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), or the inability to achieve or maintain an erection, is a common condition that affects at least 52% of American males aged 40–70. 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 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.

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 four common OTC ingredients 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, 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.

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 to 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.

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

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, 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 with 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 with 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, scientific studies of yohimbine, taken three times daily, show that it is not any more effective at controlling ED than a placebo. The National Center for Complementary and Integrative Health (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:

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

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

The FDA has found that nearly 300 products marketed for ED contained excessively high doses or undisclosed ingredients.

Importantly, the undisclosed ingredients in these supplements may interact with other medications that a person is taking, 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 help 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 a medication, or a larger dose of a medication, than is expected.
  • Quality control: A lack of quality control 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 should help a person achieve an erection.

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

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.

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:

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

Interactions

However, 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 their physicians 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 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 helps people save money, time, and preserve anonymity, which makes it more likely they can get the safe and professional help they need.

However, telehealth should not substitute an in-person exam since ED can link to 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.

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 around 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 that have 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.