What Should A Man Look For In A Sexual Health Supplement?
A decrease in male sexual satisfaction may be the first sign of significant health problems boiling under the surface (1). A strong correlation was found between men aging and their sexual function significantly reducing in frequency. Surprisingly, there was no significant correlation found between men aging and their sexual satisfaction decreasing (1,2). There was, however, a strong correlation between diminished sexual satisfaction and diminishing health (3). Meaning, that when men feel that their sex life is not satisfactory, often, the problem is not age, it is diminishing health.
Blog Contents
Stepping Into No Man's Land
It takes a lot of guts to talk about men's health because let's face it, even men do not like to talk about men's sexual health. Human sexuality is so closely interwoven with self worth, it is almost impossible to dissociate any conversion about sexual function from emotional and mental components (4). Further, when talking about men's health, it is easy to get seduced into talking about pelvic health which is the single most highly discussed aspect of men's health. While male pelvic health is worth talking about, getting lost in the world of penile sexual enhancement highly undermines the importance of overall health and the complexity of the male sexual response.
For Men's Health, The Devil Is In The Details
The male sexual response starts with a clear mind and a relaxed body. The parasympathetic nervous system (the one responsible for resting and digesting) perceives a sexual stimulus and starts producing neurotransmitters that are responsible for satisfaction seeking5. Dopamine, glutamine and norepinephrine hold the thought and energize it into what feels like that burning desire. (6)
Once the stimulus is perceived, the entire physiology of the man changes. His Sympathetic Nervous System (SNS)( responsible for fight or flight) engages abruptly (7,8). Suddenly, the nostrils widen, and the olfactory nerve becomes more sensitive to aromatic stimuli (9). Additionally, air brings aromas that bypass the thalamus, the brain's switchboard (10,11). Bypassing regulatory neurons exponentially expediting the process of taking the man to the closest memory of emotions experienced the last time he experienced such an aroma. Memories, hopes, dreams, fantasies and past experiences flavour the experience for better or for worse (11, 12). Nervous signals rush to the spinal cord and recruit thousands of miles of blood vessels to carry the excitatory signals all the way down... to the heart (13, 14). That is precisely the moment when the heart feels like it is dropping. That drop, signals that blood pressure is increasing, some heartbeats may be skipped, and the heart activates to eject the excitatory signal further. (15,16)
At this point, the man is fully aware of the need for sexual inhibition if his reaction is not taking place in an appropriate situation (17). Even when consciously inhibited, further tissues like the auditory nerve become more sensitive to sound, and the receptors on the skin become more sensitive to touch (18). Finally, the blood flow makes its way down the body to the pelvic region where the highly orchestrated invisible male sexual response triggers the visible erectile response. (7,8)
It Takes Many Means to Reach One End
The last paragraph was a highly simplified, vastly short description of only a fraction of what the male body experiences during sexual excitation. Why bother trying to demystify the male sexual response and honour its complexity? Simply to demonstrate that if any part of the previously mentioned cascade is not working properly, there is a significant chance that there will be a disruption in the sexual response. To most people, all the disturbances result in the same symptom...erectile problems. (3)
Starting from the Bottom Up
When evaluating why any man may be experiencing problems with sexual health, it is helpful to start by closely examining pelvic health. Investigating pain, discomfort, urinary symptoms, infection history and any changes to the reproductive organs may help pinpoint a problem that is easy to treat. Urinary problems and kidney problems play a large role when it comes to painful penile conditions (19). Botanicals like Damiana are traditionally used for bladder and urinary conditions that affect sexual function. (20)
A regular annual visit to the urologist is highly recommended for men over the age of 40. It is important to emphasize the delicate nature of all the fine tubes that make up the male reproductive system. Any chronic infections can risk scarring and remodelling of the tubes. It is also important to note that mild to moderate infections, left untreated, may permanently change the shape of the tubing beyond repair (21,22).
