ED Treatment

The 7 Best Over the Counter ED Medications

August 23, 2021

Medically reviewed by

David Culpepper, MD

Erectile dysfunction is a frustrating, sensitive experience for any guy. Fortunately, there are several highly effective prescription treatment options. And, prescription meds aren't nearly as hard to access as they once were thanks to telemedicine providers like Rex MD (you can do it all from home).

Still, some men prefer to pursue over-the-counter or natural ED remedies first. The issues is: there's still plenty of research that needs to be done on most OTC supplements and herbal remedies.

What we do know suggests that some may be beneficial in some cases. 

Bottom line: the regulation, research, and efficacy for most OTC erectile dysfunction meds is limited at best. Here's what to know.

What Is Erectile Dysfunction?

Erectile dysfunction is the clinical name for when a guy has difficulty achieving or sustaining an erection that's firm enough for sex.

Despite being a relatively common occurrence among men – an estimated 30 million men in the United States experience ED yearly – there's still a lot that's unknown about erectile dysfunction. For example, there is no singular cause of erectile dysfunction, and it can be multifactorial in its origins. What is known are the risk factors and conditions that can contribute to ED's development. Physical and psychological conditions are commonly associated with erectile dysfunction, including:

  • High blood pressure
  • High cholesterol
  • Diabetes
  • Cardiovascular disease
  • Atherosclerosis (hardened, clogged arteries)
  • Low testosterone
  • Multiple sclerosis
  • Obesity 
  • Alcohol abuse
  • Peyronie’s disease
  • Sleeping difficulties
  • Stress
  • Anxiety
  • Depression
  • Alcohol abuse
  • Tobacco use
  • Cancer treatments 
  • Side effect of medication
  • Parkinson’s disease
  • Relationship problems
  • Injuries to the pelvic area or spine

7 Over The Counter Medications for ED

Depending on the cause of erectile dysfunction, the most effective treatment can vary. Typically, the best way to treat erectile dysfunction is to address the underlying cause.

Second is by using oral medications like Viagra® (sildenafil), Cialis® (tadalafil), or Levitra® (vardenafil), all of which are now more affordable than ever. 

However, these drugs do require a prescription. When it comes to trying to treat erectile dysfunction with over the counter options, the results are unfortunately not likely to be as satisfying as proven, FDA-sanctioned medications like the above.

Here are some of the over the counter medications and supplements that have the potential to help with the symptoms of erectile dysfunction.

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Ginseng 

Although primarily used as an aphrodisiac, ginseng has been used in alternative medicine for a variety of conditions. In one ED study, a group of over 100 men experiencing erectile dysfunction were split into two groups. The first group was given a daily dose of 350 milligrams of ginseng extract, while the other group was given a placebo. 

The trial lasted for two months and by the end, the group taking 350 mg ginseng reported an improvement in sexual desire, erectile function, and overall sexual satisfaction. While this demonstrates that ginseng may improve various sexual functions, the group receiving the placebo also experienced improvements. 

L-Arginine 

L-arginine is an amino acid that's naturally produced by the body. Taking an l-arginine supplement could help with erectile dysfunction because of its tendency to be converted into nitric oxide. Nitric oxide is a neurotransmitter that's important in achieving an erection. When a guy becomes aroused, the brain releases this chemical messenger, and its job is to dilate and expand blood vessels to increase blood flow. Without nitric oxide, erections are almost impossible, even with oral medications. 

DHEA 

DHEA is the abbreviation for dehydroepiandrosterone, a hormonal steroid naturally produced in the body by the adrenal glands. This hormone is a precursor to testosterone, meaning that the body can convert it into testosterone if required. Low testosterone is a contributing factor in some erectile dysfunction cases. 

While it doesn’t appear to have a precise impact on erections, higher levels of testosterone can help to improve overall sexual function and might help with erectile dysfunction. 

Ginkgo Biloba 

This extract comes from one of the oldest families of trees in existence and has been used in traditional medicines for centuries. While it may not be effective in all cases of erectile dysfunction, it may be beneficial for erectile dysfunction that occurs as the result of taking certain antidepressants, according to one study

Yohimbe 

In order to achieve an erection, the penis needs steady and strong blood flow. Any issues with blood flow, such as high blood pressure or atherosclerosis (hardening of the arteries), can result in erection difficulties. Yohimbe appears to have properties that can stimulate and improve blood flow, and it's known to promote the production of norepinephrine, which can increase heart rate, leading to more blood being pumped through the body. 

Horny Goat Weed 

While research on humans has been limited, horny goat weed does contain chemical compounds that may help with erectile dysfunction. Icariin, works as a PDE5 inhibitor, which is the same mechanism as Viagra and Cialis. Research is limited, but it appears that icariin is not nearly as potent as sildenafil (Viagra) and other PDE5 inhibitors approved by the FDA. Its ability to affect PDE5 is magnitudes smaller than these prescription medications. 

