Common Problems
Low Sex Drive (Libido)
The second most common sexual dysfunction in men after premature ejaculation is low libido. Approximately 43 percent of women and 31 percent of men suffer sexual inadequacy for one reason or another. It is also very difficult for men and women to discuss such problems despite the help available from health professionals. What defines a low libido for an individual is subjective and depends upon many variables but definitely involves a loss of sex drive. Any medical problem or chronic physical condition can cause a reduction in one's sex drive. Similarly, insufficient amounts of the male sex hormone testosterone may cause low libido, though such a condition is unlikely to affect erectile function. Drugs can also decrease libido. Many, though not all, prescription antidepressants, tranquilizers and antihypertensive medications, can diminish sex drive.
In an article on Depression and Sexual desire by the American Academy of Family Physicians, the authors stated that “In a survey conducted in 1994 it was found that 33 percent of women and 17 percent of men reported sexual disinterest. Another survey concluded that one third of women from 18 to 59 years of age reported feeling a lack of sexual desire with the previous year.”
For many, this is not a surprise. Many people take it as a fact that sexual desire decreases as we age. What most people do not know is that sexual desire can be greatly increased naturally by properly taking care of our bodies: with a daily and moderate exercise routine, and by adding the right dietary supplements to our healthy diet.
Libido is an appetite, and it often can be very difficult to help someone acquire the taste for something - or to acknowledge to themselves that they really do have a craving for something delightful, says Dr. Zussman. "You can present tempting foods like a luscious dessert," she says, "but that won't necessarily help someone who doesn't feel like eating or who denies the pleasure of eating sweets." Here's what therapists might suggest to cultivate a sexy sweet tooth and put a lilt in your libido.
Low male libido is often used interchangeably to mean impotence, but the two have important differences.
Impotence is mostly characterized by an inability to achieve an erection, maintain one, or recurring failure to reach ejaculation. A low male libido, on the other hand, simply means a lack of desire for wanting sex. In short, men who have a low libido do not necessarily suffer from impotence.
Men's libido declines with age however you can fight back against the aging process and rejuvenate and enhance your libido naturally. Let's look at some common causes of low libido and how to rekindle your sex drive.
What causes Low Male Libido?
Low male libido can have many causes, both physical and emotional. Some of the more common ones include: aging (testosterone levels decrease at the rate of 2% per year after age 30), physical stress, and excessive use of some drugs, such as alcohol and certain prescription medications. Emotional causes for low male libido, on the other hand, can stem from: boredom, depression, or lack of self-esteem.
The emotional causes are more difficult to resolve, and usually require identifying the root of the trouble, which may require psychological counseling. By contrast, most physical (and especially age-related) causes of low male libido can be improved markedly.
If you have no serious medical conditions then common causes of low libido are
Fatigue and Energy Levels
A curse of modern times and huge passion killer, when we become tired stressed and fatigued energy is diverted to other areas the body considers more important.
Poor Blood Circulation
Circulation declines with age and is a common cause of numerous health problems. Strong blood flow is not just vital for your sexual health, its critical for your overall wellness.
Low Nitric Oxide Levels
This is the chemical which is needed to get an erection - if not enough of this chemical is realized you simply won't get an erection. It is realized in the blood vessels and allows sufficient blood to flow in to the penis and create an erection and it's a fact - it declines with age.
Low Testosterone Levels
In later life this key hormone starts to decline and you probably know already how vital it is!
So how do you combat the above?You simply need to take some tried and tested to herbs to increase libido and they can combat all the above. Today, many companies are providing super cocktails of various herbs, to rejuvenate libido, so you can get them all in one convenient serving.
How to Increase a Low Male Libido
There are many products on the market promising to increase male libido. However, many of these libido enhancers are of substandard quality, and have little to no scientific efficacy.
For example, many of the sexual enhancement products touted to increase male libido contain Yohimbe, which is an extract from the bark of an African tree. However, what these makers don't tell you is that Yohimbe has potentially dangerous side-effects and, in fact, has been banned in a number of countries for just this reason.
Another common herbal combination in some products that claim to increase male libido is: Rhodiola rosea and Maca. Both of these herbs have benefits for low male libido.
It is absolutely imperative you choose a libido enhancer formulated by a scientist with impeccable credentials. Most of the products for low male libido are created and pitched by marketers who are selling ill-conceived formulations, in an attempt to capitalize on the tremendous current demand for libido enhancers.
What Works to Increase Male Libido
>There are actually certain ingredients that will help with low male libido. Medicine Plants, MACA and Rhodiola rosea are pure, herbs that have been shown to increase male and female sexual response. Let's look at the herbs that can help with the above conditions.
A great combination is:
Ginseng and Ginkgo Biloba
These two tonic herbs, increase energy and wellbeing and generally make you feel more in the mood. They are also excellent for improving blood circulation, especially to the extremities and the genitals.
Cnidium and Horny Goat Weed
These two herbs are a great natural and alternative to j prescription drugs to increasing nitric oxide release and inhibit PDE-5. Horny Goat Weed also lifts energy levels; Cnidium also promotes better blood circulation.
Mucuna Pruriens and Tongkat Ali
Mucuna pruriens has anabolic and growth hormone stimulant properties and the anabolic affect of the seed sees it increase testosterone. The bioactive Glygopeptide compounds in Tongkat ali increase free testosterone and decrease SHBG levels at the same time.
So the above can increase production of nitric oxide, testosterone and improve blood circulation. Many of them increase energy as well - i.e Ginkgo Biloba, Ginseng and Horny Goat Weed but we will add in another great energy enhancing herb which is:
Tribulus Terrestris
Tibulus can improve sexual desire, performance, and increase overall energy levels in the body and is also an excellent circulatory tonic. It has been used by serious athletes for years, due to its effect on physical performance.
So there you have a great combination of 7 herbs to increase libido naturally and benefit overall health.
There are other natural libido enhancing herbs - but the above combo is great to stop men's libido declining with age.
Take them and you will get an overall health boost, rollback the years and feel like a new man again.
Erectile Dysfunction and Impotency
The problem of errectile disfunctioning and impotence affects at least 30 percent of all adult males and 50 percent of all males over 40 years of age. Some 85 percent of the causes for ED are physical and are organic and due to an actual physical problem. In general, 40 percent of all 40-year-olds, 50 percent of all 50- year-olds, and 60percent of all 60-year-olds have some form of ED. For years impotence was rarely mentioned or discussed. It was commonly believed to be due to psychological problems and treatment remained in the hands of the psychologists and psychiatrists. We know now that 80-90% of impotence is caused by physical problems, usually related to the blood supply of the penis - the arteries and veins which carry blood to and from the penis.
Erectile dysfunction (ED) is the inability of a male to attain or sustain an erection sufficient for sexual intercourse.
