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Erectile dysfunction (ED) is a common condition that doctors treat with prescription medication. Medical professionals do not typically recommend over-the-counter (OTC) ED supplements, and most of these supplements do not have Food and Drug Administration (FDA) approval.
- Best DHEA: Spring Valley DHEA Tablets | Skip to review
- Best for L-arginine: Horbäach L-Arginine | Skip to review
- Best ginseng: Mason Natural Korean Ginseng | Skip to review
Erectile dysfunction refers to difficulty developing or maintaining an erection. It is a common condition, affecting at least
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 supplements, natural remedies, and prescription medications. We also discuss the evidence and risks associated with these options.
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.
Sildenafil is the generic name for Viagra. This medication is only available via prescription in the United States (US). Therefore, viagra is not available OTC.
An OTC Viagra alternative refers to any supplement or herb that claims to produce similar effects to Viagra.
In most cases, there is insufficient research to suggest that OTC Viagra alternatives can benefit sexual function.
The US Food and Drug Administration (FDA) does not regulate OTC Viagra alternatives for their safety or effectiveness. Moreover, the FDA
Over-the-counter Viagra alternatives are a type of supplement, and the FDA does not regulate supplements for their safety or effectiveness. Supplements may contain a combination of ingredients, or product labels may not specify which ingredients the product contains. As such, the
Since OTC Viagra alternatives are not FDA-regulated, 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.
Dehydroepiandrosterone (DHEA) is an important hormone for sexual function. It helps create sex hormones, including testosterone and estrogen.
The adrenal gland naturally produces DHEA. However, DHEA levels in the body peak in a person’s 20s, then gradually decrease with age.
According to a
DHEA manufacturers also claim their supplements can boost energy, enhance immunity, and slow aging. However, there is not enough evidence to suggest that DHEA has any of these effects.
One significant drawback of DHEA is that it is not suitable for athletes. The United States Anti Doping Agency (USADA) prohibits the use of DHEA in sports, and notes that the substance falls under the category of anabolic agents on the World Anti-Doping Agency Prohibited List.
Another drawback of DHEA is the lack of studies investigating its safety, effectiveness, and dosages.
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.
L-arginine is a common amino acid in men’s health supplements.
The body converts L-arginine into the chemical “nitric oxide”. This chemical may help the blood vessels open wider, thereby improving blood flow throughout the body.
Research from 2021 found a link between L-arginine deficiency and ED. The authors noted that combining L-arginine with a prescription ED treatment such as tadalafil may improve ED. However, a person should talk to their doctor before combining supplements and medications, as doing so can cause adverse effects.
A
Additionally, a
However, a person should be cautious when taking L-arginine or similar supplements, as side effects
- nausea
- diarrhea
- slightly lower blood pressure
As with other supplements, any benefits of taking L-arginine are likely to arise from continuous use. However, scientists currently do not know how safe it is to take high dose L-arginine supplements for more than
Ginseng or “Panax ginseng” is a popular herbal remedy that 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 and around the penis.
A 2021 review found that ginseng has a trivial effect on ED in comparison to placebos. However, more research is necessary.
The
According to the NCCIH, other potential side effects include:
- headaches
- breast pain
- issues with menstruation
- fast heart rate
- changes in blood pressure
- digestive issues
It is important that a person talks to their doctor before taking ginseng, since this supplement can interact with a variety of medications,
Learn more about ginseng and ED.
Best ginseng: Mason Natural Korean Ginseng
Propionyl-L-carnitine is one of the commercially available forms of L-carnitine. This chemical
A
It is also not clear whether propionyl-L-carnitine alone would have the same beneficial effects on ED.
Scientists also have not established safe and effective dosages for propionyl-L-carnitine.
Best propionyl-L-carnitine: Swanson Propionyl L-Carnitine with Glycine
Yohimbe is an African evergreen tree. Its bark contains a compound called yohimbine, which has
According to the
However, a
The
The NCCIH also notes the possible side effects of yohimbe, which include:
- digestive issues
- increased blood pressure
- a fast or irregular heartbeat
- anxiety
Yohimbe has also been associated with heart attacks and seizures.
The NCCIH states that yohimbe can interact with certain medications, including a class of antidepressant medications called monoamine oxidase inhibitors (MOAs).
A person should speak with a doctor before taking yohimbe.
The table below compares all of the above OTC Viagra alternatives.