Pycnogenol 

Derived from tree bark, pycnogenol appears to have several similarities with l-arginine, an amino acid also found a little higher on this list. In fact, when the two are combined they may be effective. 

One study focused on 40 men, aged 25 to 45, that were experiencing erectile dysfunction. During the first month they all received a daily dose of 1.7 grams of l-arginine. For the second month they maintained the daily l-arginine, but started taking 40 mg of pycnogenol two times a day as well. For the third month an additional 40 mg dose was added daily. After the first month, only 5% of participants reported a normal erection, but after the second month the number increased to 80%. After the third month, this number reached 92.5%. There were no side effects reported. The caveat, however, is that there was no control group in this trial.

Other Ways To Treat Erectile Dysfunction 

Over the counter medications and supplements for erectile dysfunction may be effective in some cases, but the chances of fixing your ED outright are slim. 

There are a few things that you can do – with confirmed and well-vetted outcomes – to help reduce the frequency and severity of erectile dysfunction without needing a prescription. These changes include:

  • Getting more exercise. Improving the strength of your heart and cardiovascular system will improve blood flow and help keep blood pressure at healthy levels. A daily 30 minute walk is enough to substantially lower the risk of experiencing erectile function, not to mention cardiovascular conditions. 
  • Eat a balanced diet. Salty foods and saturated fats can contribute to atherosclerosis and raise blood pressure. Replacing these foods with fruits, vegetables, and whole grains can help to keep arteries clear and blood pressure normal. 
  • Reduce stress. Stress causes your body to naturally go into a “fight or flight” mode and focus on survival. Adrenaline starts pumping and an emphasis is placed on essential bodily functions. The production of testosterone can be lowered as the stress hormone cortisol climbs; low testosterone is a common risk factor for erectile dysfunction, and cortisol can contribute to a variety of physiological functions running off the rails. 
  • Get enough sleep. When it comes to your body and your health, sleep is an extremely important factor. While we don't fully understand the role of sleep, during sleep the body makes repairs and performs general upkeep. Trying to keep your body running without getting enough rest can lead to several medical complications, including erectile dysfunction, and contributes to obesity and poor general wellbeing.
  • Lose weight. Obesity is a key contributing factor to erectile dysfunction, and body mass index is a decent proxy. The higher your BMI, the more likely you are to experience trouble related to erections. Losing weight can lead to an increase in blood flow while lowering blood pressure, cholesterol, and the risk of diabetes. Men with a BMI over 30 are at a 3X risk of experiencing erectile dysfunction compared to a normal BMI.
  • Quit smoking. It’s well understood that smoking is terrible for overall health, but it can severely impact erections, too. The chemicals in tobacco smoke and cigarettes can damage the lungs and heart, and the nicotine in tobacco is a vasoconstrictor, constricting arteries and leading to an increase in blood pressure. Smoking is one of the most common causes of erectile dysfunction among younger men.
  • Cut back on alcohol. Having a couple drinks here and there won’t have a significant impact on erectile health, but drinking to excess regularly will. The CDC considers heavy drinking to be anything more than 15 drinks in a week for men, 8 drinks for women. Alcohol is a depressant and numbs the response of many bodily functions when you drink extensively, including those related to sexual functions. But drinking in the long term can also cause permanent damage to the liver, which can lead to an increase in estrogen production, and damage to the nervous system among other issues. Alcohol abuse is also a key risk factor in the development of ED.

The Takeaway

There are plenty of ED options available over the counter that might help to treat erectile dysfunction, backed mostly by small research studies or anecdotal evidence; however, most are unproven in rigorous clinical trials and none have been approved by the U.S. FDA. Prescription medications like Viagra (sildenafil) and other PDE5 inhibitors remain the gold standard in ED treatment.

Trying to treat erectile dysfunction can be frustrating, especially for those that are trying to do it with over the counter supplements or natural remedies. The reality is that the most effective methods of treatment come in the form of prescription medications – for good reason! They're effective for the majority of men who take them, but they can be unsafe when taken too frequently or in doses higher than those approved by the FDA.

If you're trying to avoid using any of these medications, then making a few lifestyle changes at home might be your best bet: more exercise, some diet changes, and less alcohol/smoking are all great ways to reduce your risk and possible symptoms of ED. 

Curious if prescription ED meds are right for you? Rex MD can help, with online consultations and pills shipped to your door, if appropriate. Click here to get started.




SOURCES

Erectogenic and Neurotrophic Effects of Icariin, a Purified Extract of Horny Goat Weed (Epimedium spp.) In Vitro and In Vivo

Ginkgo biloba for antidepressant-induced sexual dysfunction

cAMP‐dependent post‐translational modification of neuronal nitric oxide synthase neuroprotects penile erection in rats

Norepinephrine - StatPearls - NCBI Bookshelf

Red ginseng for treating erectile dysfunction: a systematic review - Jang - 2008 - British Journal of Clinical Pharmacology - Wiley Online Library

Dehydroepiandrosterone and Erectile Function: A Review.

Treatment of erectile dysfunction with pycnogenol and L-arginine