It can be a persistent condition; however, almost half of all men experience ED only occasionally. ED can have physical, psychological, or drug-induced causes.1 Although some doctors used to believe differently, most researchers and doctors now believe that physical factors are responsible for the majority of ED cases.
Several conditions may contribute to ED by impairing blood flow to the penis. These include atherosclerosis, diabetes, hypothyroidism, multiple sclerosis, and chronic alcohol abuse.
>Symptoms of erectile dysfunction
ED is defined by the symptoms listed above. Symptoms may also include loss of sexual desire (libido), premature ejaculation, or inability to achieve orgasm.
>Lifestyle changes that may be helpful
Men who smoke have been shown to have an increased incidence of ED.2
In a study of obese men with erectile dysfunction, a two-year lifestyle program consisting of a low-calorie diet plus regular exercise resulted in a significant improvement in erectile function, which became normal in 31% of the participants.3
>Other therapies
Depending on the cause, therapy may include psychological and behavioral counseling, treatment of underlying cardiovascular disease, and avoidance of medications such as cimetidine, antihypertensives, and MAO inhibitors. Penile vacuum devices and surgical options, such as penile implants and vascular repair, are usually limited to those who have not responded to other treatments.
>Vitamins and amino acids that may be helpful
Low blood levels of the hormone DHEA (dehydroepiandrosterone) have been reported in some men with ED. In one double-blind trial, 40 men with low DHEA levels and ED were given 50 mg DHEA per day for six months.4 Significant improvement in both erectile function and interest in sex occurred in the men assigned to take DHEA, but not in those assigned to take placebo. No significant change occurred in testosterone levels or in factors that could affect the prostate gland. Experts have concerns about the safe use of DHEA, particularly because long-term safety data do not exist.
Dilation of blood vessels necessary for a normal erection depends on a substance called nitric oxide, and nitric oxide formation depends on the amino acid arginine. In a preliminary trial, men with ED were given 2,800 mg of arginine per day for two weeks. Six of the 15 men in the trial were helped, though none improved while taking placebo.5 In a larger double-blind trial, men with ED were given 1,670 mg of arginine per day or a matching placebo for six weeks.6 Arginine supplementation was found to be particularly effective at improving ED in men with abnormal nitric oxide metabolism. Although little is known about how effective arginine will be for men with ED or which subset of these men would be helped, available research looks promising and suggests that at least some men are likely to benefit.
In a double-blind study, supplementing with the combination of propionyl-L-carnitine (a form of L-carnitine) and acetyl-L-carnitine (2 grams of each per day) for six months significantly improved erectile function in elderly men with erectile dysfunction associated with low testosterone levels. Propionyl-L-carnitine and acetyl-L-carnitine were significantly more effective than testosterone treatment.7
In a double-blind study of men with erectile dysfunction, supplementing with 120 mg per day of Pycnogenol®, an extract of the bark of a certain tree (Pinus pinaster), improved erectile function, whereas placebo treatment had no effect.8
L-Arginine
Arginine (amino acid L-arginine) has been the focus of increasing interest since the early 1980s when its use was first popularized as a safe and effective way to increase the amount of growth hormone (GH) released from the pituitary gland. Arginine has been heavily promoted as a health supplement capable of enhancing sexual function in men. Specifically, claims have been made that arginine supplementation may resolve erectile dysfunction, producing better erections in healthy men. The study "Effects of Long-Term Oral Administration of L-Arginine on the Rat Erectile Response" performed by the Department of Surgery, Harbor-UCLA Medical Center, Torrance, California showed that arginine supplementation does cause better erections – in rats: "Long-term oral administration of supra-physiologic doses of Larginine improves the erectile response in the aging rat. We postulate that L-arginine in the penis may be a substrate-limiting factor for NOS activity and that L-arginine may up-regulate penile NOS activity but not its expression. The blockade of penile erection by electric field stimulation with Nomega- nitro-L-arginine methyl ester suggests that if ancillary corporeal vasodilator mechanisms develop, a basal level of NO synthesis is still required for activation and relaxation of the corporeal smooth muscle. These data support the possible use of dietary supplements for treatment of erectile dysfunction."
APHRODISIAC
Aphrodisiacs! Is term used by Naturopaths for the natural remedies used to treat impotency and erectile dysfunction. Throughout the ages almost every culture has used various `substances', usually herbal in origin, to put some zip into their love lives or in an attempt to cure the impotent.
Although synthetic sex enhancers like seldinafil, teldenafil and others gets all the headlines these days due to massive and expensive marketing campaigns by the pharmaceutical companies, there are natural treatments, that appear to be equally effective in restoring erectile ability, are probably far safer and certainly less expensive. Before a man goes down these synthetics enhancer’s road, it is strongly recommended that they give one of these natural options a serious try...
>Herbal and other natural aphrodisiacs that may be helpful
Tribulus Terrestris
Tribulus Terrestris is a potent medicinal herb that increases the body's natural production of testosterone. Tribulus actually supports the release of testosterone and is one of the few herbs that actually increases seminal fluid (by volume and by sperm count). It can increase fertility in both men and women because it has a stimulating effect on spermatogenesis (the origin and development of sperm), ovogenesis (the growing of mature female egg cells), and libido. Tribulus contains powerful steroid saponins which has been used traditionally to improve the libido. Studies performed in Europe concluded that supplementation with Tribulus Terrestris could increase testosterone levels by 30% or more in just 5 days. Tribulus increases athletic and sexual performance and activity in both men and women by supporting the body's hormonal feedback system, acting as a nutrient to the glands andstimulating hormone release.
Ashwghanda
Ashwaganda (withania somnifera) is excellent for infertility, impotence, insomnia, nervous tension, rheumatism, coughs and stress. It is an Ayurvedic plant from India and is known as the "ginseng" of Ayurvedic medicine, the traditional medicine of India. Aswaganda is an "adaptogen", an herb that improves physicalenergy, increases immunity to colds and infections, and increases sexual capacity. It is used to restore male libido, cure impotence and increase male fertility. It is widely used in southern Asia as a male sexuality tonic. For women, it serves as an energy booster and to ease menopause symptoms. Proven More Effective than Ginseng Studies indicate that the herb reduces the negative effects of stress. It slows tumor growth, relieves anxiety and insomnia, reduces cholesterol and increases sexual performance.
Muria Puama
Muira Puama has been used in Central and South America and in Europe for generations as a sexual aphrodisiac and passion intensifier. It is the second-most popular natural herbal aphrodisiac for enhanced sexual performance and sensitivity. The effects of Muira Puama were first noted in 1930 by M. Penna in Notes Sobre Plantas Brasileires, a dissertation, in part, on the
treatment of impotency. In 1933 D. Schwontkowski (Herbs of the Amazon) (1993) cites the popularity of Muira Puama for male stamina and for female frigidity, menstrual cramps and premenstrual syndrome (PMS). A French experimenter treated patients with erectile dysfunction and low sexual libido with Muira Puama. After two weeks of daily dosages of Muira Puama, two-thirds showed an increase in sexual interest. One half of the male participants claimed that this herb improved their ability to achieve and maintain an erection.
