Natural alternatives to Viagra: do herbal treatments work?
If you’ve ever visited a gas station, you’ve likely seen a product or two offering “male enhancement” at the checkout counter. Pills like these are marketed as a natural, no-prescription-necessary alternative to treating erectile dysfunction (ED). But do they work?
When it comes to gas station pills, the answer is probably no. However, if you’re looking for natural alternatives to Viagra, some supplements may improve symptoms of erectile dysfunction. More research is needed, but natural alternatives to Viagra including red ginseng, yohimbe, and more could potentially increase your libido and/or improve erectile function.
Treat erectile dysfunction for up to 95% less than the cost of Viagra®
Treat erectile dysfunction for up to 95% less than the cost of Viagra®
What is natural Viagra?
The term “natural Viagra,” refers to a supplement or ingredient that treats ED similarly to medications like Viagra (generic name sildenafil; see Important Safety Information).
In order to understand what natural Viagra does (or what it’s supposed to do), let’s look at how this prescription medication works. To keep it brief, Viagra belongs to a class of drugs called PDE5 inhibitors. These drugs work by blocking the enzyme PDE5, which causes blood to leave an erect penis. In other words, it helps you stay hard.
Natural Viagra supplements make similar claims. But, like all supplements, those claiming to be a form of herbal Viagra aren’t regulated by the U.S. Food and Drug Administration (FDA). That means you can’t be sure of their purity or strength. Not only could these products be ineffective, they could also be dangerous for some people.
However, some natural remedies for ED have shown promise in early scientific studies.
5 Natural alternatives to Viagra
If you’re looking for a drug-free ED remedy, there are some supplements and herbs that may mimic the effects of their prescription counterpart, Viagra.
1. Horny goat weed
Horny goat weed is a medicinal herb that has been used in traditional Chinese medicine for thousands of years to treat fatigue and low libido.
Some anecdotal reports and studies suggest horny goat weed might help address ED by improving erections. Horny goat weed contains icariin, a mild inhibitor of PDE5, which is how Viagra works (Dell’Agli, 2008).
However, studies on the effects of icariin have only been conducted on animals and petri dishes, meaning it might not work the same way in the human body. No clinical trials on horny goat weed’s effect on ED in humans have been conducted.
2. Korean red ginseng
Korean ginseng has been touted as an ED treatment for years, and unlike some other natural alternatives to Viagra, studies have found it may actually be effective at alleviating symptoms of ED.
In a meta-analysis involving over 2,000 men with ED, researchers found that red ginseng improved erectile function in participants. While results are promising, authors of the study did caution that more studies are needed before red ginseng is touted as the next herbal Viagra (Borrelli, 2018).
3. Yohimbe
Yohimbe is a dietary supplement made from the bark of an African evergreen tree. Yohimbine, the active ingredient in yohimbe bark, is a common ingredient in supplements sold as aphrodisiacs and male sexual enhancers.
A 2014 review of studies determined that yohimbine was superior to placebo for treatment of ED, but it has yet to be compared to PDE5 inhibitors like Viagra (Corazza, 2014).
4. DHEA
One of the causes of ED is low testosterone. Dehydroepiandrosterone, or DHEA for short, is a hormone produced in the adrenal glands, which sit atop the kidneys. In our bodies, DHEA boosts certain hormones, like testosterone.
But, studies on the use of DHEA supplements to boost testosterone have been mixed. While some research shows that the supplement causes testosterone levels to rise, others found the supplement had no effect (Liu, 2013). And either way, there’s no clear evidence that DHEA will boost testosterone in a way that has any meaningful effect on symptoms of ED (Morales, 2009).
5. L-citrulline and L-arginine
Some researchers believe that L-citrulline, an amino acid, can cause blood vessels to relax similarly to how Viagra works. It’s the precursor of L-arginine, another amino acid that has been shown to improve blood flow (Cormio, 2011).
A large analysis that looked at ten studies including 540 participants found that there was potential for L-arginine to help with ED. The researchers found that dosages between 1500 mg and 5000 mg offered significant improvements in ED over placebo and participants had higher self-reported scores of sexual satisfaction and erectile function (Rhim, 2019).
