Improve Sexual Wellbeing & Intimacy

Erectile Dysfunction: Causes, Evaluation and Care

Supporting healthy erectile function means finding out why erections have changed, looking after the heart, mood and habits that affect them, and choosing care with a clinician. Diet and exercise have the best natural support, most supplements have low certainty, and "natural" male enhancement products can hide prescription drugs.

General information, not medical advice. Last updated November 1, 2026. Written by the AlternativeMed editorial team. Not medically reviewed.

Start here

If erection problems keep happening, book a visit with a GP, sexual health clinic or other clinician. The NHS says to do this, and NIDDK says ED is treatable and not a routine part of aging.
Ask for blood pressure, cholesterol and blood sugar to be checked. ED can be an early signal of heart and blood vessel disease, though most men with ED will not have a heart problem.
Build movement into your week and eat in a heart-healthy way. Diet and exercise programmes are the best-supported natural approach, and they help the heart too.

Be careful with

Do not buy "male enhancement" or ED pills sold as natural. The FDA says such products are likely to be contaminated with dangerous hidden ingredients, and in a laboratory check 14 of 20 ED supplements held an undeclared ED medicine.
Do not order an ED medicine online before talking with a health professional (NIDDK). The NHS warns that many websites sell fake medicines.
Do not stop or change a prescribed medicine on your own, even if you suspect it plays a part. Ask the prescriber to review it.
Do not try supplements first and delay the check-up. Trying products can delay finding a treatable cause, and supplements can interact with medicines.

Get help when

Chest pain, shortness of breath or fainting: call local emergency services. Do not wait for an appointment.
An erection that lasts longer than 4 hours: get care right away (NIDDK).
Vision or hearing loss after taking an oral ED medicine: get care right away (NIDDK).
Erection problems that keep happening, or that start suddenly in a younger man: see a GP or sexual health clinic (NHS).
A bad reaction after any "male enhancement" product: stop it, get medical help and tell the clinician what was in it. The FDA also invites reports.
Low mood, anxiety or any thoughts of harming yourself: talk to a clinician now, or contact local emergency or crisis services in your country.
Erection problems after an assault or in a relationship where you do not feel safe: you deserve support. A clinician or a local support service can help; we did not read a source naming a helpline, so we name none.

About Erectile Dysfunction: Causes, Evaluation and Care

What this goal means

NIDDK says erectile dysfunction (ED, sometimes called impotence) is trouble getting or keeping an erection firm enough for sex. Most men occasionally fail to get or keep an erection, usually because of stress, tiredness or drinking too much alcohol (NHS). It becomes a health question when it keeps happening.

This goal is about supporting erectile function: understanding the causes, getting a proper evaluation, using the lifestyle changes that have been studied, and being clear-eyed about supplements. The sources we read describe ED in men; people of any gender identity who have a penis can use the same general information, and the care described here is a conversation with a clinician.

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Common experiences

NIDDK cites research suggesting 30 to 50 million men in the United States have ED, about 40% by age 40 and 70% by age 70, and says it is not a routine part of aging. It is common, it is treatable, and there is no need to feel ashamed.

NIDDK lists emotional effects such as loss of intimacy, anxiety, depression and low self-esteem. Many people find it hard to bring up. A clinician has heard it before, and telling them is the first step.

^1,3

Contributing factors

ED is usually the result of several things working together. NIDDK lists diseases (diabetes, heart and blood vessel disease, high blood pressure, kidney disease, obesity, COPD, nerve damage, low testosterone, thyroid problems, an enlarged prostate), medicines (antidepressants, blood pressure medicines and diuretics, some pain relievers, sedatives, ulcer medicines and others), mind and mood (anxiety, depression, stress, loneliness, low confidence) and habits (little activity, too much alcohol, smoking, recreational drugs).

Do not stop a medicine on your own. Ask a health professional to review it.

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Why it can be an early heart signal

In a meta-analysis of 14 follow-up studies (92,757 men, 6.1 years on average), men with ED had a higher risk of cardiovascular events than men without it (pooled relative risk 1.44). A 2019 meta-analysis of 25 studies found 43% higher risk of cardiovascular disease and 33% higher risk of death from any cause. These are associations and do not prove that ED causes heart disease, and most men with ED will not have a heart problem.

A 2023 expert panel advised treating men with ED as at risk for cardiac events until proven otherwise. The practical step is to have blood pressure, cholesterol and blood sugar checked. The link was stronger at younger ages in the 2013 meta-analysis, so a check-up is worthwhile for a younger man with new ED.

^5,6,7

Relevant conditions and how ED is evaluated

Diabetes, high blood pressure, high cholesterol, low testosterone, thyroid and kidney disease, sleep apnoea, prostate conditions, depression and anxiety all appear in the sources as linked with ED. They are things a clinician can test for and treat; they are not something to self-treat with supplements.

According to the NHS, a doctor or nurse may ask about your lifestyle, relationships and any problems, take basic checks such as blood pressure and examine the genitals, and the prostate if you also have urinary symptoms. The aim is to find and treat an underlying cause where possible.

^4,2

Realistic expectations, and who this applies to

Diet and exercise programmes raised erectile function scores modestly but significantly in a 2026 meta-analysis of 16 trials (moderate certainty). That is a real but modest gain, not a cure. Supplement evidence is low or mixed. Established care (see the Therapies tab) is chosen with a clinician and tailored to the person.

This page applies to adults with erection difficulty of any age, including younger men, older men and men with long-term conditions. Desire (libido), performance anxiety, orgasm and ejaculation concerns, and how medicines affect sexual wellbeing have their own goal pages, linked below. Consent, comfort and safety are part of sexual wellbeing for everyone involved.

