Supplements for Sex: What To Know

Pam Harrison

Disclosures

April 22, 2019

In This Article

Bought and Sold: The Most Popular Sex Supplements

Both Krychman and Terlecki have published reviews[1,2] of selected popular or top-selling sex supplements marketed in the United States. Some of these target women to increase sexual desire and arousal, whereas others are aimed at men to address erectile dysfunction and sexual performance. Many contain combinations of ingredients. Within their respective reviews, Krychman and Terlecki highlight any available evidence that supports a supplement's benefit in the domain of sexual health.

Fenugreek, yohimbine, red ginseng, L-arginine, Stronvivo, dehydroepiandrosterone (DHEA), maca, and Zestra are among the popular supplements summarized here. Krychman, Terlecki, or both judge these products to have early promising evidence; however, these supplements are not necessarily endorsed or recommended by either expert, except where specifically noted. Vitamins and minerals that purport to improve sexual health will not be addressed, nor are foods, such as chocolate and oysters, in spite of their durable yet dubious reputations as effective sex enhancers.

Fenugreek

Fenugreek, a short-living annual medicinal plant, is often found in men's sexual health supplements. It contains steroidal saponins, hormonal precursors involved in the synthesis of estrogen and testosterone.[2] One placebo-controlled study[5] found that a daily standardized extract of fenugreek taken by men with normal erectile function increased arousal and orgasm at 6 weeks, but without a corresponding rise in testosterone levels. In contrast, fenugreek was associated with increases in testosterone and estradiol levels after 60 days of use by premenopausal women, who also experienced an upswing in sexual desire and arousal.[5]

However, safety is a concern with fenugreek. Krychman cautions that fenugreek's estrogenic properties could stimulate the growth of breast cancer cells, so it should not be used in patients with hormonally active cancers.[1] Fenugreek also can interact with anticoagulants, so he suggests that it should be avoided by patients receiving this therapy.[1]

Yohimbine

Yohimbine, an alkaloid derived from the African yohimbe tree, has conventionally been labeled a "fat burner" to facilitate weight loss, but without any supporting evidence. As an alpha-2 adrenergic receptor antagonist and 5-HT1A agonist, yohimbine is believed to increase nitric oxide production.[6] Taken by men 1 hour before sex, yohimbine induces vasodilation for an enhanced erection.

A meta-analysis showed that active treatment with yohimbine was almost four times more effective as placebo in men with erectile dysfunction.[6] However, Terlecki says yohimbe is burdened with a laundry list of negative adverse effects, including exacerbation of psychiatric disorders, and that people taking any type of antidepressant, antihypertensive agent, or central nervous system stimulant should not use yohimbine.[2] Terlecki knows of men who have ended up in the hospital with chest pain and arrhythmias after taking supplements containing yohimbine along with high concentrations of caffeine.

Yohimbine hydrochloride, a prescription form of yohimbine, is indicated for the treatment of erectile dysfunction. However, according to Darren J. Hein, PharmD, assistant professor at Creighton University's School of Pharmacy, the product is no longer commonly used because of its many adverse effects, adding that "much better options can be found in the form of the PDE5 inhibitors."

Korean Red Ginseng

Korean red ginseng, a traditional medicine used for thousands of years, is believed to increase nitric oxide production in both men and women. Nitric oxide release from smooth muscle stimulates blood flow to the penis in men and to the clitoris in women. A recent review[7] concluded that red ginseng can be helpful in the treatment of erectile dysfunction. Krychman warns that red ginseng may have estrogenic properties and should not be taken by patients with hormone-sensitive cancers.[1]

L-Arginine

L-arginine is a physiological substrate for nitric oxide synthesis.[8] Several prominent sexual supplements for men and women are based on L-arginine. When consumed in supraphysiologic doses, L-arginine increases nitric oxide production.[2] This relaxes smooth muscles and increases arterial blood flow to genital tissues, resulting in penile erection and vaginal wall engorgement. A nonessential amino acid, citrulline, may be equally beneficial and also might have an advantage over arginine because it bypasses intestinal and hepatic metabolism and is converted rapidly to arginine in the kidneys, increasing the plasma arginine concentration.[9]