Other Viagra alternatives
If natural alternatives to Viagra aren’t for you, there are other options to help with ED (Sooriyamoorthy, 2022):
Medical devices
Several medical devices can be helpful for ED, including penis pumps and cock rings. A penis pump works by drawing blood into the penis, giving you harder erections. A cock ring is placed around the base of the penis (or around the penis and testicles) to keep blood from flowing out once it’s entered. This can help erections stay firm and last longer.
Penis implants—which include a rod, semi-rigid implant, or one that can be inflated before sex—are also an option. These devices are typically reserved for extreme cases of ED.
Lifestyle changes
Lifestyle changes like exercising regularly, eating a heart-healthy diet, and avoiding alcohol and smoking (both of which can damage blood vessels and nerves that produce a healthy erection) can also help with symptoms of ED. Regardless of whether you’re taking Viagra or a natural alternative to Viagra, these lifestyle changes can have a significant effect on your ability to get and maintain an erection.
Other erectile dysfunction medications
Natural alternatives to Viagra or devices aren’t your only choices to treat ED. Other PDE5 inhibitors – like Cialis (tadalafil; see Important Safety Information) and Levitra (vardenafil), or non-oral ED medications like alprostadil, which is injected into the penis or placed in the urethra as a suppository, may be a better fit for you (Sooriyamoorthy, 2022).
If low testosterone is the cause of your ED, testosterone replacement therapy (TRT) may be successful to treat ED. TRT comes as a patch, gel, or injection (Sooriyamoorthy, 2022).
When it comes to natural alternatives to Viagra, you have options. But, before taking any supplements that claim to treat ED, speak with a healthcare provider. They can help rule out any serious underlying medical condition that may cause ED and develop a safe and effective treatment plan for you.
Disclaimer
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
References
- Borrelli, F., Colalto, C., Delfino, D. V., et al. (2018). Herbal dietary supplements for erectile dysfunction: a systematic review and meta-analysis. Drugs, 78(6), 643–673. doi: 10.1007/s40265-018-0897-3. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29633089/
- Corazza, O., Martinotti, G., Santacroce, R., et al. (2014). Sexual enhancement products for sale online: raising awareness of the psychoactive effects of yohimbine, maca, horny goat weed, and Ginkgo biloba. BioMed Research International, 2014, 841798. doi:10.1155/2014/841798. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082836/
- Cormio, L., De Siati, M., Lorusso, F., et al. (2011). Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction. Urology, 77(1), 119–122. doi: 10.1016/j.urology.2010.08.028. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21195829/
- Cui, T., Kovell, R. C., Brooks, D. C., et al. (2015). A Urologists Guide to Ingredients Found in Top-Selling Nutraceuticals for Men’s Sexual Health. The Journal of Sexual Medicine, 12(11), 2105–2117. doi: 10.1111/jsm.13013. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26531010/
- Dell’Agli, M., Galli, G. V., Dal Cero, E., et al. (2008). Potent inhibition of human phosphodiesterase-5 by icariin derivatives. Journal of Natural Products, 71(9), 1513–1517. doi: 10.1021/np800049y. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18778098/
- Liu, T.-C., Lin, C.-H., Huang, C.-Y., et al. (2013). Effect of acute DHEA administration on free testosterone in middle-aged and young men following high-intensity interval training. European Journal of Applied Physiology, 113(7), 1783–1792. doi: 10.1007/s00421-013-2607-x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23417481/
- Morales, A., Black, A., Emerson, L., et al. (2009). Androgens and sexual function: a placebo-controlled, randomized, double-blind study of testosterone vs. dehydroepiandrosterone in men with sexual dysfunction and androgen deficiency. The Aging Male : The Official Journal of the International Society for the Study of the Aging Male, 12(4), 104–112. doi: 10.3109/13685530903294388. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19883295/
- Smith, B. P. & Babos, M. (2022). Sildenafil. StatPearls. Retrieved on Jan. 31, 2023 from https://pubmed.ncbi.nlm.nih.gov/32644404/
- Sooriyamoorthy, T. & Leslie, S. (2022). Erectile Dysfunction. StatPearls. Retrieved on Jan. 31, 2023 from https://pubmed.ncbi.nlm.nih.gov/32965924/
- Rhim, H. C., Kim, M. S., Park, Y., et al. (2019). The potential role of arginine supplements on erectile dysfunction: a systemic review and meta-analysis. The Journal of Sexual Medicine, 16(2), 223-234. doi:10.1016/j.jsxm.2018.12.002. Retrieved from https://www.jsm.jsexmed.org/article/S1743-6095(18)31362-6/pdf
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Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.