In the case of any chronic inflammatory conditions of the male reproductive system, it may be beneficial to consider adding a safe proteolytic enzyme like Serrapeptase to the treatment regimen. Serrapeptase is an enzyme that is unique in its safety profile as it only breaks down inflamed and dead tissue, leaving living tissue completely unharmed and ready to heal. It also has an affinity to scar tissue, inflammatory markers and bacterial biofilms, making it an excellent supportive agent when treating any stubborn inflammatory pelvic condition. (23)
"Prostate Health is NOT an 'Old Man' Problem"
Most men think that supporting prostate health is only necessary once prostate problems emerge. Others feel that supporting prostate health is an older man issue and both of these ideas could not be further from the truth. Keeping in mind that the urethra pierces through the prostate and that healthy prostatic contraction plays a pivotal role in the orgasmic part of the sexual response, keeping the prostate healthy should be the objective of any man maintaining a healthy male reproductive system.
Both Zinc and Saw Palmetto are pivotal ingredients to maintaining prostate health. Preventing benign prostatic hyperplasia due to chronic testosterone exposure is something that most men are aware of. Maintaining a healthy-sized prostate is important for both urinary and sexual health as both urine, as well as ejaculatory fluids, must pass through an undisrupted urethra. Supplementing the body with the proper amount of zinc becomes pivotal when a man uses a functional sexual enhancement supplement. The reason for that is: sexual activity depletes the body's zinc stores (24).
Zinc plays a pivotal role in maintaining healthy reproductive glands and testosterone levels. It is less commonly known that zinc actually accumulates in the prostate gland (25). A significant portion of zinc leaves the body with every ejaculation as prostatic secretions contain an astonishing average of 0.6 mg of zinc per ejaculum. Upon taking a supplement that will enhance sexual function, It is important to maintain providing the body with adequate amounts of zinc to prevent such stressors from depleting zinc stores. (26)
Prostate Specific Antigen (PSA) Vs. Digital Rectal Examination (DRE)
The botanical Serenoa repens, better known as Saw Palmetto, on the other hand, is important for maintaining a healthy prostate and is likely good for maintaining the health of the prostate without impacting the Prostate Specific Antigen (PSA). (27, 28)
What most men do not know is that PSA levels can go up for many reasons other than BPH. Infections, irritation, and prostate disruption can all significantly increase PSA levels. In fact, recent sexual activity and a recent prostate Digital Rectal Examination (DRE) may significantly increase PSA. (29)
There was a past concern that saw palmetto may lower PSA measures masking prostate problems, however, several studies show that saw palmetto has no significant impact on PSA though it may significantly benefit prostate health. (28)
A well-trained, well-trusted physician may get a lot of insight from following up on the physical condition of a prostate gland. Always ask about the most appropriate time to check your PSA level. Supporting your prostate health is important even if you are a younger man.
In Sexual Health, It's Important To Have Nerve
In order for a man to be able to enjoy a healthy sex life, his neuronal pathways should be healthy enough to carry the excitatory signal from the brain, down to the heart and even lower to the pelvic region. Most inflammatory and metabolic conditions, when left untreated play a significant role in damaging the delicate peripheral nerves. Conditions like diabetes, atherosclerosis and autoimmune conditions can have a significantly negative influence on men's sexual health3. Unfortunately, if left untreated, neuropathies are likely to be permanent.
The botanical Epimedium brevicornu, better known as bishop's hat or Horny Goat Weed, contains the active ingredient icariin. It is shown to act as a phosphodiesterase type 5 inhibitor (PDE5 inhibitor). A PDE5 inhibitor is a vasodilating compound which dilates the smooth muscle layer lining the blood vessels supplying various tissues with extra blood flow. The spongy component of the penis known as the corpus cavernosum and corpus spongiosum are directly impacted by PDE5 inhibitors. Though horny goat weed is used for sexual enhancement on the premise of its activity as a vasodilator that assists with penile blood flow, it has many other health benefits that positively impact the sexual response indirectly. The following is just a short list of side benefits (30):
- Prevent premature ejaculations
- Vascular anti-inflammatory
- Prevent mitochondrial oxidative damage protecting nerve health
- Promotes the formation of new vasculature after vascular injury
- Increases free testosterone in the blood
- Increases both memory and concentration by increasing acetylcholine levels
- Promising evidence of function as a penile rehabilitation agent as a neurotrophic (30, 31)
Getting In The Flow
Cardiovascular health is one of the most critical determinants of the safety of engaging in sexual activity. Men who get the most negative reactions out of sexual enhancement drugs are those who have diminishing cardiovascular fitness. Having the fitness to participate in any physical activity that increases breathing to higher than conversational rate (breathing too hard to be able to talk) is a good indicator that a man can safely engage in sexual activity (32). Lacking such fitness only means that the body needs to be trained with an increase in physical activity and some safe, carefully selected cardiovascular exercise. It is always great to engage with a personal trainer to get the most effective and highest quality work out that can significantly increase cardiovascular fitness without the risk of overdoing it.