^8,3

Related conditions and symptoms

Urinary symptoms and enlarged prostate → Sleep apnea → Prediabetes, type 2 diabetes and metabolic syndrome → Stress, anxiety, burnout and depression → Anxiety disorders →

A manageable starting plan

An educational starting point, not a personal prescription. Adjust it to your own situation and any advice from your clinician.

Your first actions

Book an appointment if erection problems keep happening, and ask for blood pressure, cholesterol and blood sugar checks.
Bring a list of your medicines and supplements, and ask whether any could be contributing.
Start a gentle exercise routine and a heart-healthy eating pattern, built up gradually.
Cut back on alcohol, and ask for help if you smoke or use recreational drugs.

Optional additions

Ask about counselling or sex therapy, with your partner if you wish.
Mention snoring or daytime sleepiness so sleep apnoea can be considered.
Ask a pharmacist before trying any supplement, and avoid "male enhancement" products.

What to track

How often erections are firm enough for sex, and whether it varies with stress, tiredness or alcohol.
Any chest pain, breathlessness, dizziness or leg pain on effort.
Medicines and supplements you take, and any change in erections after a change.
Mood, sleep and how you and your partner feel about intimacy.

When to reassess

Review after about four to eight weeks of habit changes, or at the follow-up the clinician sets. If erections are not improving, or you are worried, go back to the clinician rather than adding supplements.

When to seek professional support

A GP, sexual health clinic or urologist for evaluation and treatment options.
A pharmacist for questions about medicines and supplements.
A counsellor or sex therapist, alone or with a partner.
The men's health safety page for red flags.

What helps

Ordered by how well the research supports each step. Evidence strength is shown on every card; precautions sit next to the advice.

Start here

Get persistent erection problems checked

Moderate certainty

Addresses: Finds a treatable cause and rules out hidden health problems

Why it may help: The NHS says to see a GP or sexual health clinic if erection problems keep happening. NIDDK says ED is treatable and often has several causes at once, so a clinician looks at health, medicines, mood and habits together.

How to apply it: Write down when it happens, any other symptoms, and every medicine and supplement you use. Say plainly that you want an assessment. You can ask for a nurse or a clinician of a particular gender if that helps.

Who it may suit: Anyone whose erection difficulty keeps happening or is worrying them.

Precautions: A one-off bad night is common and usually linked to stress, tiredness or alcohol (NHS). Chest pain, breathlessness or fainting are emergencies, not a routine appointment.

^2,4,3

Men's health: when to get help → Men's Wellness: A Starting Guide →

Have your heart and blood vessels checked

Moderate certainty

Addresses: Spots blood pressure, cholesterol or blood sugar problems early

Why it may help: In a meta-analysis of 14 follow-up studies (92,757 men), men with ED had a higher risk of cardiovascular events (relative risk 1.44), and a 2023 expert panel advised treating men with ED as at risk until proven otherwise.

How to apply it: Ask for blood pressure, cholesterol and blood sugar tests. If you have chest pain or breathlessness on effort, tell the clinician at once.

Who it may suit: Any man with new ED, especially younger men, where the link was stronger.

Precautions: This is an association, not proof of cause. Most men with ED will not have a heart problem.

^5,6,7

Build Heart-Healthy Habits → Support Healthy Blood Pressure → Prediabetes, type 2 diabetes and metabolic syndrome →

Follow a diet and exercise programme

Moderate certainty

Addresses: A modest but real gain in erectile function

Why it may help: A 2026 meta-analysis of 16 randomised trials (1,477 men with ED) found erectile function scores rose 2.35 points more than in control groups (moderate certainty). Diet-only, exercise-only and combined programmes each improved, with no clear difference between them.

How to apply it: Pick a pattern you can keep: regular movement, mostly whole foods, less alcohol, and a healthy weight if weight is a factor. Build up slowly.

Who it may suit: Most adults with ED, alongside medical evaluation.

Precautions: Check with a doctor before starting vigorous exercise if you have heart disease, chest pain, high blood pressure or diabetes. Lifestyle change does not replace an evaluation.

^8,3

Eat for Heart Health → Improve Your Cardiovascular Fitness → Healthy weight basics →

Make aerobic activity the core of your exercise

Low certainty

Addresses: Better erectile function in men not using ED medicines

Why it may help: A 2024 meta-analysis of 7 randomised trials in men not taking ED medicines found physical activity improved erectile function (standardised mean difference 0.69), and aerobic training alone did best (0.81).

How to apply it: Aim for brisk walking, cycling, swimming or similar, built up gradually and done regularly.

Who it may suit: Men who can exercise safely, including those with desk jobs or low activity.

Precautions: Only 7 trials. Lower the pace and see a doctor if exercise brings on chest pain, dizziness or breathlessness.

^9,2

Improve Your Cardiovascular Fitness → Sit Less & Move More →

Ask for a review of the medicines you take

Moderate certainty

Addresses: May remove a contributor without stopping care you need

Why it may help: NIDDK lists antidepressants, blood pressure medicines and diuretics, some pain relievers, sedatives, ulcer medicines and others as possible contributors, and says a clinician may adjust or switch a medicine.

How to apply it: Bring a full list to the appointment, including over-the-counter products and supplements, and ask whether any could be involved.

Who it may suit: Anyone with ED who takes regular medicines.

Precautions: Never stop or change a prescribed medicine on your own. Stopping some can be harmful.