Supplement | List price | Type | Dosage (amount per capsule?) | Servings per container | |
---|---|---|---|---|---|
Spring Valley | DHEA | around $13 | tablets | 50 mg | 50 |
Horbaach | L-Arginine | around $19 | caplets | 4,000 mg | 30 |
Mason Natural | ginseng | around $9 | tablets | 1,000 mg | 60 |
Over-the-counter products marketed for ED claim to benefit those with ED, either by increasing levels of certain sex hormones, or by widening blood vessels to facilitate an erection.
However, there is currently
The FDA does not test or regulate OTC Viagra alternatives, and there is insufficient research to determine whether these supplements are safe or effective.
The
- claim to produce 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
In addition, the FDA has a database of
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
Given the above, it is best to speak with a doctor before taking any supplement.
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 consuming harmful ingredients or consuming a harmful dose of ingredients.
- Quality control: A lack of quality control and FDA regulation can lead to dangerously different levels of active ingredients in the same product.
It is important not to purchase products that advertise themselves as “herbal Viagra” or over-the-counter (OTC) Viagra. The FDA does not regulate these supplements and warns that these product
A recent study found that three out of the 12 herbal ED products they investigated contained undisclosed sildenafil. This is particularly dangerous for people who take nitrates, as their blood pressure can become dangerously low.
In addition to sildenafil, these products can contain other ingredients that interact with medications or supplements a person takes. Some of these OTC supplements may even contain ingredients that
A doctor may prescribe medications that stimulate blood flow to the penis, thereby causing an erection.
These drugs are known as PDE-5 inhibitors. They
The four main FDA-approved oral drugs for ED are:
- Sildenafil (Viagra): Individuals typically take sildenafil around 1 hour before sex, up to once daily. Hims offers generic sildenafil at around $4 per dose. Branded Viagra starts from $139 per dose.
- Avanafil (Stendra): Individuals taking avanafil in doses of 100 mg or 200 mg should take the medication up to 15 minutes before sex, whereas those taking a 50 mg dose should take the medication around 30 minutes before sex. In both cases, a person should not take more than one dose in a 24-hour period. This product is unsuitable for smaller budgets, with six tablets costing $414.33 at Blink Health.
- Tadalafil (Cialis): Depending on the doctor’s instructions, individuals can take tadalafil daily, or as they need around 30 minutes before sex. However, they should not exceed more than one dose within a 24-hour period. Hims offers a generic version for around $6 per dose.
- Vardenafil (Levitra): Individuals can take vardenafil around 60 minutes before sexual activity, and should not exceed more than one dose per day. The generic version of vardenafil costs around $126 for six tablets at Blink Health.
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
Below is a table featuring the four main PDE-5 inhibitors and some of their more common side effects.
PDE-5 inhibitor | Most common side effects |
---|---|
Sildenafil (Viagra) | • headache • flushing • nasal congestion • nosebleeds • changes to color vision • sensitivity to light • heartburn • nausea • diarrhea • pain in the back and muscles • numbness, burning, or tingling in the arms, legs, or extremities |
Avanafil (Stendra) | • headache • flushing • common cold • back pain |
Tadalafil (Cialis) | • headache • flushing • indigestion or heartburn • cough • nausea • diarrhea • pain in the stomach, back, or muscles |
Vardenafil (Levitra) | • headache • flushing • stuffy or runny nose • flu-like symptoms • heartburn • upset stomach |
Interactions
Sildenafil, the
- high blood pressure
- high cholesterol
- diabetes
- heart disease
People with any of the above conditions should consult a doctor before taking ED medications or supplements, whether prescription or OTC.
Medications for ED may also not be suitable for people with certain underlying medical conditions, including:
- heart problems
- very low blood pressure or uncontrolled high blood pressure
- liver disease
- kidney disease
A person’s doctor can determine which medication is the best fit for them.
There are several other treatment options for ED. These include vacuum devices and ED rings.
Vaccum devices are mechanical pumps that create an erection by drawing blood into the penis. Around 77% of people who use vacuum devices or penis pumps for ED were satisfied with the results.
ED rings are bands that go around the base of the penis to help maintain an erection. A 2022 case report states that ED rings can be effective in improving ED.
Learn more about the various treatment options for ED here.
However, there are some risks involved with penis pumps and rings, including:
- bruising
- pain, including painful erections
- numbness and tingling
- burst blood vessels
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:
- not smoking
- exercising regularly
- maintaining a moderate weight
- eating a healthy diet
- reducing stress or anxiety
Prescription medications can help people manage ED symptoms, but they require a consultation with a physician.
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