Maca
Maca (Lepidium meyenii) has been used by Peruvians for centuries as an energy and sex-enhancing botanical. Maca is reported to alleviate erectile problems, improve libido for men and women and to relieve menopause symptoms. Today Maca is cultivated in the highlands of the Peruvian Andes. One local inhabitant of this Peruvian region says that those men and women who consume Maca as part of their daily diet are known to be fertile. Its fertility-enhancing effects are so popular that Maca is used by the locals as part of their daily diet, in food products, ingested in juice form, found in baked goods and used as a base for drinks. Presumably men and women who use Maca often notice a difference in their energy and sexual performance within a short time. In men, Maca is used to remedy impotence, restore or increase libido, and serves as an aphrodisiac. Maca alsoenhances female libido, helps promote sexual functioning, insures vaginal lubrication, and in general brings about all the benefits of healthy balanced hormone levels in the body. Maca may relieve
menopausal discomfort.
Macuna Purien
Mucuna Pruriens contains naturally occurring L-dopa a known libido-booster. It has been used by men with erectile problems, men and women with low libido, and for women undergoing menopause. Mucuna pruriens is reported in Plants of the Gods (Hofmann & Shultes) to contain tryptamine alkaloids, specifically 5MeoDMT, dimethyltryptamine and related alkaloids, in all parts of the plant. Also reported to contain L-dopa in seeds, a dopamine precursor utilized in treating Parkinson's disease. The seeds are considered astringent, aphrodisiac, tonic, nervine and nutritive. They are given in powder or in decoction in cases of leukorrhea, spermatorrhea and menstrual disorders
Oat Straw
(Avena Sativa or Wild Oat) Throughout the ages avena sativa (wild oats) has been used as a natural aphrodisiac and strength enhancer by men and women. Avena sativa is an extract from wild oats straw, and a rather recent entry to the field of aphrodisiacs. While oats have a long reputation of being the most energizing grain, the alleged sexual effects have not commonly been recognized in previous centuries. Avena sativa is said to free up bound testosterone in both men an women. Medicinal action and uses are primarily as a stimulant and antispasmodic. The pericarp of Oats contains an amorphous alkaloid which acts as a stimulant of the motor ganglia, increasing the excitability of the muscles, and in horses causes excitement.
Yohimbine
(the primary active constituent in yohimbe) has been shown in several double-blind trials to help treat men with ED;9 10 negative results have also been reported, however.11 12 Yohimbe dilates blood vessels and may help, regardless of the cause of ED. A tincture of yohimbe bark is often used in the amount of 5 to 10 drops three times per day. Standardized yohimbe extracts are also available. A typical daily amount of yohimbine is 15 to 30 mg. It is best to use yohimbe and yohimbine under the supervision of a physician.
Panax or Korean Ginseng
Korean Ginseng, or Panax Ginseng, is a brown, gnarled root about the size of a little finger that resembles the shape of the human body; therefore, it is sometimes referred to as a "manroot" or "root of man. Korean Ginseng is used in China as a preventative tonic to stimulate the entire body to overcome stress, fatigue and weakness. It helps the body to adapt to stress and to regenerate and rebuild the sexual centers. Korean Ginseng contains 29 differen ginsenosides. Panaxans help to lower blood sugar, polysaccharides work to enhance the immune system and its antioxidant properties are immunestimulating to protect the body from illness, disease and stress. Korena Ginseng helps to stimulate production of immune cells called "killer T-cells" that destroy viruses and bacteria. It balances the release of stress hormones by supporting the organs that produce them (the hypothalamus and the pituitary and adrenal glands). Its sexual benefits work to improve erectile function and to increase testosterone and sperm count. In Asian medicine, the herb is used as an aphrodisiac, and is considered a remedy for indigestion, heart problems, and urinary disturbances. In general, human studies have mainly found increased "quality of life" among those taking ginseng. This medicinal root has a street reputation as an ancient aphrodisiac. In the May 1995 issue of the journal British Pharmacology, a study concluded that substances in ginseng known as ginsenosides may work in a similar way to Viagra. One Chinese Herb company uses ginseng in pills to treat premature ejaculation. Asian ginseng (Panax ginseng) has traditionally been used as a supportive herb for male potency. A double-blind trial found that 1,800 mg per day of Asian ginseng extract for three months helped improve libido and the ability to maintain an erection in men with ED.13 The benefit of Asian ginseng confirmed in another double-blind study, in which 900 mg three times a day was given for eight weeks.14
Butea superba
is a Thai plant that has been used traditionally to increase sexual vigor. In a preliminary trial, 82% of men with erectile dysfunction reported an improvement in erectile function while taking Butea superba for three months.15 The amount used was 500 mg per day for the first four days, followed by 1,000 mg per day thereafter. The response rate in the placebo group could not be evaluated, because none of the men receiving the placebo returned for their follow-up visit.
Ginkgo biloba
may help some men with ED by increasing blood flow to the penis. One double-blind trial found improvement in men taking 240 mg per day of a standardized Ginkgo biloba extract (GBE) for nine months.16 A preliminary trial, involving 30 men who were experiencing ED as a result of medication use (selective serotonin reuptake inhibitors and other medications), found that approximately 200 mg per day of GBE had a positive effect on sexual function in 76% of the men.17
Horny Goat Weed
Horny Goat Weed (Epimedium grandiflorum, Epimedium sagittatum) is an all-natural phyto-aphrodisiac with a long history as a sex-enhancer. Many cultures report that horny goat weed supports libido, erectile function, and helps to relieve menopausal discomfort. Epimedium contains a compound known as lcariin that allegedly helps to stimulate the nerves throughout the body, particularly in the genitals. Supposedly desire is also increased along with erectile function, and testosterone levels from an androgen-like influence on the testes, prostate and sexual muscles.
Horny goat weed has long been used in traditional Asian medicine for people with sexual difficulties. It is almost always prescribed in conjunction with other herbs to improve its efficacy and to prevent side effects. People with kidney failure being treated with dialysis had improved sex drive after taking horny goat weed, compared with a similar group not given horny goat weed.18
Damiana
Damiana (Turnera diffusa) is a traditional herbal treatment for men with ED. Damiana is well known in southwestern cultures as a sexuality tonic, and is recommended by many top herbalists. It stimulates the intestinal tract and brings oxygen to the genital area. It also increases energy levels which does a lot to restore libido and desire. In women, Damiana often restores the ability to achieve orgasm. Damiana is used primarily as an energy tonic and an aphrodisiac for both men and women. Damiana can quickly stimulate the genital area by enriching the oxygen supply. Longer term use can improve sexual fitness and performance. Damiana extracts have been shown, in the test tube, to weakly bind to progesterone receptors. This is key for breast enlargement. Almost all cultural traditions in the world have favorite herbs that have the reputation of increasing libido and of reversing impotence. For one of them, Damiana, such a reputation was even carried into its botanical name, Turnera aphrodisiaca. Damiana is an excellent strengthening remedy for the nervous system. It has an ancient reputation as an aphrodisiac. While this may or may not be true, it has a definite tonic action on the central nervous and the hormonal system creating theenvironment for breast enlargement.