^4,3

Understand How Medicines Affect Sexual Wellbeing →

Additional options

Look after mood, stress and the relationship

Low certainty

Addresses: Less worry and more closeness, which can ease the cycle of anxiety

Why it may help: NIDDK lists anxiety, depression, stress, loneliness and low confidence as causes, and loss of intimacy, anxiety, depression and low self-esteem as effects. It says counselling can help, with a partner invited if you wish.

How to apply it: Tell the clinician how ED is affecting your mood and relationship. Ask about counselling or sex therapy. Talking with a partner about what feels good and what is hard can ease pressure.

Who it may suit: Anyone for whom worry, stress or low mood is part of the picture, and couples.

Precautions: Low mood lasting two weeks or more, or any thoughts of self-harm, need a doctor or crisis service now. We found no trial evidence of counselling in the sources we read; this is agency guidance.

^1,3

Manage Sexual Performance Anxiety → Communicate More Comfortably About Intimacy → Therapy for anxiety and stress → Stress, anxiety, burnout and depression →

Eat a Mediterranean-style pattern if you have diabetes

Low certainty

Addresses: May help protect erectile function

Why it may help: A 2023 systematic review found the Mediterranean diet was effective for protecting erectile function in most of the studies on people with diabetes. The abstract gives no numbers.

How to apply it: Ask a clinician or dietitian to help adapt a Mediterranean-style pattern to your diabetes care.

Who it may suit: Men with diabetes and ED.

Precautions: Do not change diabetes medicines on your own. The review focused on diabetes, so it may not apply to everyone.

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Prediabetes, type 2 diabetes and metabolic syndrome → Eat for Heart Health →

Cut back on alcohol, smoking and recreational drugs

Low certainty

Addresses: Removes known contributors

Why it may help: NIDDK lists too much alcohol, smoking and recreational drugs among habits that contribute to ED, and the NHS lists alcohol as a common reason for occasional failure.

How to apply it: Set a realistic target and ask a clinician or pharmacist about help to cut down or quit.

Who it may suit: Anyone with ED who drinks heavily, smokes or uses recreational drugs.

Precautions: We did not read trials showing ED improves after quitting, so this is agency guidance, not trial evidence.

^4,2

Ask whether sleep apnoea could be involved

Very low certainty

Addresses: A possible lead if you snore heavily or stop breathing at night

Why it may help: Obstructive sleep apnoea is often found alongside ED. A Cochrane review of 6 small trials (315 men) could not say whether a CPAP breathing device improves ED, because the evidence is very low in certainty.

How to apply it: Mention loud snoring, pauses in breathing or daytime sleepiness to your clinician. Treating sleep apnoea is worthwhile for its own sake.

Who it may suit: Men with ED who snore, wake unrefreshed or have daytime sleepiness.

Precautions: The review found no clear benefit to ED at 12 weeks and all trials had risk of bias.

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Sleep apnea → Improve Your Sleep Quality →

Pelvic floor muscle training

Not enough evidence

Addresses: Unclear; the question is open

Why it may help: In the 2024 exercise meta-analysis, pelvic floor muscle training alone did not give a statistically significant improvement (0.03), but the group was very small, so no significant result does not prove no effect.

How to apply it: Ask a pelvic health physiotherapist or clinician to teach it properly before you start.

Who it may suit: Men who want a non-drug option and have been assessed first.

Precautions: Learn the technique from a trained person; pain needs a check.

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Pelvic floor and pelvic pain →

Still being studied

Acupuncture

Very low certainty

Addresses: Higher erectile function scores in trials, with weak evidence

Why it may help: A 2026 meta-analysis of 21 randomised trials found acupuncture scored 3.28 points higher on a five-item erectile function score than control or sham treatment. The authors rate the certainty very low to moderate and say the weak evidence prevents definite conclusions. No significant difference in adverse events was found.

How to apply it: Not recommended here as a first step. If you are curious, use a qualified practitioner after a medical evaluation.

Who it may suit: People who want to understand an option they have seen.

Precautions: Tell the practitioner about medicines and any bleeding problem. It does not replace evaluation.

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Saffron and herbal supplements overall

Low certainty

Addresses: Higher erectile function scores in small, short trials

Why it may help: A 2026 meta-analysis of 14 randomised trials (1,227 men aged 35 to 65, followed 1 to 6 months) reported that herbal supplements overall improved erectile function (standardised mean difference 1.20), with saffron singled out as effective. The trials were small and short, products differed and the abstract gave no certainty grade.

How to apply it: Not advised in place of a check-up. Ask a pharmacist before using any product.

Who it may suit: Men who want to know what the research says.

Precautions: Products vary in strength and quality. Supplements can interact with medicines (NIDDK).

^13,3

Saffron →

Ginseng

Low certainty

Addresses: Little more than a trivial change

Why it may help: A Cochrane review of 9 trials (587 men) found ginseng may only have trivial effects on erectile function compared with placebo: scores rose 2.39 points on the five-item scale, which the authors judged smaller than the change that matters to patients. Side effects were not clearly different from placebo.

How to apply it: Not advised as a way to treat ED.

Who it may suit: Men who ask whether ginseng works.

Precautions: Follow-up was up to 12 weeks. Ask a pharmacist about interactions.

¹⁴

Asian ginseng →

L-arginine, Pycnogenol and carnitine

Low certainty

Addresses: May help some men, mostly when added to prescription ED medicines

Why it may help: A 2024 network meta-analysis of 15 placebo-controlled trials found the best results were for carnitine or L-arginine combined with prescription ED medicines; L-arginine alone ranked lower. A 2023 review of 3 studies (184 men) of L-arginine with Pycnogenol favoured the combination.

How to apply it: Not advised on its own. Raise it with a clinician if you are considering it.

Who it may suit: Men whose ED has a physical cause and who are already under care.

