It’s a Guy Thing

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Considering the statistics, it’s no wonder we’re bombarded by advertisements and electronic junk mail promising help with erectile dysfunction. One in four American men older than 50 experiences some form of impotence. That’s around 20 million men, and because their plumbing problems affect their partners as well, the scope of the problem is significant. As tonics and treatments, herbs can be effective collaborators in the quest for solutions.

Facts about Erectile Dysfunction

Impotence, or erectile dysfunction (ED), is the inability of a man to achieve or maintain an erection long enough to engage in sexual intercourse. Medical science tells us ED can occur from at least 15 possible underlying causes: Diabetes, pituitary tumors, drug side effects, hormonal imbalances and psychological issues all can contribute. Impotence can come from harm to the nerves of the penis, from Parkinson’s disease or multiple sclerosis. But in men older than 60, the main cause is atherosclerosis, or narrowing of the arteries.

Diabetic men are particularly at risk because of their high rate of atherosclerosis and diabetic neuropathy. Experts used to think impotence was mainly psychological, but they have now decided that, at least in elderly men, physical causes probably play a primary role in more than 60 percent (some authorities say 80 to 90 percent) of all cases. Ultimately, most impotence is caused by deadly serious vascular disease — another reason to keep heart disease at bay.

Turn to Herbs for Help

Men tend to be reluctant to seek and receive health care. Around the world, though, men use safe herbal medicines as a first resort for maintaining good health. If you want to stay healthy, start with these herbal gems.

• Asian ginseng root (Panax ginseng). This men’s herb is well-known, yet shrouded in myth. Asian ginseng is used to treat a host of conditions and, when it is taken daily, to maintain general good health. White ginseng is the dried, unprocessed root, while the steamed root is called red ginseng (considered “hotter”) and is used for sexual dysfunction.

Asian populations use ginseng to support sexual energy in older people, but so far the scientific evidence for this use is scanty. From what we know about ginseng, it’s reasonable that long-term use would augment all the body’s functions, and a healthier body is likely to work better sexually. Clinicians report that ginseng increases sexual desire, and they  generally promote the herb’s purported longevity effects.

There is some scientific evidence that ginseng treats impotence, and clinical trials published in The American Journal of Chinese Medicine have shown that it increases sperm production and sperm motility. These claims have yet to be proven scientifically, but ginseng has been used by millions of people for 5,000 years and is the most important herb for men in Traditional Chinese Medicine.

You should not take enough ginseng to feel stimulated. Ginseng generally is indicated for daily, consistent use in moderate doses by men older than 40. Don’t use ginseng as a short-term stimulant. A dose that is a bit too high can cause uneasiness, irritability, headaches and heart palpitations. A typical dose of moderate-quality ginseng powder in capsules is 1,000 to 2,000 mg per day. The effects are slow and gradual, and extend over a period of years.

• Ashwaganda root (Withania somnifera). This herb is the main tonic, especially for men, in the Ayurvedic materia medica, similar to ginseng in Chinese medicine. Ayurvedic practitioners consider this long-term building herb to be a particularly powerful rejuvenative. Science is only beginning to confirm the encouraging signs for this valuable herb. An article published in 2000 in Alternative Medicine Review lists a host of confirmed benefits: anti-inflammatory, anti-tumor, antistress, antioxidant, immune-boosting and rejuvenating. The researchers said it also appears to exert a positive influence on the endocrine, cardiopulmonary and central nervous systems.

A 2000 study, published in the Indian Journal of Experimental Biology, showed that a combination medicine containing ashwaganda was as good as ginseng for reducing stress. Another study from 2001, published in the Journal of Ethnopharmacology, showed extracts of ashwaganda increased production of sex hormones and sperm, presumably by exerting a testosterone-like effect.

In a double-blind clinical trial conducted in 1980, ashwaganda (3 grams per day for one year) was tested on the process of aging in 101 healthy male adults (50 to 59 years of age). Significant improvements in hemoglobin, red blood cells, hair pigment and physical stature were observed. Serum cholesterol decreased, nail calcium was preserved, and 71.4 percent of those who received the herb reported improvement in sexual performance. Ashwaganda also is showing a variety of benefits for heart and vascular functions. Remember that impotence is caused largely by vascular disease, so this may be the benefit.