Royal Jelly
is known as a rejuvenator and contains no less than 22 amino acids, 27 minerals, biotin, natural enzymes, coenzymes and hormones. It contains a mixture of protein, lipids and
carbohydrates in addition to several vitamins including B5 & other B vitamins and, potassium, magnesium, calcium, zinc, iron, and manganese. This natural ingredient with high nutritional value is supportive to a balanced metabolic situation and helpful in reactivating the process of physical strength. Royal Jelly may help slow the aging process, restore vitality & sexual potency, natural antidepressant, weight control, and cholesterol reduction. It may also be used for menopause, infertility, chronic fatigue, weak immune systems, viral & bacterial infections, endocrine system disorders, hormonal imbalances, bladder infections, anemia, cancer, arthritis, diabetes, athletic endurance, malnutrition and mental exhaustion with added Bee Pollen.
Bee Pollen
Bee Pollen is a popular natural source of Vitamin A, C, D, E and B complex.It contains 16 vitamins, many natural hormones, carbohydrates, 22 amino acids, 27 mineral salts, 11 enzymes and coenzymes, polyunsaturated fatty acids and more. This is one of the very few vegetable sources rich in vitamin B12. Bee Pollen is high in protein and aspartic acid, an amino acid that promotes simulation of glands. A diet rich in minerals is essential to the propper functioning of the body’s glandular system. It is good for the skin, prevents dehydration, helps build immunity, helps increase blood supply to stimulate cell growth, and has been linked to increased energy levels. It also contains the bioflavonoid Rutin that increases capillary strength. Bee Pollen may be beneficial for metabolism, digestion, acne, age spots, wrinkles, workout recovery, male and female reproductive systems and
libido, immune response, depression, allergies, constipation colitis, anemia, circulatory disorders and hair loss.
Wheat Germ Oil
is a rich source of naturally occurring vitamin E, improves the power of performance by boosting anti oxidant power of tissues. It helps lower blood fat contents and prevents hardening of the arteries. It contains vitamin E, octacosanol, linoleic and linolenic essential fatty acids which may be beneficial by increasing endurance, lowering cholesterol levels, oxygenating tissues, reducing high altitude stress and assisting with muscular dystrophies and other neuromuscular disorders..
>Holistic approaches that may be helpful
ED that cannot be linked to physical causes has been successfully treated by hypnosis.19 In one trial, three hypnosis sessions per week, later decreased to one per month, over a six-month period led to improvement in 75% of men in the trial.
Acupuncture might be of some benefit for men with ED. Electroacupuncture, which is acupuncture accompanied by electrical stimulation, was performed on various acupuncture points in men with ED in a preliminary trial of men with this condition.20 Two treatments were administered every week for one month. An improvement in quality of erection was observed in 15% of the participants and an increase in sexual activity was reported by 31% of the men. Another preliminary trial21 found good results in over half of the men treated, but the only controlled trial of electroacupuncture for ED22 found that placebo also produced a large improvement in sexual function—an effect similar to that of acupuncture. Controlled trials with larger groups of men are necessary to better test the efficacy of acupuncture therapy for men suffering from ED.
 References
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1. Hernández-López C. Drugs do not only relieve male menopause. BMJ 2000;321:451 [letter].
2. Condra M, Morales A, Owen JA, et al. Prevalence and significance of tobacco smoking in impotence. Urology 1986;27:495–8.
3. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 2004;291:2978–84.
4. Reiter WJ, Pycha A, Schatzl G, et al. Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind randomized, placebo-controlled study. Urology 1999;53:590–5.
5. Zorgniotti AW, Lizza EF. Effect of large doses of the nitric oxide precursor, L-arginine, on erectile dysfunction. Int J Impot Res 1994;6:33–6.
6. Chen J, Wollman Y, Chernichovsky T, et al. Effect of oral administration of high-dose nitric oxide donor L-arginine in men with organic erectile dysfunction: results of a double-blind, randomized study. BJU Int 1999;83:269–73.
7. Cavallini G, Caracciolo S, Vitali G, et al. Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology 2004;63:641–6.
8. Durackova Z, Trebaticky B, Novotny V, et al. Lipid metabolism and erectile function improvement by Pycnogenol®, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction—a pilot study. Nutr Res 2003;23:1189–98.
9. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159:433–6.
10. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder: Four meta-analytic integrations. Arch Sex Behav 1996;25:341.
11. Kunelius P, Häkkinen J, Lukkarinen O. Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study. Urol 1997;49:441–4.
12. Mann K, Klingler T, Noe S, et al. Effect of yohimbine on sexual experiences and nocturnal tumescence and rigidity in erectile dysfunction. Arch Sex Behav 1996;25:1–16.
13. Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impotence Res 1995;7:181–6.
14. Hong B, Ji YH, Hong JH, et al. A double-blind crossover study evaluating the efficacy of Korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol 2002;168:2070–3.
15. Cherdshewasart W, Nimsakul N. Clinical trial of Butea superba, an alternative herbal treatment for erectile dysfunction. Asian J Androl 2003;5:243–6.
16. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sec Educ Ther 1991;17:53–61.
17. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998;24:139–43.
18. Liao HJ, Chen XM, Li WG. Effect of Epimedium sagittatum on quality of life and cellular immunity in patients of hemodialysis maintenance. Zhongguo Zhong Xi Yi Jie He Za Zhi 1995;15:202–4 [in Chinese].
19. Aydin S, Ercan M, Çaskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271–4.
20. Kho HG, Sweep CG, Chen X, et al. The use of acupuncture in the treatment of erectile dysfunction. Int J Impot Res 1999;11:41–6.
21. Yaman LS, Kilic S, Sarica K, et al. The place of acupuncture in the management of psychogenic impotence. Eur Urol 1994;26:52–5.
22. Aydin S, Ercan M, Caskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol 1997;31:271–4.
Male Infertility
Infertility is defined by doctors as the failure of a couple to achieve pregnancy after a year of unprotected intercourse. About 15% of couples are infertile.
In men, infertility is usually associated with a decrease in the number, quality, or motility (power of movement) of sperm. There are multiple possible underlying causes for male infertility, some of which readily respond to natural medicine, while others do not. The specific cause of infertility should always be diagnosed by a physician before considering possible solutions.