Precautions: Few small studies. Combining products with ED medicines should only be done with a clinician's agreement.

^15,16

L-arginine and citrulline → Carnitine → Grape seed and pine bark extracts →

Tribulus terrestris

Mixed findings

Addresses: Reviews disagree

Why it may help: A 2026 meta-analysis of 8 studies reported higher five-item erectile function scores than placebo (3.23 points higher) with no difference in side effects. A second 2026 review of herbal supplements called the evidence for Tribulus insufficient.

How to apply it: Not advised until evidence is clearer.

Who it may suit: Men who ask about this popular product.

Precautions: The abstract gives no number of men. Testosterone did not differ in the meta-analysis.

^17,13

Tribulus →

Antioxidant supplements

Low certainty

Addresses: Small, uncertain gain

Why it may help: A 2022 meta-analysis of 18 randomised trials (1,331 men) found antioxidants alone gave a small, uncertain gain, compound antioxidant products gave more, and adding them to ED medicines did better than the medicines alone. The authors say the effect of antioxidants alone may be limited.

How to apply it: Not advised as a first step.

Who it may suit: Men who ask about vitamins and antioxidants.

Precautions: Many different products; the abstract named no certainty grade.

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Vitamin D

Evidence against

Addresses: No benefit in a large randomised trial

Why it may help: In the D-Health Trial of 8,920 Australian men aged 60 to 84, ED was reported by 58.8% with vitamin D and 59.0% with placebo after three years (prevalence ratio 1.00), although blood vitamin D levels were clearly higher. The authors conclude supplementing older men is unlikely to prevent or improve ED.

How to apply it: Not advised for ED. If your doctor finds low vitamin D for other reasons, follow their advice.

Who it may suit: Older men who wonder if low vitamin D causes ED.

Precautions: The trial asked about ED with a single question, in older men only.

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Food & nutrition

What the research says about diet and ED

Diet-only, exercise-only and combined programmes each improved erectile function in a 2026 meta-analysis of 16 randomised trials (moderate certainty). We did not find a source we read that names a single food that treats ED. Be wary of claims that one food or powder fixes it.

Dietary patterns matter more than single foods. The Mediterranean diet was linked with better protection of erectile function in men with diabetes in a 2023 systematic review.

^8,10

Eating habits that fit the evidence

These are habit suggestions that follow the studies and agency lists, not treatments.

A heart-healthy, Mediterranean-style pattern

Moderate certainty

Addresses: Supports erectile function and the heart

Why it may help: Programmes with a diet component improved erectile function, and a Mediterranean pattern protected function in people with diabetes in most studies.

How to apply it: Build meals around vegetables, fruit, whole grains, legumes, nuts and fish, with fewer processed foods. See the heart-healthy eating page for detail.

Who it may suit: Most adults with ED.

Precautions: People with diabetes, kidney disease or on blood-thinning medicines should check dietary changes with a clinician or dietitian.

^8,10

Eat for Heart Health →

A healthy weight, reached gradually

Low certainty

Addresses: Removes a contributor

Why it may help: NIDDK lists obesity among diseases linked with ED, and the lifestyle programmes in the meta-analysis included diet change.

How to apply it: Aim for gradual change rather than crash dieting.

Who it may suit: Men carrying extra weight.

Precautions: Avoid extreme dieting. Weight loss with eating-disorder history needs professional support.

^4,8

Healthy weight basics → Lose Weight Sustainably →

Less alcohol

Low certainty

Addresses: Fewer alcohol-related failures and a lower health load

Why it may help: The NHS says alcohol is a common reason for occasional failure, and NIDDK lists too much alcohol as a contributing habit.

How to apply it: Set alcohol-free days and avoid heavy drinking before sex.

Who it may suit: Men who drink regularly.

Precautions: If cutting down is hard or you feel withdrawal, ask a clinician for support.

^2,4

Foods and powders marketed for ED

We did not find a health-agency source we read that endorses any food, drink or powder for ED. The supplement ingredients that were studied (saffron, ginseng, L-arginine, carnitine and others) are covered on the Remedies tab, with low or mixed certainty.

Energy drinks, herbal teas and powders sold as "natural Viagra" can contain hidden prescription drug. The FDA lists such products and says a product not on its list is not proven safe.

^20,21

Remedies & supplements

Traditional use, laboratory findings and human trials are kept apart. "Natural" does not mean safe.

Saffron

Low certainty

Studied form and route: Spice extract taken as a dietary supplement

Intended outcome: Erectile function scores

Human evidence: A 2026 meta-analysis of 14 randomised trials (1,227 men) singled out saffron as effective for erectile function, within an overall benefit for herbal supplements.

Traditional use: Saffron is a culinary spice. We did not read a traditional-use source for ED.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Trials were small and short (1 to 6 months); products and amounts differed; the abstract gave no certainty grade.

Interactions and precautions: Ask a pharmacist before use if you take medicines.

¹³

Saffron →

Asian ginseng (Panax ginseng)

Low certainty

Studied form and route: Root extract taken as a dietary supplement

Intended outcome: Erectile function scores

Human evidence: A Cochrane review of 9 trials (587 men) found ginseng may only have trivial effects: scores rose 2.39 points on the five-item scale, smaller than the change that matters to patients. Side effects were not clearly different from placebo (low certainty). The 2026 herbal review also reported benefit for erectile function and desire.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Follow-up up to 12 weeks, small trials, no comparison with established treatments.

Interactions and precautions: Ask a pharmacist about interactions with medicines.