Viagra and nitrates: can you mix them?
Sexual dysfunction: what is it, causes, treatments
8 natural remedies and treatments for erectile dysfunction
How to get harder erections with or without medication
Important Safety Information for Sildenafil (Viagra)
What are the most important things I need to know about VIAGRA® (sildenafil citrate) 25 mg, 50 mg, and 100 mg tablets and generic VIAGRA®?
Discuss your health with your doctor to ensure that you are healthy enough for sex. If you experience chest pain, dizziness, or nausea during sex, seek immediate emergency medical attention.
- VIAGRA® and generic VIAGRA® can cause serious side effects. Serious, but rare, side effects include:
- an erection that will not go away (priapism). If you have an erection that lasts more than 4 hours, seek emergency medical attention right away. If it is not treated right away, priapism can permanently damage your penis.
- sudden vision loss in one or both eyes. Sudden vision loss in one or both eyes can be a sign of a serious eye problem called non-arteritic anterior ischemic optic neuropathy (NAION). Stop taking VIAGRA and call your healthcare provider right away if you have any sudden vision loss
- sudden hearing decrease or hearing loss. Some people may also have ringing in their ears (tinnitus) or dizziness. If you have these symptoms, stop taking VIAGRA and contact a doctor right away
Who should not take VIAGRA® or generic VIAGRA®?
Do not take VIAGRA® or generic VIAGRA® if you:
- Take any medicines called nitrates, often prescribed for chest pain, or guanylate cyclase stimulators like Adempas (riociguat) for pulmonary hypertension. Your blood pressure could drop to an unsafe level
- Are allergic to sildenafil, as contained in VIAGRA® and REVATIO®, or any of the ingredients in VIAGRA® or generic VIAGRA® tablets.
- Are a women or a child
When should I call my primary provider?
Call your primary provider right away if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both eyes
- Experience a sudden decrease in or loss of hearing
- Experience chest pain, dizziness, or nausea during sex
- Take too much Viagra or sildenafil citrate
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What are the most common side effects of VIAGRA® and generic VIAGRA®?
- headache
- flushing
- upset stomach
- abnormal vision, such as changes in color vision (such as having a blue color tinge) and blurred vision
- stuffy or runny nose
- back pain
- muscle pain
- nausea
- dizziness
- rash
What should I tell my Roman-affiliated provider before taking VIAGRA® and generic VIAGRA®?
Before you take VIAGRA® or generic VIAGRA® , tell your healthcare provider if you:
- Have or have had heart problems such as a heart attack,irregular heartbeat, angina, chest pain, narrowing of the aortic valve, or heart failure
- Have had heart surgery within the last 6 months
- Have pulmonary hypertension
- Have had a stroke
- Have low blood pressure, or high blood pressure that is not controlled
- Have a deformed penis shape
- Have had an erection that lasted for more than 4 hours
- Have problems with your blood cells such as sickle cell anemia, multiple myeloma, or leukemia
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including an eye problem called NAION
- Have bleeding problems
- Have or have had stomach or intestinal ulcers
- Have liver problems
- Have kidney problems or are having kidney dialysis
- Have any other medical conditions
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
VIAGRA may affect the way other medicines work, and other medicines may affect the way VIAGRA works, causing side effects.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators such as Adempas® (riociguat)
- Medicines called alpha-blockers such as Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), Jalyn® (dutasteride and tamsulosin HCl), or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. In some patients, the use of VIAGRA® with alpha-blockers can lead to a drop in blood pressure or to fainting
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir®), indinavir sulfate (Crixivan®), saquinavir (Fortovase® or Invirase®), or atazanavir sulfate (Reyataz®)
- Oral antifungal medicines, such as ketoconazole (Nizoral®) and itraconazole (Sporanox®)
- Antibiotics, such as clarithromycin (Biaxin®), telithromycin (Ketek®), or erythromycin
- Other medicines that treat high blood pressure
- Other medicines or treatments for ED
- VIAGRA® contains sildenafil, which is the same medicine found in another drug called REVATIO®. REVATIO® is used to treat a rare disease called pulmonary arterial hypertension (PAH). VIAGRA® should not be used with REVATIO® or with other PAH treatments containing sildenafil or any other PDE5 inhibitors (such as Adcirca [tadalafil])
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What is the FDA-approved use of VIAGRA® and generic VIAGRA®?