Assisting the body with oxygen transfer to increase physical fitness may help with creating a more rewarding, less tiring sexual experience. For men, supplementing a small amount of L-arginine may significantly enhance the body's ability to synthesize vasodilating compounds and lead to a long term increase in physical fitness. It is important to note that though doses of 1.5 g to 5 g were shown to significantly help men with erectile dysfunction, those doses may not be safe for all men as they may interact with blood pressure medications and other drugs. It is better to use l-arginine as a long term support of fitness than as a short term mechanism to engorge the pelvic region with as much blood flow as possible. (33, 34)
Keeping the blood flow reliable is one sure way to maintain fluid sexual function. Sometimes, it is not possible to stop the detrimental effect of toxin exposure. There are other times when drugs that affect sexual health negatively are medically necessary. In a 2020 study, it was demonstrated that about 76% of men suffering erectile dysfunction due to anti-depressant use felt that supplementing with the botanical ginkgo significantly improved their sexual function (35). It is crucial to never add a supplement or discontinue medication without consulting a medical practitioner.
Ginkgo biloba is a botanical well known for its capacity to help with memory by increasing the blood flow to the brain. Due to being a potent vasodilator and anti-platelet adhesion agent, ginkgo improves blood flow to all organs. It also has a high safety profile making it a tempting choice for practitioners who want to provide men with a natural sexual enhancement. (35, 36)
Keeping healthy vascular function also involves maintaining vasculature that is as free of cholesterol and inflammatory markers as possible. Supplementing with Folate and B12 may significantly decrease homocysteine levels (37). Asking your naturopath about following up with CRP (inflammatory marker) and homocysteine (other inflammatory markers) may significantly help you keep on track with your vascular health. Depending on your blood work, maintaining healthy blood flow by closely monitoring cholesterol levels is also very important.
Andropause and The Hormonal Male
It is no secret that like women, men experience a significant decrease in hormone levels as they age. Unlike women, however, the decrease in testosterone for men is more gradual. Symptoms of andropause include but are not limited to mood swings, irritability, muscle loss, gynecomastia (breast development), insomnia, lowered libido, erectile dysfunction, poor sexual performance and decreasing bone quality.
Supporting healthy hormone levels includes supplying the body with enough stimulus to support the synthesis of hormones. The single most important backbone to supply to maintain healthy hormone levels is Vitamin D3 (8). Ask your naturopath about the maximum safe dose of vitamin D for you if you are a male 40 years or older. Having enough vitamin D in your body can significantly increase your body's capacity at synthesizing hormones.
Importance of Fitness for Men
Men are meant to do a lot, that is why they have a significantly stronger muscular system than women. Physical activity can significantly increase testosterone levels. Additionally, due to adipose (fat) tissue being more supportive of female hormones (estrogenic) in nature, males who maintain physical activity have significantly lower levels of female hormones circulating in their blood due to being leaner.
Male Hormonal Support
External hormonal support was demonstrated to have significant health risks for healthy men who do not have a significant medical condition directly impacting their testosterone levels (39). Luckily, there are many natural ways to support the male body in maintaining healthy testosterone levels without overwhelming the body with levels that can be detrimental to health.