^14,13

Asian ginseng →

Tribulus terrestris

Mixed findings

Studied form and route: Plant extract taken as a dietary supplement

Intended outcome: Erectile function scores

Human evidence: A 2026 meta-analysis of 8 studies reported higher five-item scores than placebo (3.23 points) and no difference in side effects. A second 2026 review called the evidence insufficient.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Reviews disagree and the first abstract gives no number of men.

Interactions and precautions: Ask a pharmacist before use.

^17,13

Tribulus →

Maca

Not enough evidence

Studied form and route: Root powder taken as a dietary supplement

Intended outcome: Erectile function

Human evidence: The 2026 herbal supplements review called the evidence for maca insufficient.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: We did not read separate trials of maca for this page.

Interactions and precautions: Ask a pharmacist before use.

¹³

Maca →

L-arginine, with or without Pycnogenol (pine bark extract)

Low certainty

Studied form and route: Amino acid, or amino acid with pine bark extract, as a supplement

Intended outcome: Erectile function

Human evidence: A 2024 network meta-analysis of 15 trials found L-arginine alone ranked lower than combinations with prescription ED medicines; a 2023 review of 3 studies (184 men) favoured L-arginine with Pycnogenol for erectile function, satisfaction and desire.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Few small studies; effect sizes were not given in the abstract.

Interactions and precautions: Do not combine with ED medicines unless a clinician agrees.

^15,16

L-arginine and citrulline → Grape seed and pine bark extracts →

Propionyl and acetyl L-carnitine

Low certainty

Studied form and route: Amino acid derivatives as supplements

Intended outcome: Erectile function

Human evidence: In the 2024 network meta-analysis, carnitine combined with a prescription ED medicine ranked highest of the regimens compared; carnitine's own effect was not isolated.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Results were for combinations with prescription medicines.

Interactions and precautions: Ask a clinician before using with ED medicines.

¹⁵

Carnitine →

Antioxidant supplements

Low certainty

Studied form and route: Vitamins and compounds as supplements

Intended outcome: Erectile function

Human evidence: A 2022 meta-analysis of 18 trials (1,331 men) found a small, uncertain gain for single antioxidants, more for compound products, and better results when added to ED medicines.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Many different products and a wide range of results.

Interactions and precautions: Ask a pharmacist before use.

¹⁸

Vitamin D

Evidence against

Studied form and route: Vitamin supplement

Intended outcome: Preventing or improving ED

Human evidence: A randomised trial of 8,920 older men found no effect on ED after three years, despite higher blood levels.

Traditional use: We did not find a traditional-use source we read for ED, so none is stated.

Laboratory findings: We did not read laboratory studies for this page.

Limits: Older men only; single-question measure.

Interactions and precautions: Follow your doctor's advice if you have a diagnosed deficiency.

¹⁹

Therapies & care

Established care is chosen with a clinician. The AUA (2018) and EAU (2025) guidelines make shared decision-making the cornerstone: men and their partners should understand all suitable options, from lifestyle change to counselling and medical treatments, and care is tailored to the man. This page does not recommend any medicine or dose, and you should not stop or change a prescribed medicine on your own.

Assessment by a clinician

High certainty

Medical evaluation A doctor or nurse asks about lifestyle, relationships, medicines and symptoms, takes basic checks such as blood pressure and may examine the genitals and, with urinary symptoms, the prostate. The aim is to find and treat an underlying cause.

Who it may suit: Anyone whose erection problems keep happening.

Precautions: Urgent signs such as chest pain or an erection lasting over 4 hours should not wait for a routine visit.

^2,22,23

Men's health: when to get help →

Treating underlying conditions

Moderate certainty

Medical care NIDDK and the NHS describe treating conditions such as high blood pressure, high cholesterol, diabetes or low testosterone, and reviewing current medicines.

Who it may suit: People whose evaluation finds a contributing condition.

Precautions: These are prescribed and monitored by a clinician. Do not self-treat or stop medicines.

^3,2

Prediabetes, type 2 diabetes and metabolic syndrome → Testosterone and low testosterone →

Counselling or sex therapy

Not enough evidence

Talking therapy NIDDK says counselling can help, with a partner invited if wished, particularly where anxiety, stress, depression or relationship strain are part of the picture.

Who it may suit: People for whom mood, anxiety or the relationship play a part.

Precautions: Ask for a qualified therapist. We did not read trial evidence for counselling for this page.

^3,1

Manage Sexual Performance Anxiety → Therapy for anxiety and stress →

Prescription treatments and other clinic options

High certainty

Medical treatment The NHS and NIDDK describe prescription tablets and other clinic options for ED. A clinician chooses and monitors them after checking your health and your other medicines. We did not read a source for the interaction cautions between ED medicines and heart medicines, so we state none here: a clinician or pharmacist checks this before anything is prescribed.

Who it may suit: People who want medical treatment, after an assessment.

Precautions: Do not buy these online without a clinician, and tell the clinician about all medicines and supplements. Vision or hearing loss, or an erection over 4 hours, need care right away.

^3,2,22,23

CPAP for sleep apnoea

Very low certainty

Medical device A Cochrane review of 6 small trials (315 men) could not say whether CPAP improves ED in men with sleep apnoea, because the evidence is very low in certainty.

Who it may suit: Men diagnosed with obstructive sleep apnoea.

Precautions: Treatment of sleep apnoea is decided by a sleep clinician.

¹¹

Sleep apnea →

Acupuncture

Very low certainty

Complementary therapy A 2026 meta-analysis of 21 randomised trials found higher erectile function scores, with very low to moderate certainty and no clear safety difference from controls.

Who it may suit: People who want a complementary option after a medical evaluation.

Precautions: Use a qualified practitioner. It does not replace evaluation.

¹²

What to avoid

Habits, products and claims that can get in the way. Never stop a prescribed medicine without talking to the professional who prescribed it.