Symptoms
The inability of a couple to become pregnant after one year of regular, unprotected sex may indicate infertility of one or both sexual partners. Low sperm count in the semen, decreased sperm motility, or abnormal shape of the sperm are responsible for infertility in about 40% of these couples.
>How often are male factors involved?
About one-third of cases of infertility are caused by male factors alone. A combination of male and female factors causes about one-third of cases.
>What causes male infertility?
The most common cause of male infertility is a varicocele (say: "var-ee-koh-seal"). This is when the veins in the scrotum (the skin "sack" that hangs beneath the penis) are dilated (enlarged) on 1 or both sides. This heats the inside of the scrotum and may affect sperm production. A blockage in a man's reproductive system may cause male infertility. Some medicines can also cause infertility.
Other causes of male infertility may include:
- low sperm count
- sperm that are abnormally shaped or that don't move correctly
- undescended testicle
- an underlying medical problem
Sometimes the cause of male infertility cannot be identified. In these cases, there may be an underlying genetic problem.
>When should I see a doctor?
Usually, a couple should wait to see a doctor until after they've tried to get pregnant for a year. However, it's OK to see a doctor sooner, especially if the woman's age may be a factor.
>Should men be checked for infertility?
Yes. It's important to identify and treat any correctable problems. In some men, a doctor's exam may find an underlying medical problem that is causing the infertility.
>How is infertility evaluated?
Your doctor will obtain your medical history, examine you and test your semen at least twice. A semen analysis can tell your doctor about your sperm count and sperm quality. These are important parts of fertility. More testing may be needed, depending on the results of this first evaluation.
>Is male infertility treatable?
More than one-half of cases of male infertility can be corrected. Treatment may help a couple get pregnant through normal sexual intercourse. Even if you can't get pregnant in this way, you may not need expensive or invasive treatments to get pregnant. If the man needs surgery to correct the problem that is causing his infertility, it can be an outpatient procedure. This means he doesn't have to stay in the hospital overnight.
>Dietary changes that may be helpful
In a study of men with poor sperm quality, excessive alcohol consumption was associated with a decrease in the percentage of normal sperm.1 In a study of Danish greenhouse workers, an unexpectedly high sperm count was found among organic farmers, who grew their products without the use pesticides or chemical fertilizers. The sperm count was more than twice as high in these men as in a control group of blue-collar workers.2 Although these findings are not definitive, they suggest that consuming organically grown foods may enhance fertility.
>Lifestyle changes that may be helpful
Some conventional medications can interfere with fertility. If in doubt, men taking prescription drugs should consult their physician.
The optimal temperature of the testes for sperm production is slightly lower than body temperature, which is why the testes hang away from the body in the scrotum. Men with low sperm counts are frequently advised to minimize lifestyle factors that may overheat the testes, such as wearing tight (e.g., “bikini-style”) underwear or frequently using spas and hot baths.
Environmental exposures (e.g., formaldehyde), smoking, and use of recreational drugs (e.g., marijuana, cocaine, hashish) may reduce sperm count or cause abnormal sperm morphology (shape).3 4 Smoking adversely affects the semen quality of infertile men.5
>Other therapies
Initial treatments may include timing sexual activity for ovulation (usually during the second week of the menstrual cycle), avoiding drugs that may reduce sperm count, and limiting intercourse to no more than once every three days, except during ovulation. Artificial insemination can also be used to place sperm directly in the cervix or uterus. Another more advanced procedure is called “in vitro fertilization” (IVF), wherein the man’s sperm and the woman’s egg (collected from the ovary in a surgical procedure) are combined under controlled conditions in a laboratory. The fertilized embryo is then implanted into the woman’s uterus. The injectable drug follitropin alfa (Gonal-f) may be beneficial in certain situations. Clomiphene (Clomid), though controversial, and anastrozole (Arimidex) might also improve fertility in some men.
>Vitamins that may be helpful
Vitamin C protects sperm from oxidative damage.6 Supplementing vitamin C improves the quality of sperm in smokers.7 When sperm stick together (a condition called agglutination), fertility is reduced. Vitamin C reduces sperm agglutination,8 and supplementation with 200–1,000 mg per day increased the fertility of men with this condition in a controlled study.9 10 Many doctors recommend 1 gram of vitamin C per day for infertile men, particularly those diagnosed with sperm agglutination. However, a double-blind trial studying the effects of combined vitamin C and vitamin E supplementation found no improvements in semen quality among men with low sperm motility.11
Zinc deficiency leads to reduced numbers of sperm and impotence in men.12 The correlation between blood levels of zinc and sperm quality remains controversial. Infertile men have been reported to have lower levels of zinc in their semen, than do men with normal fertility.13 Similarly, men with normal sperm density tend to have higher amounts of zinc in their semen, than do men with low sperm counts.14 However, other studies have found that a high concentration of zinc in the semen is related to decreased sperm motility in infertile men.15 16 A few studies have shown that oral zinc supplementation improves both sperm count17 18 motility,19 20 and the physical characteristics of sperm in some groups of infertile men.21 For infertile men with low semen zinc levels, a preliminary trial found that zinc supplements (240 mg per day) increased sperm counts and possibly contributed to successful impregnation by 3 of the 11 men.22 However, these studies all included small numbers of volunteers, and thus the impact of their conclusions is limited. In a controlled trial, 100 men with low sperm motility received either 57 mg of zinc twice daily or a placebo.23 After three months, there was significant improvement in sperm quality, sperm count, sperm motility, and fertilizing capacity of the sperm. The ideal amount of supplemental zinc remains unknown, but some doctors recommend 30 mg two times per day. Long-term zinc supplementation requires 1–2 mg of copper per day to prevent copper deficiency.
Arginine, an amino acid found in many foods, is needed to produce sperm. Research, most of which is preliminary shows that several months of L-arginine supplementation increases sperm count, quality,24 25 26 and fertility.27 28 However, when the initial sperm count was extremely low (such as less than 10 million per ml), L-arginine supplementation produced little or no benefit.29 30 While some pregnancies have been attributed to arginine supplementation in preliminary reports,31 no controlled research has confirmed these claims. For infertile men with sperm counts greater than 10 million per milliliter, many doctors recommend up to 4 grams of L-arginine per day for several months.
In a double-blind study of infertile men with reduced sperm motility, supplementation with selenium (100 mcg per day for three months) significantly increased sperm motility, but had no effect on sperm count. Eleven percent of 46 men receiving selenium achieved paternity, compared with none of 18 men receiving a placebo.32
Vitamin B12 is needed to maintain fertility. Vitamin B12 injections have increased sperm counts for men with low numbers of sperm.33 These results have been duplicated in double-blind research.34 In one study, a group of infertile men were given oral vitamin B12 supplements (1,500 mcg per day of methylcobalamin) for 2 to 13 months. Approximately 60% of those taking the supplement experienced improved sperm counts.35 However, controlled trials are needed to confirm these preliminary results. Men seeking vitamin B12 injections should consult a physician.