Hormonal support for men is most effective when taking a slow and steady approach as the male body is not designed to handle abrupt hormonal disturbances like that of the female. Starting with energy support, like simply a green tea supplement may give a man the energy boost he needs to become more physically active. Becoming more physically active has many health benefits including increasing cardiac fitness, promoting the building of more blood vessels and supporting the demand for more testosterone to be made. (40)
Panax ginseng, or what is better known as Korean ginseng functions as a stimulating adaptogen that gives the body more energy, more power and more will to be physically active. studies show that ginseng directly increases testosterone, sperm production, follicular stimulating hormone and luteinizing hormones. Ginseng was also found to significantly increase sexual performance even in males who did not have erectile dysfunction or other sexual inhibiting conditions (41). Additionally, ginseng was found to be uniquely associated with decreasing men's sexual excitation threshold. Studies theorize that this unique ability is related to ginseng being a de-stressor and an anti-anxiety botanical. From a Chinese Medicine point of view, Ginseng is the root of life that promotes yang energy. The simple act of promoting yang energy magnetizes the body to draw in more yin energy. Thus, making the more yang male attract and experience more balancing yin experiences. (42)
Korean ginseng has been demonstrated by research to increase testosterone, elevate mood, and strengthened immunity. Moreover, Korean ginseng specifically, has been demonstrated to suppress prolactin production which may play a role in decreasing male breast tissue development. (41,42)
Nature Loves Balance
Men and women too, usually like to go into overdrive. There is this idea that if a little bit of something is good for you then a ton of it is a ton better. Nature on the other hand, thrives on balancing and maintaining the scale. Botanicals like tribulus are amazing at doing just that, maintaining the balance of testosterone. Tribulus terrestris unlike other botanicals, is not a stimulant, it is a modulator of testosterone levels. It maintains testosterone to levels that are most supportive of optimal health.
Mental Health: Being in the Mood
One of the most highly neglected aspects of male sexual health is mental health. It may sound like an unattractive topic to discuss when speaking about the realm of sexuality, but the sexual response is initiated by thought and arguably can also be disrupted by one. There is an overwhelming amount of research that demonstrates the benefits of meditation as a male sexual health enhancement. Thought not every man many be interested in meditating for 30 min/ day to improve his sex life, such studies have demonstrated that there is neurochemical parts to the sexual response that can benefit from maintaining a healthy mental space. (44)
A long list of mentally enhancing botanicals and vitamins happens to also incidentally benefit and enhance the sexual response.
Botanicals and vitamins that participate directly in the synthesis of neurotransmitters may significantly enhance the sexual response. For someone with a distracted mind, such ingredients may motivate the brain to focus on the stimulus long enough to seek the reward. Holding the burning thought in place may be one of the most significant factors in determining how strong of a sexual response can be triggered by the thought. Mucuna pruriens is a botanical known to boost dopamine levels, making it easy to focus on reward-seeking activities. Many studies show that mucuna significantly enhances general mood (45). Providing the body with enough vitamin B6 is very important for the synthesis of dopamine and other healthy, rewarding neurotransmitters. (46)
Niacin acts as a detoxifying agent in the brain. It removes toxic metabolites and facilitates the brain to focus. This is crucial for the person to be relaxed enough and mindful enough to feel the neurotransmitters the brain is putting the effort into producing. A dopamine, oxytocin, and phenylethylamine rush is only fun when you can get the chemicals into the right receptors. Making them and dumping them in a sea of adrenergic metabolites is pointless. (47)
The second way it works is by stimulating the nervous signal to travel further by providing the nerve cells more energy. The neurotransmitter cocktail hits the first brain neuron and must make its way to the rest of the body via the carefully orchestrated action potential. If any of the receiving cells are too tired to fire the signal to the neighbouring cell, we have signal disruption. Pair the neural stimulation with some increase in blood flow due to an increase in Nitric Oxide (NO) and you have a very effective signal facilitator for any neurological signal, sexual or otherwise.
The Male Specific 'Refractory Period'
The refractory period is a phenomenon that only men experience. It acts as protective mechanism as males expend a lot of energy with every sexual encounter. Thus, the body saves itself from exhaustion by leaving a period after sexual activity where the neurons are no longer receptive to stimulation. Females do not experience the same refractory period, but they also expend much less energy per sexual encounter, making them less likely to deplete body resources with repeated sexual activity (48).
Decreasing the length of the refractory period has a lot to do with the body feeling rejuvenated enough to fulfil the physical demands of a possible sexual encounter. Replenishing the body with protein and nutrients may decrease recovery time. Greens and a broken protein supplement like Best Start may help the body by providing the much-needed, promptly available fuel. Other natural, quick sources of fuel like honey, royal jelly, pine pollen and bee pollen may also help rejuvenate the body and make recovery easier.