Risks that apply to most people

Ignoring chest pain, breathlessness or fainting

High certainty

Why: These can signal heart problems, and ED itself can be an early sign of heart and blood vessel disease. An expert panel advised treating men with ED as at risk for cardiac events until proven otherwise.

Who it applies to: Any person with ED.

Try instead: Call local emergency services for chest pain, breathlessness or fainting, and ask for a heart check if ED is new.

^7,3

Men's health: when to get help →

Waiting out an erection that lasts more than 4 hours

High certainty

Why: NIDDK says an erection lasting longer than 4 hours needs care right away.

Who it applies to: Anyone, especially after using an ED medicine or product.

Try instead: Go to urgent or emergency care without waiting.

Ordering an ED medicine online without talking to a clinician

Moderate certainty

Why: NIDDK advises not to order an ED medicine online before talking with a health care professional, and the NHS warns many websites sell fake medicines whose ingredients vary.

Who it applies to: Anyone tempted by online sellers.

Try instead: See a clinician first. The NHS says to check that an online pharmacy is registered with the regulator (GPhC in the UK).

^3,2

Stopping or changing a prescribed medicine on your own

High certainty

Why: NIDDK lists several common medicines as possible contributors, but stopping them can cause harm.

Who it applies to: Anyone taking regular medicines.

Try instead: Ask the prescriber to review them, and mention the ED.

^4,3

Understand How Medicines Affect Sexual Wellbeing →

Personal triggers to check

Heavy drinking

Moderate certainty

Why: The NHS says occasional failure is often due to stress, tiredness or too much alcohol, and NIDDK lists too much alcohol among contributing habits.

Who it applies to: People who drink heavily or before sex.

Try instead: Cut back and ask for support if reducing is hard.

^2,4

Smoking and recreational drugs

Moderate certainty

Why: NIDDK lists smoking and recreational drugs among habits that contribute to ED.

Who it applies to: Smokers and drug users.

Try instead: Ask a clinician or pharmacist about help to stop.

⁴

Long periods of inactivity

Moderate certainty

Why: NIDDK lists little activity as a contributing habit, and exercise programmes improved erectile function in trials.

Who it applies to: People who sit most of the day.

Try instead: Move regularly; see the activity pages.

^4,8

Sit Less & Move More → Improve Your Cardiovascular Fitness →

Unchecked stress, anxiety and low mood

Moderate certainty

Why: NIDDK lists anxiety, depression, stress and loneliness as causes of ED, and ED can feed back into them.

Who it applies to: Anyone under strain.

Try instead: Talk to a clinician; counselling can help, with a partner if you wish.

^4,3

Manage Sexual Performance Anxiety → Stress, anxiety, burnout and depression →

Products that need caution

"Male enhancement", "stamina" and ED pills sold as natural

High certainty

Why: The FDA says these products are likely to be contaminated with dangerous hidden ingredients, can lead to severe health problems and hospitalisation, and are sometimes falsely advertised as dietary supplements, food or all-natural. A product not on the FDA list is not proven safe.

Who it applies to: Anyone buying from shops, websites or social media.

Try instead: Skip them. Talk to a health professional about care that has been checked.

²⁰

Testosterone boosters: claim check →

ED supplement blends

High certainty

Why: In an Italian analysis of 25 marketed products, 80% fell in the group with no expected efficacy, usually blends of many substances at negligible doses. In a laboratory check of 20 ED supplements, 14 contained an undeclared prescription ED medicine, sometimes above the maximum recommended amount, and none carried interaction warnings.

Who it applies to: Anyone considering a blend.

Try instead: If you want to try an ingredient with some research behind it, ask a pharmacist, and have the evaluation first.

^24,21

Unsupported claims

"100% natural, no side effects"

Evidence against

Why: All 20 products in the laboratory check were claimed to be 100% natural without side effects, yet 14 held undeclared drug.

Who it applies to: Anyone reading product labels or adverts.

Try instead: Treat the claim as a warning sign, not a reassurance.

^21,20

"Works as well as the prescription tablets"

Evidence against

Why: We did not find a trial that compared a natural option against established ED medicines head to head. The best supplement results were for combinations with prescription medicines.

Who it applies to: Anyone reading adverts.

Try instead: Ask a clinician what is suitable for you.

^15,24

"Low vitamin D (or testosterone) causes your ED and a pill fixes it"

Evidence against

Why: Vitamin D did not change ED in an 8,920-man randomised trial. Low testosterone is one possible cause that a clinician can test for, not a universal one.

Who it applies to: Anyone looking for a single cause.

Try instead: Have a proper evaluation; low testosterone is tested by a clinician.

^19,4

Understand Hormone Tests → Testosterone and low testosterone →

Common mistakes

Assuming it is only in the mind, or only physical

Moderate certainty

Why: NIDDK describes physical, medicine-related, emotional and lifestyle causes that often work together.

Who it applies to: Anyone with ED.

Try instead: Ask for both a physical and a mood-and-relationship conversation.

^4,3

Trying products first and booking the check later

Moderate certainty

Why: Trying products can delay finding a treatable cause, and NIDDK advises talking with a clinician before using supplements because they can interact with medicines.

Who it applies to: Anyone self-treating.

Try instead: Book the check first.

^3,24

Staying silent because of embarrassment

Moderate certainty

Why: NIDDK says there is no need to feel ashamed, ED is common and treatable, and counselling can include a partner.

Who it applies to: Anyone who finds it hard to raise.

Try instead: Say it plainly: "I have trouble getting or keeping an erection." The clinician has heard it before.