L-carnitine is a substance made in the body and also found in supplements and some foods (such as meat). It appears to be necessary for normal functioning of sperm cells. In preliminary studies, supplementing with 3–4 grams per day for four months helped to normalize sperm motility in men with low sperm quality.36 37 While the majority of clinical trials have used L-carnitine, one preliminary trial found that acetylcarnitine (4 grams per day) may also prove useful for treatment of male infertility caused by low quantities of immobile sperm.38
Coenzyme Q10 (CoQ10) is a nutrient used by the body in the production of energy. While its exact role in the formation of sperm is unknown, there is evidence that as little as 10 mg per day (over a two-week period) will increase sperm count and motility.39 In one study, men with low sperm counts were given CoQ10 (60 mg per day for about three months). No significant change was noted in most sperm parameters, but a significant improvement was noted in in-vitro fertilization rates.40
Vitamin E deficiency in animals leads to infertility.41 In a preliminary human trial, 100–200 IU of vitamin E given daily to both partners of infertile couples led to a significant increase in fertility.42 Vitamin E supplementation may enhance fertility by decreasing free-radical damage to sperm cells. In another preliminary study, men with low fertilization rates in previous attempts at in vitro fertilization were given 200 IU of vitamin E per day for three months.43 After one month of supplementation, fertilization rates increased significantly, and the amount of oxidative stress on sperm cells decreased. However, the evidence in favor of vitamin E remains preliminary. A review of research on vitamin E for male infertility concluded that there is no justification for its use in treating this condition.44 Controlled trials are needed to validate these promising preliminary findings.
Preliminary research suggests that oral SAMe (S-adenosyl-L-methionine), in amounts of 800 mg per day, may also increase sperm activity in infertile men.45
Calcium is a key regulator of human sperm function.46 The concentration of calcium in semen determines sperm motility (i.e., the ability of sperm to move spontaneously).47 48 However, calcium deficiency has not been confirmed as a cause of male infertility nor is there any evidence that calcium supplementation improves male infertility.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
>Herbs that may be helpful
Asian ginseng may prove useful for male infertility. One preliminary study found that 4 grams of Asian ginseng per day for three months led to an improvement in sperm count and sperm motility.49
A small clinical trial found that healthy men who took dried maca powder had increased sperm counts and enhanced sperm motility.50
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
Acupuncture may be helpful in the treatment of some cases of male infertility due to impairment of sperm function. A controlled study of men with reduced sperm function found that one measure of sperm function significantly improved in the men treated with acupuncture (two times per week for five weeks) compared to controls.51 Similar results have been reported in other studies.52 53 Nevertheless, double-blind trials are needed to determine conclusively whether acupuncture is a useful treatment for male infertility.
References
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1. Goverde HJM, Dekker HS, Janssen HJG, et al. Semen quality and frequency of smoking and alcohol consumption - an explorative study. Int J Fertil 1995;40:135–8.
2. Abell A, Ernst E, Bonde JP. High sperm density among members of organic farmers’ association. Lancet 1994;343:1498.
3. Hruska KS, Furth PA, Seifer DB, et al. Environmental factors in infertility. Clin Obstet Gynecol 2000;43:821–9.
4. Wang SL, Wang XR, Chia SE, et al. A study on occupational exposure to petrochemicals and smoking on seminal quality. J Androl 2001;22:73–8.
5. Zhang JP, Meng QY, Wang Q, et al. Effect of smoking on semen quality of infertile men in Shandong, China. Asian J Androl 2000;2:143–6.
6. Fraga CG, Motchnik PA, Shigenaga MK, et al. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proc Natl Acad Sci 1991;88:11003–6.
7. Dawson EB, Harris WA, Teter MC, Powell LC. Effect of ascorbic acid supplementation on the sperm quality of smokers. Fertil Steril 1992;58:1034–9.
8. Dawson EB, Harris WA, McGanity WJ. Effect of ascorbic acid on sperm fertility. Fed Proc 1983;42:531 [abstr 31403].
9. Dawson EB, Harris WA, Powell LC. Relationship between ascorbic acid and male fertility. In: Aspects of Some Vitamins, Minerals and Enzymes in Health and Disease, ed. GH Bourne. World Rev Nutr Diet 1990;62:1–26 [review].
10. Dawson EB, Harris WA, Rankin WE, et al. Effect of ascorbic acid on male fertility. Ann N Y Acad Sci 1987;498:312–23.
11. Rolf C, Cooper TG, Yeung CH, Nieschlag E. Antioxidant treatment of patients with asthenozoospermia or moderate oligoasthenozoospermia with high-dose vitamin C and vitamin E: a randomized, placebo-controlled, double-blind study. Hum Reprod 1999;14:1028–33.
12. Prasad AS, Cossack ZT. Zinc supplementation and growth in sickle cell disease. Ann Intern Med 1984;100:367–71.
13. Kvist U, Kjellberg S, Bjorndahl L, et al. Seminal fluid from men with agenesis of the Wolffian ducts: zinc-binding properties and effects on sperm chromatin stability. Int J Androl 1990;13:245–52.
14. Saaranen M, Suistomaa U, Kantola M, et al. Lead, magnesium, selenium and zinc in human seminal fluid: comparison with semen parameters and fertility. Hum Reprod 1987;2:475–9.
15. Danscher G, Hammen R, Fjerdingstad E, Rebbe H. Zinc content of human ejaculate and motility of sperm cells. Int J Androl 1978;1:576–81.
16. Carpino A, Siciliano L, Petroni MF, et al. Low seminal zinc bound to high molecular weight proteins in asthenozoospermic patients: evidence of increased sperm zinc content in oligoasthenozoospermic patients. Hum Reprod 1998;13:111–4.
17. Stankovic H, Mikac-Devic D. Zinc and copper in human semen. Clin Chim Acta 1976;70:123–6.
18. Hartoma TR, Nahoul K, Netter A. Zinc, plasma androgens and male sterility. Lancet 1977;2:1125–6.
19. Stankovic H, Mikac-Devic D. Zinc and copper in human semen. Clin Chim Acta 1976;70:123–6.
20. Kynaston HG, Lewis-Jones DI, Lynch RV, Desmond AD. Changes in seminal quality following oral zinc therapy. Andrologia 1988;20:21–2.
21. Tikkiwal M, Ajmera RL, Mathur NK. Effect of zinc administration on seminal zinc and fertility of oligospermic males. Indian J Physiol Pharmacol 1987;31:30–4.
22. Marmar JL, Katz S, Praiss DE, DeBenedictis TJ. Semen zinc levels in infertile and postvasectomy patients and patients with prostatitis. Fertil Steril 1975:26:1057–63.
