5 Supplements For Better Sex – Erectile Dysfunction Supplements

5 Supplements That Can Boost Your Erection and Sex Life

Skip the shady “Boner Blaster 5000” and consider these instead.

by Elizabeth Millard, Zachary Zane and Ashley Martens   Published: Jun 30, 2023

This article is a repost which originally appeared on Men’sHealth

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Key Points

‧ Erection supplements are a multi-billion dollar a year endeavor.

‧ The supplement list below can go a long way towards helping your male enhancement goals.

‧ Certain supplements- like L-Arginine can be an alternative to erector drugs like Cialis.

It doesn’t matter what you call it—getting a boner, a hard-on, or wood—internet searches for stronger erections won’t stop. That’s especially true for people who are living with erectile dysfunction. It’s no surprise that the market for erectile dysfunction treatments is expected to reach 4.7 billion dollars in revenue by 2026.

There’s a big market for erection-boosting medications including Cialis and Viagra, especially given how easily you can access them via a prescription from your doctor and via telehealth companies like Hims and Roman that have them delivered to your door. But what about other options, like those over-the-counter supplements for a better sex life you see advertised on television or through random Instagram ads? Are those safe supplements for better sex and stronger erections?

Of the many supplements out there that claim to boost your erection and give you a better hard-on, many are dubious. There are significant dangers when it comes to “herbal Viagra,” explains Jamin Brahmbhatt, MD, a urologist and sexual wellness expert at Orlando Health. This term is used to describe the natural supplements advertised to boost your erection.

If you go to a convenience store and see something behind the counter with a name like “Boner Blaster 5,000,” it’s a surefire way to know a supplement is not legit. “Even if you buy them at a big retailer, and they seem to be made of ‘natural’ ingredients, be cautious,” he says. “No one is regulating this stuff.” That’s concerning. It’s not clear what you could be putting in your body and there’s always the chance it could harm your overall health—including your sexual health.

Is it all bad, though? Are any of these over-the-counter erection supplements safe and effective for your sex life? Surprisingly, yes, there are a few. Here is what to know about a few expert-approved sex supplements that are good for your health and your erectile health.

Omega-3s

Omega-3 fatty acids are a maybe when it comes to protecting your heart and your erections. The research goes back and forth about whether fish oil supplements are really helpful for the heart. If the scales tip toward them being helpful to your heart, then your erections may benefit as well, explains Brahmbhatt. That’s because heart-healthy changes are geared toward improving blood flow and increasing the size of blood vessels, he says.

Your penis has the smallest blood vessels in your body, meaning they’re easier to get clogged up. And impeded blood flow is bad for erections, so anything that improves blood flow is good.

At first, it might not make sense that many blood pressure medications list erectile dysfunction as a side effect, he adds. That’s because they modulate the way that blood vessels open and close, which can reduce flow overall, especially down south.

By contrast, omega-3 fatty acids can have the opposite effect because they lower inflammation that might be affecting blood vessels, while also reducing blood clotting. That can help boost your blood flow. While you can get your omegas from supplements, getting them from foods such as fatty fish is your best bet.

L-Arginine

L-arginine is an essential amino acid that can be good for both heart health and erectile issues, Brahmbhatt says.

In fact, a study in the journal Andrology found that patients with severe or complete erectile dysfunction had L-arginine levels that were significantly lower than that of men with milder forms of ED. L-arginine might help trigger the production of nitric oxide, a compound important in getting and maintaining erections.

In addition, “L-Arginine is a peripheral vasodilator via a pathway similar to PDE5 inhibitors [those include Cialis and Viagra]. Vasodilation is associated with increased blood flow and thus possibly better erections,” says Peter Tsambarli, MD, assistant professor of urology at RUSH University Medical Center in Chicago.

L-arginine is found in most protein-rich foods such as red meat, poultry, beans, and dairy products, according to according to the Mayo Clinic, which has marked it as generally safe but cautions people who take blood pressure meds to talk to a doctor first.

