What are the Alternatives to Viagra That Won’t Fall Flat

Viagra is a multi-billion dollar blockbuster drug, but it has serious side effects. Thankfully evidence-based natural alternatives abound…

Erectile dysfunction is no trivial matter. In fact, Dr. Mercola correctly labeled it ‘the canary in the trousers,’ insofar as dysfunction ‘where it counts’ reflects body-wide endothelial dysfunction, a well known precursor to cardiovascular disease.

But putting aside its importance for overall health, the male ego depends in large part on the ability to ‘get it up,’ and when things don’t work out as planned, quite a lot can go wrong as far as intimacy is concerned. It has been said that when sexual issues emerge in a relationship, they take on 90% importance, but when they aren’t an issue, they only figure 10% in the overall success of the relationship.

Men, especially in the 35-45 range, also are faced with what is known as andropause, as the levels of key ‘erotic’ hormones such as testosterone and human growth hormones start to take a precipitous decline.

The pharmaceutical industry has capitalized heavily on this ‘change of life’ phase, with Viagra taking on a ‘pole position’ for several decades.   But these pharmaceuticals have severe, if not sometimes deadly side effects. All the more reason why natural alternatives are in great need today.

So, what does the ‘hard evidence’ itself have to say on the topic of natural alternatives. Take a moment to look at what we have found:

• L-arginine: #1 on the list is the amino acid l-arginine. A precursor to nitric oxide, this conditionally non-essential amino acid is especially important in times of trauma or stress. What makes is ‘conditionally essential’ is that while the body can normally produce adequate quantities, during times of stress (including burn trauma), the body is unable to produce sufficient quantities, at which time supplementation is of key importance. Also, when the arteries undergo what is called ‘endothelial dysfunction,’ and are incapable of dilating sufficiently, adding additional l-arginine can correct the condition by inducing nitric oxide up-regulation, subsequently increasing blood flow, which can lead to resolution of cardiovascular dysfunction, including erectile dysfunction. We have indexed no less than six clinical studies on l-arginine, either alone or in combination with another nutraceutical, indicating it can contribute to a reversal of erectile dysfunction. 
• Pycnogenol: This amazing substance has a wide range of health benefits. In fact, we have indexed over 80 evidence-based health applications here. When it comes to erectile dysfunction, pycnogenol figures as a profound synergist, working to amplify the benefits of l-arginine to the point where two separate clinical studies found the combination highly effective and safe in resolving erectile dysfunction.[1][2]
• Panax Ginseng: This amazing Asian herb has been used for thousands of years to increase stamina and longevity. There is now a sizable body of scientific evidence supporting its traditional folkoric use, with a 2008 meta-analysis of the extant research on the topic, which looked at 7 randomized clinical trials to ascertain its value in erectile dysfunction, concluding: “Collectively these RCTs provide suggestive evidence for the effectiveness of red ginseng in the treatment of erectile dysfunction.”[3]
• Maca: this South American tuber, both a food and medicine, and long identified as a means to increasing fertility and libido in both men and woman, was found in a 2009 clinical trial to have a significant effect “…on subjective perception of general and sexual well-being in adult patients with mild ED.”[4]
• Tongkat Ali (Eurycoma longifolia): Like most traditional herbs, Tongkat Ali has had a variety of traditional uses, including as an “antimalarial, aphrodisiac, antidiabetic, antimicrobial, and antipyretic [fever-reducer].”[5] As far as its libido enhancing properties, two preclinical trials have found it effective in the animal model at improving sexual performance, confirming its aphrodisiacal properites.[6],[7]
• Saffron: this sacred spice, highly prized as both a culinary ingredient and medicine, has been studied to have significant effects in reversing erectile dysfunction at doses of 200 mg a day. A 2009 study found: “Saffron showed a positive effect on sexual function with increased number and duration of erectile events seen in patients with ED even only after taking it for ten days.”[8]
• Yohimbe: This potent herb has been found effective when combined with l-arginine to improve erectile dysfunction. A 2002 study concluded: “oral administration of the L-arginine glutamate 6g and 6 mg yohimbine combination is effective in improving erectile function in patients with mild to moderate ED.”[9] [Warning: Yohimbe and its active ingredient yohimbine is a potent nutraceutical with possible severe side effects such as hypertension. It is advisable to use it only under the guidance of a physician or medical herbalist to avoid possible side effects, especially if already using prescription drugs.]
• Tribulis: This potent herb has libido enhancing properties for both men and women. We recently featured a study showing it helps women to increase their libido. The preclinical research on male libido is promising, with no less than three studies indicating its benefits for erectile dysfunction.[10][11][12]
• Green Tea: A highly provocative animal study from 2008 indicates that green tea may address both the origin of erectile dysfunction by diminishing atherosclerotic progression in the corpus cavernosum of the male rat penis, subsequently indicating improvement in both erectile dysfunction and cardiovascular health.[13] This is, in fact, not the first study to show that green tea can correct endothelial dysfunction.[14]
• Exercise: One of the best ways to improve your body image, self-esteem, and sexual vitality is through exercise. A 2009 study found that physical inactivity contributes to erectile dysfunction – essentially a no-brainer.[15]
• A Sense of Humor: Living life with a negative attitude, especially when afflicted with a health condition, doesn’t reflect well as far as sexuality is concerned. A remarkable 2008 study found that viewing humorous films in patients with atopic dermatitis leads to short-term improvement of erectile dysfunction.[16] While we don’t know for sure if this study extends to everyone with the condition, it is instructive, perhaps, to look at a degree of levity and light-heartedness as an essential precondition to alleviating some degree of sexual dysfunction.  Sex should be fun, right? So lighten up by increasing you humor and joy, whenever possible.
• AVOID STATIN DRUGS: One of the primary precepts of functional medicine is to avoid the cause of disease, rather than just suppress the symptoms. Statin drugs are well-known to adversely affect the male gonads, as well as reducing both testosterone and libido, leading to the well known consequence of statin-induced erectile dysfunction. Take a look at these 7 clinical studies if you need convincing that this side effect is read.Were statins effective at preventing heart disease, it would be difficult to reject them. But the fact that they are cardiotoxic makes it all the more questionable to continue on them, especially considering the severe quality of life issues they generate, including erectile dysfunction. Please share with your physician our research page on the 300+ adverse effects of statins to come up with a more reasonable approach to cardiovascular disease prevention.
• AVOID Anti-Depressants: Perhaps surprisingly, antidepressant drugs have been found to be a major cause of sexual dysfunction. A 2006 study found that selective serotonin reuptake inhibitors (SSRIs), e.g. Prozac, Paxil, are associated with sexual dysfunction in 95.6% of women and 97.9% men.[17] What a misnomer! What could be more depressing than killing your sexual desire with a pharmaceutical Band-Aid?