VIAGRA® (sildenafil citrate) is prescription medicine used to treat erectile dysfunction (ED).
Roman-affiliated doctors may prescribe VIAGRA® or generic VIAGRA® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment. While this is not an FDA-approved use of the drug, the American Urological Association has included the use of sildenafil citrate in the treatment of PE in its Guideline on the Pharmacologic Management of Premature Ejaculation.
You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see the full Prescribing Information for complete safety information.
Product names referenced herein are trademarks of their respective owners.
Important Safety Information for Tadalafil (Cialis)
What Is The Most Important Information I Should Know About CIALIS® (tadalafil) and generic CIALIS®?
- CIALIS® and generic CIALIS® can cause serious side effects. Serious, but rare, side effects include:
- An erection that won’t go away (priapism). If you get an erection that lasts more than 4 hours, get medical help right away. Priapism must be treated as soon as possible or lasting damage can happen to your penis, including the inability to have erections.
- Changes in vision. Color vision changes, such as seeing a blue tinge (shade) to objects or having difficulty telling the difference between the colors blue and green.
- Sudden decrease or loss of vision. In rare instances, men taking PDE5 inhibitors (oral erectile dysfunction medicines, including CIALIS® and generic CIALIS®) reported a sudden decrease or loss of vision in one or both eyes. It is uncertain whether PDE5 inhibitors directly cause the vision loss. If you experience sudden decrease or loss of vision, stop taking PDE5 inhibitors, including CIALIS® and generic CIALIS®, and call a healthcare provider right away.
- Sudden loss or decrease in hearing. Sudden loss or decrease in hearing, sometimes with ringing in the ears and dizziness, has been rarely reported in people taking PDE5 inhibitors, including CIALIS® and generic CIALIS®. It is not possible to determine whether these events are related directly to the PDE5 inhibitors, to other diseases or medications, to other factors, or to a combination of factors. If you experience these symptoms, stop taking CIALIS® and generic CIALIS® and contact a healthcare provider right away.
- ED is a condition where the penis does not fill with enough blood to harden and expand when a man is sexually excited, or when he cannot keep an erection. A man who has trouble getting or keeping an erection should see his healthcare provider for help if the condition bothers him.
- CIALIS® and generic CIALIS® help increase blood flow to the penis and may help men with ED get and keep an erection satisfactory for sexual activity. Once a man has completed sexual activity, blood flow to his penis decreases, and his erection goes away. Some form of sexual stimulation is needed for an erection to happen with CIALIS® or generic CIALIS®.
- CIALIS® and generic CIALIS® do not:
- Cure ED
- Increase a man’s sexual desire
- Protect a man or his partner from sexually transmitted diseases, including HIV. Speak to your healthcare provider about ways to guard against sexually transmitted diseases.
- Serve as a male form of birth control
- Take CIALIS® or generic CIALIS® exactly as your healthcare provider prescribes it. Your healthcare provider will prescribe the dose that is right for you. Do not change your dose or the way you take CIALIS® or generic CIALIS® without talking to your healthcare provider.
Who Should Not Take CIALIS® or generic CIALIS®?
Do not take CIALIS® or generic CIALIS® if you:
- Have severe liver disease. Tell your doctor if you have mild to moderate liver disease as you may need dosage reductions.