^1,3

Communicate More Comfortably About Intimacy →

Adding supplements to medicines without asking

Low certainty

Why: The sources do not test interactions for natural options, and hidden drug ingredients make interactions unpredictable.

Who it applies to: Anyone on medicines.

Try instead: Ask a pharmacist before combining products.

^3,21

Evidence & safety

What the research shows

Health agencies (NIDDK, NHS) and the AUA and EAU guidelines agree that ED deserves an evaluation and tailored care. ED is linked with higher cardiovascular risk (relative risk 1.44). For natural options, diet and exercise programmes gave a modest but significant gain (moderate certainty), aerobic exercise helped in 7 trials, herbal supplements overall showed benefit in small short trials (low certainty) while ginseng's effect was trivial, Tribulus is disputed, vitamin D did not help in an 8,920-man trial, and marketed blends are not supported and may contain undeclared drugs (14 of 20 tested).

Limits of the evidence

We did not find a trial of lifestyle change against established ED medicines head to head.
Several review abstracts give few numbers or no certainty grade.
We did not read primary trials of saffron, ginseng or L-arginine.
We did not read a source for nitrate and heart-medicine warnings for ED drugs, so none are stated.
We did not find long-term safety data for supplements, or interaction data for the natural options.
The NHS page read does not list separate urgent warning signs for ED, and agency pages were read through a tool that summarises text, so wording is second-hand.

Precautions and interactions

Tell a clinician or pharmacist about every supplement, tea, powder or product you use.
Do not use supplements in place of an evaluation.
Never stop or change a prescribed medicine, including blood pressure, heart or antidepressant medicines, without the prescriber.
Avoid "male enhancement" products; the FDA warns of hidden ingredients.

Life-stage considerations

Younger men: new ED deserves a check-up because the cardiovascular link was stronger at younger ages in a meta-analysis.
Older men: ED is common (about 70% by age 70 in the research NIDDK cites) but not a routine part of aging; medicines and long-term conditions are more likely to contribute.
Pregnancy and breastfeeding: supplements and herbs in this page are for men and were not studied in pregnancy; partners who are pregnant should not take them.
Men with heart disease, high blood pressure or diabetes: check with a clinician before starting vigorous exercise or any supplement.

Warning signs

Chest pain, shortness of breath or fainting: call local emergency services. Do not wait for an appointment.
An erection that lasts longer than 4 hours: get care right away (NIDDK).
Vision or hearing loss after taking an oral ED medicine: get care right away (NIDDK).
Erection problems that keep happening, or that start suddenly in a younger man: see a GP or sexual health clinic (NHS).
A bad reaction after any "male enhancement" product: stop it, get medical help and tell the clinician what was in it. The FDA also invites reports.
Low mood, anxiety or any thoughts of harming yourself: talk to a clinician now, or contact local emergency or crisis services in your country.

Claim checks

Diet and exercise improve erectile function

Supported, modestly

⁸

Ginseng is a proven natural treatment for ED

Overstated

^14,13

Tribulus boosts erections

Mixed evidence

^17,13

Vitamin D supplements help ED

Not supported

¹⁹

All-natural male enhancement pills are a safe alternative

Not supported and risky

^20,21,24

Erectile dysfunction can be an early sign of heart disease

Supported as an association

^5,6,7

Acupuncture treats ED

Uncertain

¹²

Questions people ask

What is erectile dysfunction?

NIDDK says erectile dysfunction (ED, sometimes called impotence) is trouble getting or keeping an erection firm enough for sex. Most men occasionally fail to get or keep an erection, usually because of stress, tiredness or too much alcohol (NHS). It becomes a health question when it keeps happening.

How common is erectile dysfunction?

NIDDK cites research suggesting 30 to 50 million men in the United States have ED, with about 40% affected by age 40 and 70% by age 70. It also says ED is not a routine part of aging.

What causes erectile dysfunction?

NIDDK lists diseases (diabetes, heart and blood vessel disease, obesity, kidney disease, nerve damage, low testosterone, thyroid problems, prostate conditions), medicines, mental and emotional issues such as anxiety, depression and stress, and habits such as low activity, smoking, heavy alcohol and recreational drugs. Often several causes work together.

Can erectile dysfunction be a sign of heart disease?

It can be. In a meta-analysis of 14 studies (92,757 men), men with ED had a higher risk of cardiovascular events (relative risk 1.44), and a 2019 meta-analysis of 25 studies found similar results. This is an association, not proof, and most men with ED will not have heart disease, but it is a good reason to have blood pressure, cholesterol and blood sugar checked.

How is erectile dysfunction evaluated?

The NHS says a doctor or nurse may ask about your lifestyle, relationships and any problems, take basic checks such as blood pressure, and examine the genitals, and the prostate if you also have urinary symptoms. The aim is to find an underlying cause and treat it.

What does established care look like?

The AUA and EAU guidelines emphasise shared decision-making and treatment tailored to the man, with all suitable options explained. The NHS and NIDDK describe lifestyle change, counselling, reviewing current medicines, prescription tablets and other clinic options, which a clinician chooses and monitors.

Can lifestyle changes alone help?

Diet and exercise programmes gave modest but significant improvements in a 16-trial meta-analysis (1,477 men; moderate certainty), and aerobic exercise helped in a 7-trial review. They also help heart health. They do not replace an evaluation.

Do natural erectile dysfunction supplements work?

Evidence is mixed to limited. A 2026 meta-analysis of 14 trials reported benefit for herbal supplements overall, with saffron and ginseng singled out, but the trials were small and short; a Cochrane review judged ginseng's effect trivial; evidence for Tribulus and maca was called insufficient or mixed; and vitamin D did not help in a large trial.

