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Erectile Dysfunction Erectile dysfunction (ED), or impotence, is the inability to achieve an erection. Erection occurs when the blood flow to the penis increases when a man becomes sexually aroused. Blood vessels going to the penis dilate, and blood fills the penis causing it to become engorged. This occurs via the secretion of a chemical called nitric oxide (NO). An erection will typically last until arousal is diminished, or orgasm is achieved. Many conditions can affect erection, especially conditions that can compromise blood flow to the penis. These include physical conditions such as diabetes and vascular disease. Psychological conditions may also have a bearing on the initiation and maintenance of an erection. Erectile dysfunction is more prevalent than it may seem. It occurs to some degree in up to 40% of men 40 years old, and up to 67% in those age 70. It is a significant area of research for the pharmaceutical industry. The first aids for ED were mechanical devices: vacuum pumps that draw blood into the penis and implantable balloons or rods. Viagra was the first prescription drug for ED, but it has significant side effects, and should not be used in people with heart disease. Recently, more attention has been focused on natural and herbal remedies, which seem to be effective yet have fewer side effects. Supplements That May Be Useful in the treatment of Erectile Dysfunction:

DHEA: A study looked at levels of DHEA in men over the age of 60. It was found that those with ED had lower levels of DHEA then in those without ED. Supplementation with DHEA at a dose of 50 mg daily improved symptoms of ED in a small group of patients with this disorder². L-Arginine: This amino acid is a precursor to nitric oxide (NO). High dose arginine (5 grams per day given for 6 weeks) has been shown to improve erection in men with ED³. It is generally safe and well tolerated. Doses of 3 grams per day also seem to be beneficial. Arginine at doses of up to 3 grams three times daily has beneficial effects on cardiac blood vessel reactivity. It also may improve cardiac function in those with congestive heart failure⁴, and may be useful to patients with a history of heart disease. Horny Goat Weed (Yin Yang Huo): This herbal agent derived its name from the observation that when goats were grazing on this weed, they became sexually aroused. It has several uses in Traditional Chinese Medicine, including impotence, involuntary ejaculation, fatigue, cardiac disease polio and hepatitis⁵. It contains a number of active constituents, and some of those appear to have both hormonal and blood vessel dilating properties⁶. There have been no human trials done published in English. The four available human studies have been published in Chinese. Three of these were done in people with kidney failure. The studies showed improvement in men with Erectile Dysfunction (ED) in 76% of cases in the study done on people with normal kidney function. The usual recommended dosage is 0.5 to 1.5 mg per day of a formulation standardized to 5% icariin flavonoid. Animal studies have shown it to be basically safe. Some side effects may include dizziness, nausea, dry mouth and nosebleed⁷. Ginkgo Biloba: Ginkgo appears to help increase arterial blood flow, and may have a beneficial effect on sexual function in men with impotence⁸. One study in men with ED secondary to medication revealed a 76% improvement in sexual function. The dosage used in this study was 200 mg per day in divided doses⁹. Other herbs: Muira Puama Root: This is a shrub native to Brazil, and has a long history of use as an aphrodisiac. It reportedly improves libido as well as potency. An unpublished study from France reports that at a daily dose of 1 to 1.5 grams of the extract, 62 percent of patients with loss of libido had significant improvement while 51 percent of patients with ED felt that Muira Puama was of benefit^11-14. Damiana and Ginseng have also been traditionally used for male erectile dysfunction, however this is based on traditional use, and no scientific studies have been performed. Yohimbe has been shown to marginally improve erectile dysfunction compared to placebo, however it is associated with significant side effects in people with hypertension and coronary artery disease, and should not be used in people with these medical problems^11-14. References:

1. Reiter WJ; Pycha A; Schatzl G; Klingler HC; Mark I; Auterith A; Marberger M . Serum dehydroepiandrosterone sulfate concentrations in men with erectile dysfunction. Urology 2000 May;55(5):755-8.
2. Reiter WJ, Pycha A, Schatzl G, et al. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective double-blind, randomized, placebo-controlled study. Urology. 1999;53:590-595.
3. Chen J, Wollman Y, Chernichovsky T, et al. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized placebo-controlled study. BJU Int. 1999;83:269-273.
4. Sorrentino M. Oral L-Arginine for improving vascular function in hypercholesterolemia, PVD and Atherosclerotic heart disease. Alternative Medicine Alert. Vol. 2, No. 11: 121-123, 1999.
5. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley and Sons: 1996.
6. Huang KC. Yin Yang Huo. In: The Pharmacology of Chinese Herbs. Boca Raton, FL. CRC Press; 1999.
7. Ciriglianno MD, Szapary PO. Horny goat weed for erectile dysfunction. Alternative Medicine Alert.Vol. 4 No. 2. 2001; 19-21.
8. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sec Educ Ther 1991;17:53-61.
9. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139-43.
10. 1993 GAIA SYMPOSIUM PROCEEDINGS, NATUROPATHIC HERBAL MEDICINE, "Herbal Healing Wisdom for the Future" May 29-31, 1993
11. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433-6.
12. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder: Four meta-analytic integrations. Arch Sex Behav 1996;25:341.
13. Kunelius P, Häkkinen J, Lukkarinen O. Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study. Urol 1997;49:441-4.
14. Mann K, Klingler T, Noe S, et al. Effect of yohimbine on sexual experiences and nocturnal tumescence and rigidity in erectile dysfunction. Arch Sex Behav 1996;25:1-16.

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