23. Omu AE, Dashti H, Al-Othman S. Treatment of asthenozoospermia with zinc sulphate: andrological, immunological and obstetric outcome. Eur J Obstet Gynecol Reprod Biol 1998;79:179–84.
24. De Aloysio D, Mantuano R, Mauloni M, Nicoletti G. The clinical use of arginine aspartate in male infertility. Acta Eur Fertil 1982;13:133–67.
25. Tanimura J. Studies on arginine in human semen. Part II. The effects of medication with L-arginine-HCl on male infertility. Bull Osaka Med School 1967;13:84–9.
26. Scibona M, Meschini P, Capparelli S, et al. L-arginine and male infertility. Minerva Urol Nefrol 1994;46:251–3.
27. Schacter A, Goldman JA, Zukerman Z. Treatment of oligospermia with the amino acid arginine. J Urol 1973;110:311–3.
28. Schacter A, Friedman S, Goldman JA, Eckerling B. Treatment of oligospermia with the amino acid arginine. Int J Gynaecol Obstet 1973;11:206–9.
29. Mroueh A. Effect of arginine on oligospermia. Fertil Steril 1970:21:217–9.
30. Pryor JP, Blandy JP, Evans P, et al. Controlled clinical trial of arginine for infertile men with oligozoospermia. Br J Urol 1978;50:47–50.
31. Aydin S, Inci O, Alagol B. The role of arginine, indomethacin and kallikrein in the treatment of oligoasthenospermia. Int Urol Nephrol 1995;27:199–202.
32. Scott R, MacPherson A, Yates RWS, et al. The effect of oral selenium supplementation on human sperm motility. Br J Urol 1998;82:76–80.
33. Sandler B, Faragher B. Treatment of oligospermia with vitamin B12. Infertility 1984;7:133–8.
34. Kumamoto Y, Maruta H, Ishigami J, et al. Clinical efficacy of mecobalamin in treatment of oligozoospermia. Acta Urol Jpn 1988;34:1109–32.
35. Isoyama R, Baba Y, Harada H, et al. Clinical experience of methyl-cobalamin (CH3-B12)/clomiphene citrate combined treatment in male infertility. Hinyokika Kiyo 1986;32:1177–83 [in Japanese].
36. Costa M, Canale D, Filicori M, et al. L-carnitine in idiopathic asthenozoospermia: a multicenter study. Andrologia 1994;26:155–9.
37. Vitali G, Parente R, Melotti C. Carnitine supplementation in human idiopathic asthenospermia: clinical results. Drugs Exp Clin Res 1995;21:157–9.
38. Moncada ML, Vicari E, Cimino C, et al. Effect of acetylcarnitine treatment in oligoasthenospermic patients. Acta Europaea Fertilitatis 1992;23:221–4.
39. Tanimura J. Studies on arginine in human semen. Part III. The influences of several drugs on male infertility. Bull Osaka Med School 1967;13:90–100.
40. Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med 1997;18 Suppl:S213–9.
41. Thiessen DD, Ondrusek G, Coleman RV. Vitamin E and sex behavior in mice. Nutr Metab 1975;18:116–9.
42. Bayer R. Treatment of infertility with vitamin E. Int J Fertil 1960;5:70–8.
43. Geva E, Bartoov B, Zabludovsky N, et al. The effect of antioxidant treatment on human spermatozoa and fertilization rate in an in vitro fertilization program. Fertil Steril 1996;66:430–4.
44. Martin-Du Pan RC, Sakkas D. Is antioxidant therapy a promising strategy to improve human reproduction? Are anti-oxidants useful in the treatment of male infertility? Hum Reprod 1998;13:2984–5.
45. Piacentino R, Malara D, Zaccheo F, et al. Preliminary study of the use of s. adenosyl methionine in the management of male sterility. Minerva Ginecologica 1991;43:191–3 [in Italian].
46. Hong CY, Chiang BN, Turner P. Calcium ion is the key regulator of human sperm function. Lancet 1984;2:1449–51.
47. Kilic S, Sarica K, Yaman O, et al. Effect of total and ionized calcium levels of seminal fluid on sperm motility. Urol Int 1996;56:215–8.
48. Prien SD, Lox CD, Messer RH, DeLeon FD. Seminal concentrations of total and ionized calcium from men with normal and decreased motility. Fertil Steril 1990;54:171–2.
49. Salvati G, Genovesi G, Marcellini L, et al. Effects of Panax ginseng C.A. Meyer saponins on male fertility. Panmineva Med 1996;38:249–54.
50. Gonzales GF, Cordova A, Gonzales C, et al. Lepidium meyenii (maca) improved semen parameters in adult men. Asian J Androl 2001;3:301–3.
51. Siterman S, Eltes F, Wolfson V, et al. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl 1997;39:155–61.
52. Riegler R, Fischl F, Bunzel B, Neumark J. Correlation of psychological changes and spermiogram improvements following acupuncture. Urologe [A] 1984;23:329–33 [in German].
53. Fischl F, Riegler R, Bieglmayer C, et al. Modification of semen quality by acupuncture in subfertile males. Geburtshilfe Fraunheilkd 1984;44:510–2 [in German].
Enlarged Prostate
About benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland.
The prostate is a small gland that surrounds the neck of the bladder and urethra in men. Its major function is to contribute to seminal fluid. If the prostate enlarges, pressure may be put on the urethra, acting like a partial clamp and causing a variety of urinary symptoms. Half of all 50-year-old men have BPH, and the prevalence of the condition increases with advancing age. The name “benign prostatic hyperplasia” has replaced the older term “benign prostatic hypertrophy”; both terms refer to the same condition.
What are the symptoms?
A man with BPH has to urinate more often, especially at night, and experiences less force and caliber while urinating, often dribbling. If the prostate enlarges too much, urination is difficult or impossible, and the risk of urinary tract infection and kidney damage increases. A doctor can usually detect an enlarged prostate during a rectal exam.
Lifestyle changes that may be helpful
More physically active men have a lower frequency of symptoms related to BPH. In a preliminary study, physical activity was associated with a decrease in occurrence of BPH, surgery for BPH, and symptoms of BPH.1 Walking, the most prevalent activity among men in this study, was related to a decreased risk of BPH. Men who exercised by walking two to three hours per week had a 25% lower risk of BPH compared with men who didn’t use walking for exercise.
Other therapies
Doctors often recommend surgery when symptoms are severe or when there is a high risk of urinary obstruction. Though prostate surgery has a high success rate, it also has a higher rate of complications than drug therapy.