A typical dose of ashwaganda is about 1 gram per day, taken over long periods (up to many years) as a rejuvenator. Because ashwaganda is very safe, larger quantities often are used short term in Ayurveda.

• Saw palmetto berry (Serenoa repens). Saw palmetto is a small, scrub palm tree that grows in Florida. This common plant provides a potent medicine that eases the symptoms of a painful disorder that affects many older men.

Native Americans used saw palmetto berries for hundreds of years as a nutritive food and a reproductive tonic. They also used it for kidney stones, male fertility, breast disorders and urinary tract problems. Saw palmetto is lauded today to treat symptoms of benign prostatic hyperplasia (BPH).

BPH involves a slow, continual enlargement of the prostate gland. As the gland swells, it compresses the urethra, obstructing urine flow, resulting in weakened urination, night urinary urges, urine retention and pain. About 90 percent of men older than 85 have some evidence of BPH, but only half of them will have painful prostate enlargement. One theory on BPH focuses on the levels of dihydrotestosterone (DHT) in the prostate. In vitro experiments indicate that saw palmetto inhibits DHT from binding to cellular receptors, reducing DHT’s ability to make prostate cells grow.

A recent one-year randomized international study, published in the French Journal Progres en Urologie in 2002, found that saw palmetto performed as well for BPH as a common pharmaceutical drug, with fewer side effects.

Bladder emptying problems also are common in older men. As well as its effect on the prostate side of this problem, saw palmetto also relaxes smooth muscle in the bladder neck.

• Yohimbe bark (Pausinystalia yohimbe). This West African tree is a traditional herbal aphrodisiac. Drinking the bark tea assisted warriors who were preparing for battle to become aggressive and have more stamina. Now yohimbe helps make love, not war. It developed a reputation for increasing libido as well as improving male sexual performance. It enhances the size of the erect penis and the staying power of erections. Scientists who have studied yohimbe since the 1930s have confirmed that the bark has noted effects on sexual performance.

Scientists don’t completely understand how yohimbe works. Current thought suggests it functions by suppressing areas of the brain that keep sexual arousal under control, according to a British Journal of Clinical Practice study. With this suppression reduced, men might find themselves more passionate, so yohimbe seems like it could be especially good for ED from psychological causes.

With yohimbe, the balancing act is that the effective dose is close to the dose that can produce side effects. A dose designed to inflame passion might make you more amorous, and also a bit jittery and sweaty — which doesn’t sound like a fun date. Try taking 200 mg of the raw powdered herb in a capsule. Take it in one dose, not late in the day, and work up from there.

Be very cautious using yohimbe if you are taking tricyclic antidepressants, phenothiazines, clonidine, other drugs for lowering blood pressure or central nervous system stimulants.

• Ginkgo leaf (Ginkgo biloba). A few scientific studies (including one published in the Journal of Sex and Marital Therapy in 1998), plus case reports, suggest that ginkgo can reverse sexual dysfunction and ED caused by Prozac-type drugs and other types of antidepressants.

Studies from past years have shown that ginkgo could improve ED caused from arterial insufficiency. One study, published in the Journal of Urology, tested 60 mg per day of standardized ginkgo extract (24 percent flavoneglycosides) for 12 to 18 months. Penile blood flow was measured every four weeks. After six to eight weeks, improvement began to show. Within six months, half of the patients had regained potency. Nowadays, this is considered a very modest dose of ginkgo, especially in cases of circulatory insufficiency, so larger doses might work even better.

My experience has been very good in suggesting ginkgo. Clinically, it definitely promotes improvement over time. Erections are firmer, and it seems to assist orgasm sensation, again presumably because of increased circulation. 

Karta Purkh Singh Khalsa, a frequent contributor to Herbs for Health, is an adjunct faculty member in the botanical medicine department of Bastyr University. He currently is writing a book on Ayurvedic herbalism.

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