8 Natural Remedies for Erectile Dysfunction (ED, Impotence)

Throughout history, men have used various natural remedies to combat erectile dysfunction (ED), which is the recurring inability to achieve or maintain an erection firm enough for sexual intercourse. However, the effectiveness of these remedies remains uncertain from a scientific perspective. Moreover, it is important to note that using these remedies carries risks, as their safety profiles have not been established. Here, we present commentaries by experts and reviews of alternative treatments that can be purchased over the counter for ED and impotence.

Causes of Erectile Dysfunction (Impotence)

While impotence can arise at any age, the likelihood of developing it increases as one grows older. It is crucial to exclude any underlying medical conditions before embarking on a naturopathic path, cautions Andrew McCullough, MD, an associate professor of clinical urology at New York University Langone Medical Center and one of the original clinical investigators for the ED drug Viagra. A staggering 30 million American men experience erection problems, and 70% of these cases occur due to conditions that obstruct blood flow, such as atherosclerosis, kidney disease, vascular disease, neurological disease, or diabetes. Additionally, certain medications, surgical injuries, and psychological issues can contribute to ED.

Erectile Dysfunction Drugs

The consensus among experts is that self-treatment for ED without consulting a doctor is unsafe. "If you suffer from ED, seeking a diagnosis should be the first step," says impotence expert Steven Lamm, MD, author of The Hardness Factor and other books on male sexual health. Severe ED typically requires prescription drugs such as Levitra, Cialis, Stendra, or Viagra. However, mild ED, which includes the sensation of not achieving maximum hardness, often responds to natural remedies.

Natural Treatment of Erectile Dysfunction without Drugs

Acupuncture. The use of acupuncture for male sexual problems dates back centuries, but the scientific evidence supporting its effectiveness for treating ED remains inconclusive. A 2009 systematic review of acupuncture studies for ED found significant design flaws in all of them, leading to a conclusion that "the evidence is not enough to confirm acupuncture as an effective intervention for ED."

Arginine. L-arginine, an amino acid present in certain foods, stimulates the body’s production of nitric oxide, a compound that facilitates erections by widening blood vessels and increasing blood flow to the penis. Studies on L-arginine’s effectiveness against impotence have produced mixed results. For instance, a 1999 trial published in BJU International found that high doses of L-arginine improved sexual function in men with abnormal nitric oxide metabolism associated with cardiovascular disease. Similarly, a 2003 study in the Journal of Sex & Marital Therapy reported significant improvements in sexual function without side effects in ED patients who took L-arginine alongside pine extract pycnogenol. However, it is important for men with known cardiovascular issues to use L-arginine only under medical supervision, as it may interact with certain medications.

DHEA (Dehydroepiandrosterone). Testosterone plays a critical role in a healthy libido and normal sexual function. Low testosterone levels in men with ED improve when they receive prescription testosterone replacement therapy. Similarly, over-the-counter DHEA supplements, which the body converts into testosterone and estrogen, have been shown to alleviate some cases of ED. However, DHEA can cause side effects such as pituitary function suppression, acne, hair loss, and its long-term safety remains unknown. Many experts therefore discourage the use of DHEA supplements.

Ginseng. While Korean red ginseng has been used for centuries to enhance male sexual function, there is a lack of systematic studies confirming its benefits. In a 2002 study involving 45 men with significant ED, the herb demonstrated potential in improving symptoms of erectile dysfunction and penile rigidity. The precise mechanism of action of red ginseng remains unclear, but it is believed to promote nitric oxide synthesis. However, before taking ginseng, it is advisable to consult with a doctor, as it can interact with existing medications and cause allergic reactions.

Pomegranate Juice. The consumption of antioxidant-rich pomegranate juice has been linked to various health benefits, such as reduced risks of heart disease and high blood pressure. Although there is no concrete evidence supporting its protective effects against ED, a promising small-scale pilot study conducted in 2007 called for further research to investigate pomegranate juice’s efficacy in treating erectile dysfunction. "I recommend my patients to try it," says Geo Espinosa, ND, director of the Integrative Urological Center at NYU Langone Medical Center. "It has the potential to improve ED, and even if it doesn’t, it offers other health benefits."

Yohimbe. Before the availability of prescription erectile dysfunction drugs like Viagra, doctors occasionally prescribed a derivative of the herb yohimbe (yohimbine hydrochloride) to ED patients. However, experts agree that this medication is not particularly effective and can cause jitteriness and other adverse effects. "It’s not a remarkable drug," states McCullough. "In fact, I suspect that yohimbe’s potency is inferior to that of its pharmaceutical counterpart." Furthermore, evidence suggests that yohimbe is associated with high blood pressure, anxiety, headaches, and other health problems. Experts strongly discourage its use.

Horny Goat Weed. Horny goat weed (Epimedium) and related herbs have traditionally been used to treat sexual dysfunction. Italian researchers found that icariin, the main compound in horny goat weed, acts similarly to drugs like sildenafil.

Ginkgo Biloba. Ginkgo, primarily known as a herbal treatment for cognitive decline, has also been used to manage erectile dysfunction, particularly cases caused by certain antidepressant medications. However, the evidence supporting its efficacy is not convincing. A 1998 study published in the Journal of Sex & Marital Therapy reported positive results, but a more rigorous study published in Human Pharmacology in 2002 failed to replicate these findings. "Ginkgo has fallen out of favor in recent years," says Ronald Tamler, MD, assistant professor of medicine and co-director of the men’s health program at Mount Sinai Medical Center. "That’s because it doesn’t do much. In my practice, I have never seen ginkgo work."

Other unproven herbal remedies, dietary supplements, and natural treatments for ED include panax, propionyl-L-carnitine, L-citrulline, pomegranate, rhodiola rosea, golden root, Indian ginseng, zinc supplements, and ashwagandha.

Lifestyle Changes to Improve Erectile Dysfunction

Regardless of the chosen treatment for erectile dysfunction, it is vital to adopt a healthy diet, quit smoking, limit alcohol consumption, engage in regular physical activity, manage stress, and ensure sufficient sleep. Lamm emphasizes the importance of having a responsive and supportive partner. "After all, this remains a concern for both partners in a relationship," he notes.

Sources: Chen, J. BJU International 83 (1999): 269-273; "Erectile Dysfunction." National Kidney and Urologic Disease Information Clearinghouse; Espinosa, Geo. Integrative Urological Center, NYU Langone Medical Center; Lamm, Steven. The Hardness Factor (Harper Collins); Lee, M.S. BJU International, Feb. 23, 2009; McCullough, Andrew. NYU Langone Medical Center; Shabsigh, Ridwan, et al. "A Multicenter, Double-blind, Placebo-controlled Trial to Assess The Efficacy of Sildenafil Citrate in Men With Unrecognized Erectile Dysfunction." Urology 76.2 Aug. 2010: 373-379; Stanislov, R. Journal of Sex & Marital Therapy 29 (2003): 207-213; Tamler, Ronald. Men’s Health Program, Mount Sinai Medical Center, New York City.