Vitamins that may be helpful
Beta-sitosterol, a compound found in many edible plants, has also been found to be helpful for men with BPH. In one double-blind trial, 200 men with BPH received 20 mg of beta-sitosterol three times a day or a placebo for six months. Men receiving beta-sitosterol had a significant improvement in urinary flow and an improvement in symptoms, whereas no change was reported in men receiving the placebo.2 Another double-blind study reported similarly positive results using 130 mg per day of beta-sitosterol.3
Rye pollen extract has improved the symptoms of BPH in preliminary trials.4 5 6 Double-blind trials have also reported that rye pollen extract is effective for reducing symptoms of BPH7 8 This rye pollen extract was shown to be comparable in effect to an amino acid mixture used for BPH in a double-blind study.9 A double-blind comparison with pygeum resulted in significant subjective improvement in 78% of those given the rye pollen extract compared with 55% using pygeum.10 Research on this commercial rye pollen extract has used three to six tablets, or four capsules, per day; the effect of other pollens in men with prostate conditions has not yet been studied.
In a controlled trial, men with BPH received a supplement containing three amino acids (glycine, alanine, and glutamic acid) totaling about 760 mg three times per day for two weeks, then 380 mg three times per day for a total of three months. After three months, about half of these men reported reduced urgency, frequency, and/or less delay starting urine flow, compared to 15% or less of the men who received a placebo.11 Another similar controlled trial of this combination also reported positive results12 Although it is not known how the amino acid combination works, it is believed to reduce the amount of swelling in prostate tissue.
In a 1941 preliminary report, 19 men with BPH were given an essential fatty acid (EFA) supplement.13 In every case, the amount of retained urine was reduced, and nighttime urination problems stopped in 69% of cases. Dribbling was eliminated in 18 of the 19 men. All men also reported improved libido and a reduction in the size of the enlarged prostate, as determined by physical examination. Because this study did not include a control group and the amount given was surprisingly small, the possibility of a placebo effect cannot be ruled out.
Despite the lack of good published research, many doctors have been impressed with the effectiveness of essential fatty acids (EFAs) in cases of BPH. A typical recommendation is one tablespoon of flaxseed oil per day, perhaps reduced to one or two teaspoons per day after several months. Because taking EFAs increases the requirement for vitamin E, most doctors recommend taking a vitamin E supplement along with EFAs. However, controlled research is needed to establish whether EFAs are helpful for BPH.
Prostatic secretions are known to contain a high concentration of zinc; that observation suggests that zinc plays a role in normal prostate function. In one preliminary study, 19 men with benign prostatic hyperplasia took 150 mg of zinc daily for two months, and then 50 to 100 mg daily. In 74% of the men, the prostate became smaller.14 Because this study did not include a control group, improvements may have been due to a placebo effect. Zinc also reduced prostatic size in an animal study but only when given by local injection.15 Although the research supporting the use of zinc is weak, many doctors recommend its use. Because supplementing with large amounts of zinc (such as 30 mg per day or more) may potentially lead to copper deficiency, most doctors recommend taking 2 to 3 mg of copper per day along with zinc.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
In many parts of Europe, herbal supplements are considered standard medical treatment for BPH. Although herbs for BPH are available without prescription, men wishing to take them should be monitored by a physician.
The fat-soluble (liposterolic) extract of the saw palmetto berry has become the leading natural treatment for BPH. This extract, when used regularly, has been shown to help keep symptoms in check.16 Saw palmetto appears to inhibit 5-alpha-reductase, the enzyme that converts testosterone to its more active form, dihydrotestosterone (DHT). Saw palmetto also blocks DHT from binding in the prostate.17 Studies have used 320 mg per day of saw palmetto extract that is standardized to contain approximately 80 to 95% fatty acids.
A three-year preliminary study in Germany found that 160 mg of saw palmetto extract taken twice daily reduced nighttime urination in 73% of patients and improved urinary flow rates significantly.18 In a double-blind trial at various sites in Europe, 160 mg of saw palmetto extract taken twice per day treated BPH as effectively as finasteride without side effects, such as loss of libido.19 A one-year dose-comparison study found that 320 mg once per day was as effective as 160 mg twice per day in the treatment of BPH.20 A review of all available double-blind trials has concluded that saw palmetto is effective for treatment of men with BPH and is just as effective as, with fewer side effects than, the drug finasteride.21 One study found saw palmetto to be ineffective as a treatment for BPH. However, the study excluded men with mild BPH, even though previous studies had found the herb effective for mild to moderate BPH.22
In a preliminary study, supplementation with a special aged garlic extract (Kastamonu Garlic) in the amount of 1 ml per 2.2 pounds of body weight per day for one month resulted in a 32% reduction in the size of the prostate gland and a significant improvement in urinary symptoms.23 It is not known whether other forms of garlic would have the same effect.
Pygeum, an extract from the bark of the African tree, has been approved in Germany, France, and Italy as a remedy for BPH. Controlled studies published over the past 25 years have shown that pygeum is safe and effective for men with BPH of mild or moderate severity.24 These studies have used 50 to 100 mg of pygeum extract (standardized to contain 13% total sterols) twice per day. This herb contains three compounds that may help the prostate: pentacyclic triterpenoids, which have a diuretic action; phytosterols, which have anti-inflammatory activity; and ferulic esters, which help rid the prostate of any cholesterol deposits that accompany BPH.
Another herb for BPH is a concentrated extract made from the roots of the nettle plant. This extract may increase urinary volume and the maximum flow rate of urine in men with early-stage BPH.25 It has been successfully combined with both saw palmetto and pygeum to treat BPH in double-blind trials.26 It has also been shown in a double-blind trial, when used by itself, to relieve symptoms of BPH and to improve disease severity.27 An appropriate amount appears to be 120 mg of nettle root extract (in capsules or tablets) twice per day or 2 to 4 ml of tincture three times per day.
Pumpkin seed oil has been used in combination with saw palmetto in two double-blind human studies to effectively reduce symptoms of benign prostatic hyperplasia (BPH).28 29 Only one group of researchers has evaluated the effectiveness of pumpkin seed oil alone for BPH, but the results of their large preliminary trials have been favorable.30 31 Researchers have suggested the zinc, free fatty acid, or plant sterol content of pumpkin seeds may account for their benefit in men with BPH, but this has not been confirmed. Animal studies have shown that pumpkin seed extracts may improve the function of the bladder and urethra; this might partially account for BPH symptom relief.32 Pumpkin seed oil extracts standardized for fatty acid content have been used in BPH studies in the amount of 160 mg three times per day with meals.
References
(To view, roll mouse over the "References" heading; to hide, click on the heading)
1. Platz EA, Kawachi I, Rimm EB, et al. Physical activity and benign prostatic hyperplasia. Arch Intern Med 1998;158:2349–56.
2. Berges RR, Windeler J, Trampisch HJ, et al. Randomized, placebo-controlled, double-blind clinical trial of beta-sitosterol in patients with benign prostatic hyperplasia. Lancet 1995;345:1529–32.
3. Klippel KF, