Men’s sexual health supplements — evidence-based review (for education only, not medical advice)

Products marketed for male performance, libido, testosterone support, and erectile dysfunction (ED) are widely available online and in pharmacies. This review summarizes what high‑quality evidence says about common ingredients, what remains uncertain, and how to approach these products safely. It does not replace professional medical care.

Quick summary

• Some supplements (e.g., L‑arginine, Panax ginseng) show modest benefits for erectile function in small trials; effects are usually smaller than prescription treatments.
• Evidence for “testosterone boosters” is generally weak unless a man has clinically confirmed low testosterone.
• Many products are blends; quality and ingredient amounts vary, and contamination or undisclosed drugs have been reported.
• Lifestyle measures (weight loss, exercise, sleep, smoking cessation) have strong evidence for improving sexual health.
• Persistent ED can be an early sign of cardiovascular disease and warrants medical evaluation.

What is known

Erectile dysfunction (ED) and vascular health

ED is commonly related to blood vessel function. Conditions such as hypertension, diabetes, obesity, and smoking impair nitric oxide signaling and penile blood flow. Major guidelines (e.g., American Urological Association, European Association of Urology) emphasize cardiovascular risk assessment in men with ED.

L‑arginine and nitric oxide pathways

L‑arginine is an amino acid involved in nitric oxide production. Small randomized trials and meta‑analyses suggest modest improvement in erectile function scores compared with placebo, particularly in men with mild to moderate ED. Benefits appear greater when combined with other agents (e.g., pycnogenol), though combination studies are heterogeneous. Gastrointestinal side effects can occur; interactions are possible with blood pressure medicines and nitrates.

Panax ginseng (Korean red ginseng)

Several small trials report improvements in erectile function scores versus placebo. Proposed mechanisms include nitric oxide modulation and anti‑inflammatory effects. Overall evidence quality is moderate at best due to small sample sizes and variable preparations. Side effects may include insomnia or headaches; interactions with anticoagulants and stimulants are possible.

Dehydroepiandrosterone (DHEA)

DHEA is a hormone precursor. Evidence for ED is mixed; some studies show benefit in men with low DHEA levels, others do not. Because DHEA can affect hormone levels, it may cause acne, mood changes, or alter lipid profiles. Long‑term safety data are limited.

Zinc and “testosterone support”

Zinc deficiency can impair testosterone production, but in men with normal zinc status, supplementation has not consistently raised testosterone to a clinically meaningful degree. Broad claims that multivitamins or herbal blends “boost testosterone” are not supported by strong evidence unless a deficiency or medical hypogonadism is present and diagnosed.

Yohimbine

An alkaloid derived from yohimbe bark, yohimbine has some evidence for psychogenic ED. However, it can increase heart rate and blood pressure and may cause anxiety. Because of safety concerns and variable supplement quality, many clinicians avoid it.

Safety and product quality

Regulators such as the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have repeatedly warned that some “male enhancement” supplements contain undisclosed prescription drugs (e.g., sildenafil‑like compounds). This poses risks of dangerous interactions, especially with nitrates used for heart disease. Independent third‑party testing (e.g., USP, NSF) may improve quality assurance but does not guarantee efficacy.

What is unclear / where evidence is limited

• Long‑term outcomes: Most trials last weeks to a few months; durability of benefit is uncertain.
• Optimal formulations: Herbal extracts vary in species, dose, and processing; results are not interchangeable.
• Combination products: Multi‑ingredient blends are common, but high‑quality trials on specific combinations are scarce.
• Effects in specific populations: Men with diabetes, post‑prostatectomy, or severe cardiovascular disease are under‑represented in supplement trials.
• True impact on testosterone: In men without diagnosed hypogonadism, clinically meaningful increases are uncommon.

Overview of approaches

Lifestyle interventions (first‑line foundation)

Weight reduction, regular aerobic and resistance exercise, improved sleep, limiting alcohol, and smoking cessation consistently improve erectile function and overall sexual health. These measures also reduce cardiovascular risk and are recommended by major guidelines.

Prescription therapies (for comparison)

Phosphodiesterase‑5 (PDE5) inhibitors (e.g., sildenafil, tadalafil) have strong evidence for ED and are regulated medications with established safety profiles when prescribed appropriately. For official prescribing information, see the FDA label database: FDA drug labels. (This link is provided for general information; do not self‑medicate.)

Over‑the‑counter supplements

Common categories include nitric‑oxide precursors (L‑arginine, L‑citrulline), herbal extracts (ginseng, maca), hormone precursors (DHEA), minerals (zinc, magnesium), and proprietary blends. Evidence ranges from low to moderate quality, typically with smaller effect sizes than prescription therapy. No supplement should be considered a substitute for evaluation of underlying conditions.

Psychological and relationship factors

Performance anxiety, depression, and relationship stress can contribute to sexual dysfunction. Counseling or sex therapy may be effective, alone or combined with medical approaches.

Evidence table

Statement	Confidence level	Why
Lifestyle changes improve erectile function.	High	Supported by multiple trials and guideline recommendations.
PDE5 inhibitors are effective for many men with ED.	High	Large randomized trials and long-term data.
L‑arginine provides modest benefit in mild–moderate ED.	Medium	Meta‑analyses of small RCTs; heterogeneity present.
Panax ginseng improves erectile function.	Medium	Several small RCTs; variable preparations and sizes.
Most “testosterone boosters” meaningfully raise testosterone in healthy men.	Low	Limited supportive evidence without documented deficiency.
Some male enhancement supplements contain undisclosed drugs.	High	Repeated regulatory warnings and product recalls (FDA/EMA).

Practical recommendations

• Start with a health check: If you have persistent ED (≥3 months), reduced morning erections, low libido, or symptoms of low testosterone (fatigue, decreased muscle mass), seek medical evaluation.
• Screen for cardiovascular risk: Check blood pressure, glucose, and lipids. ED can precede heart disease.
• Review medications: Some drugs (e.g., certain antidepressants, antihypertensives) affect sexual function.
• Be cautious with supplements: Choose products with third‑party testing; avoid products promising “instant” results; never combine with nitrates or unknown online pills.
• Prepare for consultation: Note symptom duration, severity (e.g., using IIEF‑5 questionnaire), current medications, alcohol/tobacco use, sleep patterns, and stressors.
• Urgent care: Seek immediate help for chest pain during sex, painful prolonged erection (>4 hours), or severe side effects.

For updates on regulatory actions and safety alerts, see our Noticias section. Professional statements and institutional updates are available under Comunicados. Educational meetings on men’s health are listed in Eventos, and additional background articles can be found in Sin categoría.

Sources

• American Urological Association (AUA). Guideline on Erectile Dysfunction.
• European Association of Urology (EAU). Guidelines on Sexual and Reproductive Health.
• U.S. Food and Drug Administration (FDA). Tainted Sexual Enhancement Products Alerts.
• National Institutes of Health (NIH) Office of Dietary Supplements. Fact Sheets (Zinc, DHEA).
• Cochrane Reviews and peer‑reviewed meta‑analyses on L‑arginine and Panax ginseng for ED.

This article is for educational purposes and reflects evidence available from major guidelines and systematic reviews at the time of writing.