Sexual Health

As men age, concerns with fertility and sexual health arise. Erectile dysfunction (ED) is the inability to achieve or maintain an erection that is satisfactory for sexual intercourse. Prevalence of ED increases with age, with approximately 20% before age 30, 25% between age 30 to 39, 40% between age 40 to 49, 60% between age 50 to 59, 80% between age 60 to 69, and 90% above age 70. (1) ED is found as a comorbid condition to a variety of metabolic disorders and heart conditions. For example, the estimated prevalence of ED among patients with atrial fibrillation is 57%. (5) Both type 1 and type 2 diabetes mellitus also increase the likelihood of ED roughly 3.5-fold. (14) 

Typical treatment of ED is varied and may consist of testosterone therapy, pharmaceutical interventions, or psychological and behavioral interventions. Many of the ingredients presented below focus on improving function and sexual satisfaction as assessed by the International Index of Erectile Function (IIEF), which is a questionnaire that assesses sexual activity, intercourse, stimulation, ejaculation, and orgasm, allowing insight into some of the possible mechanisms and areas of focus for treatment. (21)

Based on the research findings, the ingredients in the protocol below have shown efficacy in improving a variety of factors associated with improving male sexual function. 

Korean ginseng (Panax ginseng)

2000 mg, total per day, minimum 8 weeks (6)(10)(13)

• International Index of Erectile Function (IIEF) score improved accounting for improvement in erectile function (ED) and overall satisfaction among patients after 8 weeks of supplementation with 1000 mg twice per day of tissue-cultured mountain ginseng extract when compared to placebo (13)
• 66.6% of patients with mild or moderate ED reported improved erection specifically rigidity, penetration, and maintenance as shown by an improvement in IIEF-5 score when given 1000 mg of Korean red ginseng 3 times per day compared to placebo (6) 
• Improved IIEF scores for penetration and maintenance and improved penile tip rigidity as shown by RigiScan; 60% of patients noted that treatment helped with global efficacy (10)
• Meta-analysis of six RCTs showed benefits of Korean red ginseng for ED response rate (RR 2.40) and psychogenic ED response rate (RR 2.05) compared to placebo (11) 
• Significant improvement in total and all IIEF domain scores in individuals with mild-to-moderate ED given 1400 mg ginseng berry extract daily for eight weeks (4)

750 mg, total per day, minimum 3 months (8)(12) 

• Standardized active extract of Tribulus terrestris improved IIEF scores for intercourse satisfaction, orgasmic function, and sexual desire, and global efficacy (12)
• An increase in total testosterone and Arabic index of erectile function score from 2.2 at baseline to 2.7, IIEF from 10.7 at baseline to 16.1 were observed in aging males with partial androgen deficiency, ED and lower urinary tract symptoms when supplemented with Tribulus terrestris (8)
• 78% improvement in patients with Kshina Shukra (oligozoospermia) occurred when supplemented with Gokshura (Tribulus terrestris. Linn) for 60 days versus a 70% improvement for placebo (22)

Maca (Lepidium meyenii)

1500-2400 mg, total per day, minimum 8 weeks (9)(24)  

• Psychological performance-related satisfaction profile (SAT-P) score increased with a particular improvement in physical and social performance aspects of the score in patients with ED supplemented with 2400 mg of dry maca extract per day for 12 weeks (24)
• Maca supplementation at both 1500 mg and 3000 mg doses improved sexual desire at week 8 and week 12 when compared to placebo (9)
• Endurance athletes improved self-rated sexual desire with maca extract supplementation compared to baseline and placebo; athletic performance in cycling time for 40 km improved as well when compared to baseline (23)

Arginine

5 g once per day for a minimum of 6 weeks (7)

• IIEF score improved accounting for increase in overall satisfaction, intercourse satisfaction, orgasmic function, and erectile function in patients with ED provided with 1500 mg to 5000 mg daily (20)
• L-arginine given as a concomitant to tadalafil improved IIEF and total testosterone compared to single-use of either in diabetic male patients (7) 
• Patients with ED and a low initial urinary NOx improved subjective sexual function with high dose l-arginine of 5 g per day (3) 
• Erectile function improved with 6 g of l-arginine glutamate combined with 6 mg of yohimbine supplementation taken 1-2 hours before intended sexual intercourse (15)

DHEA

*available in the US catalog

50 mg of DHEA for a minimum of 6 months (18)(19)

• IIEF score increased in patients with ED when supplemented with 50 mg of DHEA for 6 months when compared to placebo (19)
• All domains of IIEF improved in elderly men with ED supplemented with 50 mg of DHEA (18)

Ashwagandha

*available in the CA catalog 

675 mg total per day, minimum 3 months (2)

• Systematic review of 42 studies found Withania somnifera effective for improving spermatogenesis in males (17)
• Males with sexual dysfunction and infertility increased sperm count 157%, semen volume 53% and sperm motility 57% compared to baseline when given 675mg total per day (2)
• Ashwagandha extract beads (21 mg of withanolide glycosides per day) improved DHEA-S and testosterone in overweight men with mild fatigue aged 40-70 years (16)