What Should A Man Look for in A Sexual Enhancement Supplement?
-
A safe supplement! Most safe sexual enhancement supplements use several sexual enhancement botanicals and vitamins, never a very high dose of one ingredient
-
A sexual enhancement supplement that puts general health in mind using ingredients that maintain and enhance cardiovascular, neuronal and mental health
-
Prostate health should be addressed with any sexual enhancement supplement as any increase in sexual activity adds more stress and demand on the prostate gland
- Supplements that keep in mind the highly significant effect of mood on sexual health are most successful at making the process of sexual enhancement feel more natural and spontaneous
Find Out if A Sexual Enhancement Supplement is Actually Working
The Male Sexual Quotient (MSQ) is a simple, short questionnaire that is designed to help men gain a good insight into their sexual health. Both, the aspect of male sexual function and satisfaction are taken into account in the questionnaire. The questionnaire can be used to track sexual health for both personal as well as medical purposes. It was of great benefit to share the results of the questionnaire with your healthcare provider.
Never Give Into Shame
Studies demonstrate that roughly 3 million Canadian men over the age of 40 suffer erectile dysfunction. Failing to sustain an erection is an experience that every man will experience at some point or the other. It is important to have enough self-compassion to bypass any shame or embarrassment and talk to a healthcare provider. Taking a critical, healthy look at male sexual health may pave a satisfying way to long-term physical and mental health. On the other hand, every step a man takes towards his physical health, in one way or the other, is going to enhance his sex life and benefit his mental health. Supporting the body with a balanced, safe, healthy sexual enhancement supplement may prove to be beneficial to many other dimensions of life.
Article References:
1. Flynn, K. E., Lin, L., Bruner, D. W., Cyranowski, J. M., Hahn, E. A., Jeffery, D. D., ... & Weinfurt, K. P. (2016). Sexual satisfaction and the importance of sexual health to quality of life throughout the life course of US adults. The journal of sexual medicine, 13(11), 1642-1650.
2. Kalra, G., Subramanyam, A., & Pinto, C. (2011). Sexuality: Desire, activity and intimacy in the elderly. Indian journal of psychiatry, 53(4), 300.
3. Chung, E. (2019). Sexuality in ageing male: review of pathophysiology and treatment strategies for various male sexual dysfunctions. Medical Sciences, 7(10), 98.
4. Özkent, M. S., Hamarat, M. B., Taşkapu, H. H., Kılınç, M. T., Göger, Y. E., & Sönmez, M. G. (2021). Is erectile dysfunction related to self‐esteem and depression? A prospective case–control study. Andrologia, 53(1), e13910.
5. Ralph, D. J. (2005). Normal erectile function. Clinical cornerstone, 7(1), 13-17.
6. Hull, E. M., & Dominguez, J. M. (2006). Getting his act together: roles of glutamate, nitric oxide, and dopamine in the medial preoptic area. Brain research, 1126(1), 66-75.
7. Lange, J. D., Wincze, J. P., Zwick, W., Feldman, S., & Hughes, K. (1981). Effects of demand for performance, self-monitoring of arousal, and increased sympathetic nervous system activity on male erectile response. Archives of Sexual Behavior, 10(5), 443-464.
8. Andersson, K. E. (1999). The pharmacological perspective: role for the sympathetic nervous system in micturition and sexual function. Prostate cancer and prostatic diseases, 2(4), S5-S8.
9. Doty, R. L., & Cameron, E. L. (2009). Sex differences and reproductive hormone influences on human odor perception. Physiology & behavior, 97(2), 213-228.
10. Bendas, J., Hummel, T., & Croy, I. (2018). Olfactory function relates to sexual experience in adults. Archives of sexual behavior, 47(5), 1333-1339.
11. Shepherd, G. M. (2005). Perception without a thalamus: how does olfaction do it?. Neuron, 46(2), 166-168.
12. Willander, J., & Larsson, M. (2007). Olfaction and emotion: The case of autobiographical memory. Memory & cognition, 35(7), 1659-1663.
13. Deforge, D., Blackmer, J., Garritty, C., Yazdi, F., Cronin, V., Barrowman, N., ... & Moher, D. (2006). Male erectile dysfunction following spinal cord injury: a systematic review. Spinal cord, 44(8), 465-473.
14. Lee, J. Y., Joo, K. J., Kim, J. T., Cho, S. T., Cho, D. S., Won, Y. Y., & Choi, J. B. (2011). Heart rate variability in men with erectile dysfunction. International Neurourology Journal, 15(2), 87.
15. Krüger, T., Exton, M. S., Pawlak, C., von zur Mühlen, A., Hartmann, U., & Schedlowski, M. (1998). Neuroendocrine and cardiovascular response to sexual arousal and orgasm in men. Psychoneuroendocrinology, 23(4), 401-411.
16. Lee, J. Y., Joo, K. J., Kim, J. T., Cho, S. T., Cho, D. S., Won, Y. Y., & Choi, J. B. (2011). Heart rate variability in men with erectile dysfunction. International Neurourology Journal, 15(2), 87.
17. Janssen, E., & Bancroft, J. (2007). The dual-control model: The role of sexual inhibition and excitation in sexual arousal and behavior. The psychophysiology of sex, 15, 197-222.
18. Hoffmann, H., Janssen, E., & Turner, S. L. (2004). Classical conditioning of sexual arousal in women and men: Effects of varying awareness and biological relevance of the conditioned stimulus. Archives of Sexual Behavior, 33(1), 43-53.
19. Morán, E., Budía, A., Broseta, E., & Boronat, F. (2013). Phytotherapy in urology. Current scientific evidence of its application in urolithiasis, chronic pelvic pain, erectile dysfunction and urinary tract infections. Actas Urológicas Españolas (English Edition), 37(3), 174-180.
20. Baez-Parra, K. M., Alcaraz-Melendez, L., Santamaria-Miranda, A., Heredia, J. B., Leon-Felix, J., Muy-Rangel, M. D., & Angulo-Escalante, M. A. (2018). Leaf morphology and anatomy of varieties of Turnera diffusa var. diffusa and Turnera diffusa var. aphrodisiaca (Ward) Urb. African Journal of Traditional, Complementary and Alternative Medicines, 15(1), 110-116.
21. Smith, C. P. (2016). Male chronic pelvic pain: An update. Indian journal of urology: IJU: journal of the Urological Society of India, 32(1), 34.
22. Pavlica, P., Barozzi, L., & Menchi, I. (2003). Imaging of male urethra. European radiology, 13(7), 1583-1596.
23. Jadhav, S. B., Shah, N., Rathi, A., Rathi, V., & Rathi, A. (2020). Serratiopeptidase: Insights into the therapeutic applications. Biotechnology Reports, e00544.
24. Meadows, A., & Cupp, M. J. (2000). Saw palmetto. In Toxicology and Clinical Pharmacology of Herbal Products (pp. 133-139). Humana Press, Totowa, NJ.
25. Prasad, A. S., Mantzoros, C. S., Beck, F. W., Hess, J. W., & Brewer, G. J. (1996). Zinc status and serum testosterone levels of healthy adults. Nutrition, 12(5), 344-348.
26. Foster, D. M., Aamodt, R. L., Henkin, R. I., & Berman, M. (1979). Zinc metabolism in humans: a kinetic model. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 237(5), R340-R349.
27. Marks, L. S., Partin, A. W., Epstein, J. I., Tyler, V. E., Simon, I., Macairan, M. L., ... & DeKernion, J. B. (2000). Effects of a saw palmetto herbal blend in men with symptomatic benign prostatic hyperplasia. The Journal of urology, 163(5), 1451-1456.
28. Gordon, A. E., & Shaughnessy, A. F. (2003). Saw palmetto for prostate disorders. American family physician, 67(6), 1281-1283.
29. Demir, K., Tarhan, F., Orçun, A., Aslan, H., & Türk, A. (2014). Effects of ejaculation on serum prostate-specific antigen levels. Turkish journal of urology, 40(1), 40.