This is good advice for any supplements if you’re on blood pressure medications, Brahmbhatt says. That’s because a product like L-arginine can reduce your blood pressure—which is great if it’s a bit too high, but not if you’re already bringing it down with meds. In that case, you may see a sudden and dramatic drop in pressure that could cause you to faint, or in extreme cases, have a stroke.

If you’re not on those meds and want to try the amino acid, Brahmbhatt suggests starting at a dose of about six grams a day to see how you tolerate it. In some people, the supplement can cause side effects including nausea, abdominal pain, diarrhea, and bloating.

L-Citrulline

In addition to L-Arginine, L-Citrulline may help with stronger erections. This is because L-Citrulline is converted in the body to L-Arginine, explains Tsambarli. L-Citrulline can also aid in the production of nitric oxide. “Nitric oxide is involved in vasodilation (widening and opening up of blood vessels) which can begin and maintain the erectile response,” says Michael Eisenberg, MD, professor of urology at Stanford Health.

A 2001 study published in Expert Opinion Pharmacotherapy states that “NO is the principal agent responsible for relaxation of penile smooth muscle.” (FYI, penile erection is a vascular phenomenon that directly results from smooth muscle relaxation along with arterial dilation and venous restriction.)

Vitamin D

Some studies suggest that men with vitamin D deficiencies are more likely to have erectile dysfunction, says Brahmbhatt. That may be because low levels of the vitamin are associated with diseases like hypertension, coronary artery disease, and peripheral vascular disease. Basically, blood flow issues that affect your system can also raise your risk of ED.

Although you can get some vitamin D from foods including salmon and eggs, along with sunshine, most people in the U.S. are lacking the vitamin, especially if you live in the northern part of the country, says Brianna Elliott, R.D., a coach at nutrition counseling service EvolutionEat.

She adds that the longer you maintain low levels, the more effects you might see, including potential ED. But how much you should take is a moving target. The National Institutes of Health recommends 600 IU, while the Endocrine Society suggests much higher levels of up to 2,000 IU daily.

“This would be a good topic for your next doctor visit,” Elliott says, noting that it’s easy to test for vitamin D levels, and from there, you can get a recommendation about dosage amounts based on that information.

Folic Acid (B9)

Another supplement that is good for overall health and wellness, including erectile health, is folic acid or B9. Some research has linked improvement in sexual performance with folic acid supplementation, which lowered levels of the amino acid homocysteine, explains Tsambarli. “Homocysteine levels were previously found to be higher in men with ED than their counterparts who were not suffering from ED.”

The bottom line on sexual supplements?

Despite the fact that there are some supplements that may help with erections to a certain extent, supplements are not held to the standards of pharmaceuticals. Always choose supplements with a third-party verification, like NSF or USP. “I always attempt to temper expectations when utilizing supplements for sexual performance,” says Tsambarli.

In general, here’s the best possible “supplement” you can take for your sex life: lifestyle changes. A healthy diet, regular exercise, good sleep habits, and lower stress levels all go a long way toward improving your health, as you’ve heard a million times.

“Overall health and sexual health are closely related,” explains Dr. Eisenberg. “Thus, anything that benefits heart health can also benefit sexual health. A good diet, exercise, and maintaining a good body weight can all help [as well].”

“Diet and exercise have consistently outperformed supplements and have a significant and reliable impact on sexual performance,” says Tsambarli.

“It’s definitely easier to stop at the gas station and get some shady supplement that makes promises about boosting your libido or increasing your girth,” Brahmbhatt says. “But play it safe, skip that junk, and do what’s proven to help your sex life: healthy lifestyle habits.”

 

 

 

Male sexual health and reproductive medicine: All that glitters is not gold

September 19, 2022
Navid Leelani, DO, Scott D. Lundy MD, PhD

This article is a repost which originally appeared on Urology Times.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Telehealth is an increasingly popular method for obtaining medical services

· More studies need to be done in the areas of male sexual and reproductive medicine.

· Studies cite the prevalence of ED as high as 52%!

“With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness,” write Navid Leelani, DO, and Scott D. Lundy, MD, PhD.