Are "natural male enhancement" pills safe?

The FDA warns such products are likely to be contaminated with dangerous hidden ingredients and can lead to severe health problems and hospitalisation, even when advertised as all-natural. In a laboratory check, 14 of 20 ED supplements held undeclared ED medicine. Talk to a health professional before using one.

Can I buy erectile dysfunction pills online?

NIDDK advises not to order an ED medicine online before talking with a health care professional, and the NHS warns many websites sell fake medicines.

When should I see a doctor about erectile dysfunction?

See a GP or sexual health clinic if erection problems keep happening (NHS). Get care right away for an erection lasting longer than 4 hours or vision or hearing loss after an ED medicine (NIDDK), and call emergency services for chest pain, breathlessness or fainting.

Is it normal to feel embarrassed or low about erectile dysfunction?

Very. NIDDK lists emotional effects such as loss of intimacy, anxiety, depression and low self-esteem, and says counselling can help, with a partner if you wish. A clinician has heard it before; telling them is the first step.

References

NIDDK (NIH). Definition and facts for erectile dysfunction (reviewed October 2024). Read 2026-10-31 through a tool that summarises the page. source
NHS. Erectile dysfunction (impotence) (last reviewed 28 July 2023; due for review July 2026). Read 2026-10-31 through a tool that summarises the page. source
NIDDK (NIH). Treatment for erectile dysfunction (reviewed October 2024). Read 2026-10-31 through a tool that summarises the page. source
NIDDK (NIH). Symptoms and causes of erectile dysfunction (reviewed October 2024). Read 2026-10-31 through a tool that summarises the page. source
Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circ Cardiovasc Qual Outcomes 2013. PMID 23300267. source
Zhao B, Hong Z, Wei Y et al. Erectile dysfunction predicts cardiovascular events as an independent risk factor: a systematic review and meta-analysis. J Sex Med 2019. PMID 31104857. source
Kohler TS, Kloner RA, Rosen RC et al. The Princeton IV consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc 2024. PMID 39115509. source
Li T, He X, Huang W et al. Efficacy of lifestyle interventions in treating erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials. J Sex Med 2026. PMID 42143598. source
Chen Z, Wang J, Jia J et al. Effect of different physical activities on erectile dysfunction in adult men not receiving phosphodiesterase-5 inhibitors therapy: a systematic review and meta-analysis. Andrology 2024. PMID 38937909. source
Defeudis G, Mazzilli R, Di Tommaso AM et al. Effects of diet and antihyperglycemic drugs on erectile dysfunction: a systematic review. Andrology 2023. PMID 35485604. source
Barbosa FT, Silva MP, Fontes LES et al. Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea. Cochrane Database Syst Rev 2021. PMID 34555186. source
Yan M, Zhu T, Xue K et al. Efficacy and safety of acupuncture for erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials. Sex Med Rev 2026. PMID 42364146. source
Ho CY, Hsu CH, Chien TJ. Herbal dietary supplements for erectile dysfunction: a systematic review and meta-analysis of randomized-controlled trials. J Tradit Complement Med 2026. PMID 41696741. source
Lee HW, Lee MS, Kim TH et al. Ginseng for erectile dysfunction. Cochrane Database Syst Rev 2021. PMID 33871063. source
Barbonetti A, Tienforti D, Antolini F et al. Nutraceutical interventions for erectile dysfunction: a systematic review and network meta-analysis. J Sex Med 2024. PMID 39279185. source
Tian Y, Zhou Q, Li W et al. Efficacy of L-arginine and Pycnogenol in the treatment of male erectile dysfunction: a systematic review and meta-analysis. Front Endocrinol 2023. PMID 37908749. source
Suharyani S, Amanda B, Angellee J et al. Tribulus terrestris for management of patients with erectile dysfunction: a systematic review and meta-analysis of randomized trials. Int J Impot Res 2026. PMID 40360723. source
Su L, Yang ZT, Qu H et al. Effect of antioxidants supplementation on erectile dysfunction: a systematic review and meta-analysis of randomized controlled trials. Sex Med Rev 2022. PMID 35246405. source
Duarte Romero B, Waterhouse M, Baxter C et al. The effect of three years of vitamin D supplementation on erectile dysfunction: results from the randomized placebo-controlled D-Health Trial. Clin Nutr ESPEN 2024. PMID 38479897. source
US FDA. Sexual enhancement and energy product notifications (content current as of 15 October 2026). Read 2026-10-31 through a tool that summarises the page. source
Petkova-Gueorguieva E, Gueorguiev S, Lebanova H et al. Survey on sildenafil, tadalafil, and vardenafil concentrations in food supplements for erectile dysfunction. Int J Anal Chem 2022. PMID 35855809. source
Burnett AL, Nehra A, Breau RH et al. Erectile dysfunction: AUA guideline. J Urol 2018. PMID 29746858. source
Salonia A, Capogrosso P, Boeri L et al. European Association of Urology guidelines on male sexual and reproductive health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie's disease. Eur Urol 2025. PMID 40340108. source
Petre GC, Francini-Pesenti F, Vitagliano A et al. Dietary supplements for erectile dysfunction: analysis of marketed products, systematic review, meta-analysis and rational use. Nutrients 2023. PMID 37686709. source

Related on AlternativeMed

Ingredients, foods and supplements

Saffron → Asian ginseng → Tribulus → Maca → L-arginine and citrulline → Carnitine → Grape seed and pine bark extracts →

Research, safety and claim-check resources

Men's Wellness → Men's Wellness: A Starting Guide → Men's health: when to get help → Men's wellness: research and evidence → Understand Hormone Tests →