Ultimately, sexual dysfunction begins in the brain. Nothing can eliminate a dysfunctional relationship or a lack of intimacy that often follows from it. While natural interventions exist – Ginseng, Arginine, Tribulus, etc. – it should be remembered that that erectile dysfunction stems from more than just physiological issues. A lack of desire may reflect a lack of appreciation for one’s own self, body image, or sense of sensuality. Nonetheless, it is good to know that alternatives to pharmaceuticals like Viagra exist, and are evidence-based, safer and time-tested. Moreover, it is important to acknowledge that the ‘canary in the trousers’ often reflects cardiovascular dysfunction body-wide, and the best way to address that is through a radical transformation of the diet, focusing on a grain and dairy-free ancestral diet rich in high nutrient, low carbohydrate vegetables, tubers and fruits and berries, as well as high quality natural fats and protein sources that are consistent with our biological heritage.

Article References

[1] Andrea Ledda, Gianni Belcaro, Maria R Cesarone, Mark Dugall, Frank Schönlau.Investigation of a complex plant extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study. BJU Int. 2010 Feb 22. Epub 2010 Feb 22. PMID: 20184576

[2] Hiromitsu Aoki, Junji Nagao, Taro Ueda, Jeffry M Strong, Frank Schonlau, Song Yu-Jing, Yan Lu, Shigeo Horie. Clinical assessment of a supplement of Pycnogenol ® and L-arginine in Japanese patients with mild to moderate erectile dysfunction. Phytother Res. 2012 Feb ;26(2):204-7. Epub 2011 May 27. PMID: 21618639