With the intensified direct-to-consumer marketing of male sexual medicine treatments, the recent legislative changes in reproductive rights and their unknown long-term effect on assisted reproduction availability for infertile men, and the explosion of telehealth, the practice of male sexual medicine is evolving at a breakneck pace. Specialists in male sexual and reproductive medicine have been tasked with digesting the evolving literature and forming evidence-based treatment guidelines for men with erectile dysfunction, Peyronie disease, infertility, and a host of other conditions. Compared with other areas of urology and medicine in general, male sexual and reproductive medicine has a disappointingly small number of well-designed prospective studies, along with a significant gap in funding for male reproductive health compared with female reproductive health. Several manuscripts published in 2022 started to narrow this gap and provide valuable level 1 evidence supporting (or discounting) key areas within sexual medicine and infertility.

For men with severe male factor infertility and nonobstructive azoospermia, surgical intervention is often indicated to retrieve sperm. Testicular sperm aspiration (TESA) and microdissection testicular sperm extraction (mTESE) are 2 commonly used approaches. A recent study by Jensen et al compared the efficacy of these 2 approaches in one of the few prospective randomized-controlled trials in male infertility.1 In the study, 49 patients were randomly assigned to mTESE with a sperm retrieval rate of 43%, and 51 patients were randomly assigned to TESA with a sperm retrieval rate of 22%. Men with failed TESA then went on to salvage mTESE with a combined sperm retrieval rate of 29%. Participants in the mTESE arm, however, had decreased postoperative testosterone levels, and 24% of participants experienced de novo hypogonadism at 6 months. Prior literature has suggested the testosterone drop is transient and that it will likely recover by 12 months. In summary, the study results showed that mTESE remains the gold standard for treatment of nonobstructive azoospermia, but patients should be counseled on the risk of de novo hypogonadism.

Despite this, mTESE success rates remain modest and are subject to the expertise and skill level of the laboratory and andrologist processing the tissue. Multiple hours can be spent trying to find the few viable sperm hidden among a sea of distractors. A recent study by Lee et al examined the power of artificial intelligence to detect human sperm in semen and mTESE samples using bright-field microscopy for nonobstructive azoospermic (NOA) patients.2 They first trained the program to identify sperm from semen samples of fertile patients. After validating the effectiveness of their algorithm, they retrained it to identify sperm in tissue from NOA patients that had been spiked with large amounts of sperm. When testing it on samples containing 3000 to 6000 sperm among other cell types, they achieved 84.0% positive predictive value and 72.7% sensitivity. Finally, without retraining their algorithm, they tested it on samples containing 10 to 200 sperm, replicating the “rare sperm” phenomenon seen in patients with NOA. Their model was able to detect 2969 sperm cells out of a total 3517 with an 84.4% PPV and 86.1% sensitivity. The clinical applications of artificial intelligence and machine learning in medicine continue to expand and have made their way to male infertility. Although this is not ready for immediate clinical use, it does highlight the need for further work to harness the power of technology to improve workflow of andrologists and in turn increase the success of infertility care for patients.

There has been a rapid rise in the need for male sexual health and reproductive specialists as the population ages and the number of comorbidities rise, although certain disease processes that fall within this specialty may be able to be addressed by a general urologist. In an analysis of the current educational landscape, Asanad et al call attention to the need for a structured educational curriculum in residency for male infertility.3 In a survey of urology residents, 54 of 72 respondents (75%) reported that male infertility comprises less than 10% of their training. Compared with residents who did not learn from infertility-trained faculty, residents who were exposed to infertility-trained faculty were 14.4 times more likely to feel confident performing infertility procedures (P < .001) and were more likely to feel confident performing fertility procedures after residency (P = .001).3 For trainees, their career depends on what they are exposed to. Smaller subdisciplines within urology may be more difficult to teach uniformly, and perhaps there are ways to improve the exposure to these areas for motivated residents (eg, visiting other programs).

Within male sexual health, one disease process that all urologists should be able to diagnose and initially manage is erectile dysfunction (ED). With studies citing the prevalence of ED as high as 52%, the demand for providers to manage ED remains sky high. Current treatment options include phosphodiesterase type 5 inhibitors (PDE5is), intracavernosal injections, vacuum erection devices, and penile prosthesis. A newcomer to the field is shock wave therapy, which uses controlled energy to induce angiogenesis.