A placebo-controlled study[10] of L-arginine found an improvement in sexual desire and satisfaction in women at or near menopause, but not in postmenopausal women. In another small study[11] an arginine-based product for men improved erectile dysfunction. However, arginine was not the sole ingredient in these supplements, so the effects cannot be attributed to L-arginine alone. The authors of a recent systematic review and meta-analysis[8] of 10 studies concluded that L-arginine and citrulline (compared with placebo or no treatment) are safe and effective for mild to moderate erectile dysfunction. They also found that these supplements were superior in terms of overall sexual satisfaction, intercourse satisfaction, sexual desire, orgasmic function, and erectile function.[8] Still, the evidence supporting the use of L-arginine as a first-line treatment for male sexual functioning is equivocal.[1] Krychman said he sometimes recommends L-arginine-based products to men or women seeking to improve sexual function.

Stronvivo

Stronvivo is a combination product containing pharmaceutical-grade L-arginine, L-citrulline, L-carnitine, magnesium, and zinc. It is the only supplement in this summary that has been certified by Informed Choice, an organization that conducts quality assurance on sports nutrition products by testing for banned substances, so at least it is not tainted by nonapproved pharmaceutical drugs.

Stronvivo is believed to have sexual health benefits by improving endothelial health, stimulating nitric oxide production, and enhancing circulation. A small study of Stronvivo in men and women showed improvements in all areas of sexual functioning.[12] Women reported an improvement in mood, whereas men reported an improvement in desire and erectile function.[12]

DHEA

DHEA is a prohormone in the androgen synthesis pathway, produced by the peripheral tissues. DHEA supplementation does not seem to affect systemic hormone levels. One study[13] found that DHEA significantly improved all domains of sexual function in premenopausal, infertile women with poor sexual function before treatment. However, two other studies in men treated with DHEA had mixed results, with one placebo-controlled trial[14] indicating that men's erectile scores improved after 6 months of DHEA treatment and another[15] showing no change in any of the same endpoints. No adverse events have been reported thus far, but the effects of long-term DHEA use are unknown.

A related product, Tribulus terrestris extract, is converted in the body to DHEA.[16] In placebo-controlled trials of men and women with hypoactive sexual desire disorder, Tribulus terrestris improved a range of sexual function parameters[17,18] and has been shown to improve sperm motility.[19] Although well tolerated in these trials, with no drug-related adverse events, little is known about safe dosages.[3] In one report, Tribulus terrestris was associated with hepatonephrotoxicity after high-dose ingestion.[20]

Zestra

Applied to the labia and clitoris a few minutes before intercourse, Zestra is designed to enhance female arousal and orgasm by vasodilating the genital tissues. A "tingling" sensation, which some women describe as mild to moderate genital burning, follows application of the oil.[1]

The first placebo-controlled study of Zestra[21] was conducted in women with low to normal sexual arousal. Users felt that the product improved sexual desire, arousal, and orgasm when compared with placebo. Zestra was also effective in women who took selective serotonin-reuptake inhibitors, which are known to interfere with sexual function.[21] The findings of a larger placebo-controlled follow-up study[22] were not as convincing, but investigators still concluded that Zestra improved desire, arousal, and treatment satisfaction in this broadly generalized group of women with a range of sexual difficulties. No trials have been conducted in men. Krychman recommends Zestra to women hoping to enhance arousal and orgasm.

Maca

Maca, a common ingredient in male sexual health supplements, is taken by men to enhance libido and erections. It is not clear how maca improves these parameters, but it has been suggested that maca contains phytosterols and phytoestrogens that could function as endocrine disruptors. Thus far, there is no evidence that maca alters testosterone or estrogen levels.[1]

Krychman and Terlecki judge the evidence that supports claims of maca's effectiveness differently. Terlecki maintains that the evidence of positive effects in men is limited or inconclusive, whereas Krychman gives it a more favorable thumbs up, citing four randomized trials, summarized in a systematic review,[23] in which investigators looked at male and female responses to maca. Three of these trials showed a positive effect on sexual function in healthy men and women, as well as in men with erectile dysfunction.[1]

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