[3] Dai-Ja Jang, Myeong Soo Lee, Byung-Cheul Shin, Young-Cheoul Lee, Edzard Ernst. Red ginseng for treating erectile dysfunction: a systematic review. Br J Clin Pharmacol. 2008 Oct;66(4):444-50. Epub 2008 Jun 9. PMID: 18754850

[4] T Zenico, A F G Cicero, L Valmorri, M Mercuriali, E Bercovich. Subjective effects of Lepidium meyenii (Maca) extract on well-being and sexual performances in patients with mild erectile dysfunction: a randomised, double-blind clinical trial. Andrologia. 2009 Apr;41(2):95-9. PMID: 19260845

[5] Bhat, R; Karim, AA (2010). “Tongkat Ali (Eurycoma longifolia Jack): a review on its ethnobotany and pharmacological importance”. Fitoterapia 81 (7): 669–79.doi:10.1016/j.fitote.2010.04.006. PMID  20434529.

[6] P Zanoli, M Zavatti, C Montanari, M Baraldi. Influence of Eurycoma longifolia on the copulatory activity of sexually sluggish and impotent male rats. J Ethnopharmacol. 2009 Nov 12;126(2):308-13. Epub 2009 Aug 22. PMID: 19703544

[7] Hooi Hoon Ang, Kheng Leng Lee, Matsumoto Kiyoshi. Sexual arousal in sexually sluggish old male rats after oral administration of Eurycoma longifolia Jack. J Basic Clin Physiol Pharmacol. 2004;15(3-4):303-9. PMID: 15803965

[8] Ali Shamsa, Hossein Hosseinzadeh, Mahmood Molaei, Mohammad Taghi Shakeri, Omid Rajabi. Evaluation of Crocus sativus L. (saffron) on male erectile dysfunction: a pilot study.Phytomedicine. 2009 Aug;16(8):690-3. Epub 2009 May 9. PMID: 19427775

[9] Thierry Lebret, Jean-Marie Hervé, Philippe Gorny, Manuel Worcel, Henry Botto. Efficacy and safety of a novel combination of L-arginine glutamate and yohimbine hydrochloride: a new oral therapy for erectile dysfunction. Eur Urol. 2002 Jun;41(6):608-13; discussion 613. PMID:12074777

[10] P G Adaikan, K Gauthaman, R N Prasad, S C Ng. Proerectile pharmacological effects of Tribulus terrestris extract on the rabbit corpus cavernosum. Ann Acad Med Singapore. 2000 Jan;29(1):22-6. PMID: 10748960

[11] Sung Chul Kam, Jung Mo Do, Jae Hwi Choi, Byeong Tak Jeon, Gu Seob Roh, Jae Seog Hyun. In vivo and in vitro animal investigation of the effect of a mixture of herbal extracts from Tribulus terrestris and Cornus officinalis on penile erection. J Sex Med. 2012 Oct ;9(10):2544-51. Epub 2012 Aug 20. PMID: 22906304

[12] Kalamegam Gauthaman, Adaikan P Ganesan. The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction–an evaluation using primates, rabbit and rat. Phytomedicine. 2008 Jan;15(1-2):44-54. PMID: 18068966

[13] D Neves, M Assunçà£o, F Marques, J P Andrade, H Almeida. Does regular consumption of green tea influence expression of vascular endothelial growth factor and its receptor in aged rat erectile tissue? Possible implications for vasculogenic erectile dysfunction progression. Age (Dordr). 2008 Dec;30(4):217-28. Epub 2008 Apr 18. PMID: 19424845

[14] Greenmedinfo.com, Green Tea Corrects Endothelial Dysfunction

[15] Johanna L Hannan, M Tina Maio, Marina Komolova, Michael A Adams. Beneficial impact of exercise and obesity interventions on erectile function and its risk factors. J Sex Med. 2009 Mar;6 Suppl 3:254-61. PMID: 19170860

[16] Hajime Kimata. Short-term improvement of erectile dysfunction by viewing humorous films in patients with atopic dermatitis. J Sex Med. 2008 Sep;5(9):2107-10. Epub 2008 Feb 4. PMID:18266651

[17] Anita Clayton, Adrienne Keller, Elizabeth L McGarvey. Burden of phase-specific sexual dysfunction with SSRIs. J Affect Disord. 2006 Mar;91(1):27-32. Epub 2006 Jan 20. PMID:16430968

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