The short-term effectiveness of focused shock wave therapy for patients with moderate ED was investigated in a double-blind, randomized, sham-controlled trial.4 In this study of 70 patients with moderate ED, 35 were randomly assigned to low-intensity shock wave therapy (LiST) and the other 35 were randomly assigned to sham therapy. After a 4 week washout from PDE5i, patients underwent LiST or sham twice weekly for 6 weeks. One month after treatment completion, 59% patients in the LiST group experienced an International Index of Erectile Function (IIEF) score improvement of at least 5 points, compared with 1 patient (2.9%) in the sham group (P < .001). This effect remained present at 3 months post treatment. Thus, the short-term data for LiST are compelling and suggest this may be a viable option in the management of vasculogenic ED for men with mild/moderate ED. Further studies are desperately needed to validate these findings, and urologists have an obligation to provide patients with an honest assessment of the data and only recommend treatments where the risks (including the financial burden) are outweighed by the benefits.

In stark contrast to focused therapy, radial shock wave therapy uses low-pressure radial shock waves to treat ED. In order to characterize its effectiveness, a randomized, double-blind, sham-controlled clinical trial enrolled 80 men with mild to moderate ED.5 Patients were treated weekly with either radial wave therapy or sham therapy for 6 weeks, and the primary outcome measured was change in the IIEF score between baseline and after treatment. Study results showed that there was no significant difference in IIEF scores between groups at 6 weeks or 10 weeks after randomization. Study results displayed the lack of evidence to support the use of radial wave therapy.

Despite the evidence of their ineffectiveness in managing ED, shock wave therapy and particularly radial wave therapy have been heavily marketed directly to consumers in the US. A recent article using a “secret-shopper” method found troubling marketing and practice trends in the US. The authors noted that patients often are not adequately educated on the different types of treatments and may not know if the administrator is a licensed medical professional.6 With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness.

Recent advancements in the field of male sexual health and reproduction present a bright future for the field with new diagnostic and therapeutic options on the horizon. However, it is apparent that demand still outpaces supply for men’s health specialty care. Urologists must work diligently to fill this void to not only increase access for patients to receive evidence-based care, but also to prevent men from falling to prey to practices looking to take advantage of this unmet demand and a vulnerable patient population.

References

1. Jensen CFS, Ohl DA, Fode M, et al. Microdissection testicular sperm extraction versus multiple needle-pass percutaneous testicular sperm aspiration in men with nonobstructive azoospermia: a randomized clinical trial. Eur Urol. Published online May 19, 2022. doi:10.1016/j.eururo.2022.04.030

2. Lee R, Witherspoon L, Robinson M, et al. Automated rare sperm identification from low-magnification microscopy images of dissociated microsurgical testicular sperm extraction samples using deep learning. Fertil Steril. 2022;118(1):90-99. doi:10.1016/j.fertnstert.2022.03.011

3. Asanad K, Nusbaum D, Fuchs G, Rodman JCS, Samplaski MK. The impact of male infertility faculty on urology residency training. Andrologia. 2022;54(8):e14457. doi:10.1111/and.14457

4. Kalyvianakis D, Mykoniatis I, Pyrgidis N, et al. The effect of low-intensity shock wave therapy on moderate erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial. J Urol. 2022;208(2):388-395. doi:10.1097/JU.0000000000002684

5. Sandoval-Salinas C, Saffon JP, Martínez JM, Corredor HA, Gallego A. Are radial pressure waves effective for the treatment of moderate or mild to moderate erectile dysfunction? A randomized sham therapy controlled clinical trial. J Sex Med. 2022;19(5):738-744. doi:10.1016/j.jsxm.2022.02.010

6. Weinberger JM, Shahinyan GK, Yang SC, et al. Shock wave therapy for erectile dysfunction: marketing and practice trends in major metropolitan areas in the United States. Urol Pract. 2022;9(3):212-219. doi:10.1097/UPJ.0000000000000299