30. Shindel, A. W., Xin, Z. C., Lin, G., Fandel, T. M., Huang, Y. C., Banie, L., ... & Lue, T. F. (2010). Erectogenic and neurotrophic effects of icariin, a purified extract of horny goat weed (Epimedium spp.) in vitro and in vivo. The journal of sexual medicine, 7(4pt1), 1518-1528.
31. Edwards, S. E., da Costa Rocha, I., Williamson, E. M., & Heinrich, M. (2015). Phytopharmacy: An evidence-based guide to herbal medicinal products. John Wiley & Sons.
32. Stein, R. A. (2000). Cardiovascular response to sexual activity. The American journal of cardiology, 86(2), 27-29.
33. Klotz, T., Mathers, M. J., Braun, M., Bloch, W., & Engelmann, U. (1999). Effectiveness of oral L-arginine in first-line treatment of erectile dysfunction in a controlled crossover study. Urologia internationalis, 63(4), 220-223.
34. Schulman, S. P., Becker, L. C., Kass, D. A., Champion, H. C., Terrin, M. L., Forman, S., ... & Gerstenblith, G. (2006). L-arginine therapy in acute myocardial infarction: the Vascular Interaction With Age in Myocardial Infarction (VINTAGE MI) randomized clinical trial. Jama, 295(1), 58-64.
35. MacKay, D. (2004). Nutrients and botanicals for erectile dysfunction: examining the evidence. Alternative Medicine Review, 9(1).
36. McKenna, D. J., Jones, K., & Hughes, K. (2001). Efficacy, safety, and use of ginkgo biloba in clinical and preclinical applications. Alternative therapies in health and medicine, 7(5), 70.
37. Sansone, A., Cignarelli, A., Sansone, M., Romanelli, F., Corona, G., Gianfrilli, D., ... & Lenzi, A. (2018). Serum homocysteine levels in men with and without erectile dysfunction: a systematic review and meta-analysis. International journal of endocrinology, 2018.
38. Wehr, E., Pilz, S., Boehm, B. O., März, W., & Obermayer‐Pietsch, B. (2010). Association of vitamin D status with serum androgen levels in men. Clinical endocrinology, 73(2), 243-248.
39. Parsons, J. K., Carter, H. B., Platz, E. A., Wright, E. J., Landis, P., & Metter, E. J. (2005). Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiology and Prevention Biomarkers, 14(9), 2257-2260.
40. Kumagai, H., Yoshikawa, T., Zempo-Miyaki, A., Myoenzono, K., Tsujimoto, T., Tanaka, K., & Maeda, S. (2018). Vigorous physical activity is associated with regular aerobic exercise-induced increased serum testosterone levels in overweight/obese men. Hormone and Metabolic Research, 50(01), 73-79.
41. Kennedy, D. O., Reay, J. L., & Scholey, A. B. (2007). Effects of 8 weeks administration of Korean Panax ginseng extract on the mood and cognitive performance of healthy individuals. Journal of Ginseng Research, 31(1), 34.
42. Murphy, L. L., & LEE, T. J. F. (2002). Ginseng, sex behavior, and nitric oxide. Annals of the New York Academy of Sciences, 962(1), 372-377.
43. Ghanbari, A., Akhshi, N., Nedaei, S. E., Mollica, A., Aneva, I. Y., Qi, Y., ... & Echeverría, J. (2021). Tribulus terrestris and female reproductive system health: A comprehensive review. Phytomedicine, 153462.Sunnen, G. V. (1979). Meditative treatment for erectile dysfunction. Love and Attraction, 435-437.
45. Kavitha, C., & Thangamani, C. (2014). Amazing bean Mucuna pruriens: A comprehensive review. Journal of Medicinal Plants Research, 8(2), 138-143.
46. Bernstein, A. L. (1990). Vitamin B6 in clinical neurology. Annals of the New York Academy of Sciences, 585(1), 250-260.
47. Xu, X. J., & Jiang, G. S. (2015). Niacin-respondent subset of schizophrenia–a therapeutic review. Eur Rev Med Pharmacol Sci, 19(6), 988-97.
48. Yilmaz, U., & Aksu, M. (2000). The postejaculatory refractory period: a neurophysiological study in the human male. BJU international, 85(9), 1093-1096.
Leave a comment