Erectile dysfunction (ED) is a common concern. Medications to treat this condition were previously available on prescription only, but some options are now available over the counter.

Viagra is the most well-known treatment for ED. There are, however, many other pills and tablets available on the market, including over-the-counter (OTC) treatments and dietary supplements.

Before trying these, it is important to know if they work and if they are safe for short- or long-term use.

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

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ED is a medical condition, so the manufacturers of OTC products are not legally allowed to say that they treat ED. Instead, the manufacturers may market them as sexual enhancers. These pills aim to help people maintain an erection.

Although many pills are available for purchase, none have yet received approval from the Food and Drug Administration (FDA) to treat ED.

The FDA do not recommend using OTC products for ED because they are not regulated for safety and may contain undisclosed ingredients or varying doses.

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

Dehydroepiandrosterone

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 reach their peak in a person’s 20s, then they gradually decrease with age.

According to a 2018 review, there is evidence to suggest that low levels of DHEA in the body can increase the chance of ED. However, studies have not convincingly shown that taking DHEA supplements helps with ED or improves sexual performance.

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

Along with being touted for ED, DHEA has become a common supplement for boosting energy, enhancing immunity, slowing aging, and improving weight loss. There is not enough evidence to suggest that it is effective for any of these uses, however.

L-arginine

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 helps the blood vessels open wider, which improves 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 issue.

A small-scale clinical trial from 2020 reported that taking 2.5 grams of L-arginine improved the symptoms of moderate ED.

That said, it is important to be cautious when taking L-arginine or similar supplements, as side effects can include nausea and stomach cramps. Supplements can also cause more serious side effects, such as low blood pressure and an increased risk of bleeding, when a person takes them alongside other medications.

Ginseng

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.

It is worth noting that ginseng is a stimulant and may interrupt sleep or lead to insomnia. Also, it may not be safe for people with heart disease, autoimmune conditions, or bleeding disorders.

The side effects of ginseng may include nausea, diarrhea, and headaches. Ginseng can also interact with a variety of medications. It is important to talk to a doctor before using ginseng.

Learn more about ginseng and ED here.

Yohimbe

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

People use yohimbe as a natural supplement for ED, weight loss, high blood pressure, and diabetes-related nerve damage.

However, the National Center for Complementary and Integrative Health (NCCIH) say that there is not enough evidence to support the use of yohimbe for ED or any other medical condition.

The NCCIH also detail its risks, which include:

  • stomach problems
  • increased blood pressure
  • a fast or irregular heartbeat
  • anxiety

Several OTC pills contain a combination of ingredients, while other pills do not specify which ingredients they contain.

To date, there is not enough research to confirm that any store-bought supplements or pills are effective or safe for treating ED.

Many products that the manufacturers claim to be sexual enhancers have not undergone testing or regulation by the FDA.

The FDA have found that nearly 300 products marketed for ED contained excessively high doses or undisclosed ingredients. This included prescription drugs such as Viagra.

Importantly, the undisclosed ingredients in these supplements may interact with other medications that a person is taking. This may have 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 help treat high blood pressure
  • amyl nitrate

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

The FDA recommend being cautious about ED pills that:

  • claim to have quick 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
  • contain warnings and directions that mimic those of prescription products

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

There are several prescription ED drugs, and each has potential side effects.

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

  • sildenafil (Viagra)
  • avanafil (Stendra)
  • tadalafil (Cialis)
  • vardenafil (Levitra)

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.

Different drugs vary in dose, how long they work for, and possible side effects.

Some possible side effects include:

  • flushing
  • nasal congestion
  • headache
  • visual changes
  • backache
  • upset stomach

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

Some groups should not take medications for ED, 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

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, or medications that the person injects directly into their penis
  • testosterone replacement
  • blood vessel surgery

Learn more about the various treatment options for ED here.

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

Making the following lifestyle changes can help naturally treat erectile problems and boost the person’s overall health:

To date, research has not confirmed that any OTC pills or supplements can safely or effectively treat ED. Prescription drugs, however, can effectively treat ED — though these are not safe for everybody.

If a person is concerned about erectile problems, they may benefit from talking to a doctor to learn more about the treatment options.