC alternatives for erectile dysfunction.

Are there over-the-counter pills that works like Viagra?

According to the National Center for Complementary and Integrative Health (NCCIH), there are no safe and effective alternative treatments for ED. Some OTC treatments may contain active ingredients found in prescription drugs, but not at safe levels. They may also contain other unapproved drugs with unknown and potentially dangerous effects.

How can I get ED treatment without seeing a doctor?

Prescription medications, such as Viagra, are a widely effective way to treat ED, but it is not possible to obtain prescription drugs without consulting a doctor.

Telehealth makes it possible for people to consult with doctors and receive prescriptions for ED medications from the privacy of their homes. Telehealth can also help people save time and money and avoid feeling potentially uncomfortable.

What is the best over-the-counter ED treatment?

Lifestyle measures are typically the first step in treating ED. These may be the best approach to treating the condition since the NCCIH reports that there are no safe and effective alternative treatments for ED.

These changes include not smoking, increasing physical activity, eating a healthy diet, moderating alcohol use, and managing chronic conditions such as diabetes and high cholesterol.

Prescription medications may be an effective treatment for ED, although they are not safe for everyone. Telehealth options make it more convenient and private for people to access the medical consultations they need to obtain prescription ED drugs.

To date, research has not confirmed any OTC pills or supplements that safely or effectively treat ED, but prescriptions and supplements are not the only ways to address this condition. Individuals with questions about ED treatment should discuss options with their physicians.