- Have severe kidney disease. Tell your doctor if you have mild to moderate kidney disease as you may need dosage reductions
- Take any medicines called “nitrates”
- Use recreational drugs called “poppers” like amyl nitrite and butyl nitrite
- Take any medicines called guanylate cyclase stimulators, such as riociguat
- Are allergic to CIALIS®, tadalafil or ADCIRCA®, or any of its ingredients
When should I call my primary provider?
Call your primary provider right away if you:
- Have an erection that lasts longer than 4 hours
- Experience a sudden loss of vision in one or both of your eyes
- Experience a sudden decrease or loss hearing
- Take too much CIALIS® or generic CIALIS®
- Have an allergic reaction to CIALIS® or generic CIALIS®
- Symptoms of an allergic reaction may include:
- Rash
- Hives
- Swelling of the lips, tongue, or throat
- Difficulty breathing or swallowing
Call your healthcare provider or get help right away if you have any of the symptoms of an allergic reaction listed above.
If you are experiencing a medical emergency, call 911 or seek immediate medical attention.
What Should I Tell My Roman-affiliated Provider Before Taking CIALIS® and generic CIALIS®?
Tell your Roman-affiliated provider about all your medical problems, including if you:
- Have heart problems such as angina, heart failure, irregular heartbeats, or have had a heart attack. Ask your healthcare provider if it is safe for you to have sexual activity. You should not take CIALIS® and generic CIALIS® if your healthcare provider has told you not to have sexual activity because of your health problems.
- Have pulmonary hypertension
- Have low blood pressure or have high blood pressure that is not controlled
- Have had a stroke
- Have liver problems
- Have kidney problems or require dialysis
- Have retinitis pigmentosa, a rare genetic (runs in families) eye disease
- Have ever had severe vision loss, including a condition called NAION
- Have stomach or intestinal ulcers
- Have a bleeding problem
- Have a deformed penis shape or Peyronie’s disease
- Have had an erection that lasted more than 4 hours
- Have blood cell problems such as sickle cell anemia, multiple myeloma, or leukemia
Tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.
Especially tell your healthcare provider if you take any of the following:
- Medicines called nitrates
- Medicines called guanylate cyclase stimulators, such as riociguat (Adempas®), used to treat pulmonary hypertension
- Medicines called alpha blockers. These include Hytrin® (terazosin HCl), Flomax® (tamsulosin HCl), Cardura® (doxazosin mesylate), Minipress® (prazosin HCl), Uroxatral® (alfuzosin HCl), 4 Jalyn® (dutasteride and tamsulosin HCl) or Rapaflo® (silodosin). Alpha-blockers are sometimes prescribed for prostate problems or high blood pressure. If CIALIS® or generic CIALIS® is taken with certain alpha blockers, your blood pressure could suddenly drop. You could get dizzy or faint.
- Other medicines to treat high blood pressure (hypertension)
- Medicines called HIV protease inhibitors, such as ritonavir (Norvir® , Kaletra® )
- Oral antifungals such as ketoconazole (Nizoral® ), itraconazole (Sporanox® )
- Antibiotics such as clarithromycin (Biaxin® ), telithromycin (Ketek® ), erythromycin (several brand names exist. Please consult your healthcare provider to determine if you are taking this medicine).
- Other medicines or treatments for ED.
- Tadalafil is also marketed as ADCIRCA® for the treatment of pulmonary arterial hypertension. Do not take both CIALIS® or generic CIALIS® and ADCIRCA®. Do not take sildenafil citrate (Revatio®, Viagra®) with CIALIS® or generic CIALIS®.
Withholding or providing inaccurate information about your health and medical history in order to obtain treatment may result in harm, including, in some cases, death.
What are the most common side effects of CIALIS® or generic CIALIS®?
The most common side effects with CIALIS® and generic CIALIS® are:
What is the FDA-approved Use of CIALIS® and generic CIALIS®?
CIALIS® and generic CIALIS® are prescription medicines used to treat erectile dysfunction (ED), symptoms of benign prostatic hyperplasia (BPH), or both.
Roman-affiliated doctors may prescribe CIALIS® for the treatment of premature ejaculation (PE), if they believe in their medical judgment that it is an appropriate course of treatment.
You are encouraged to report negative side effects of prescription products to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see the full Prescribing Information for complete safety information.
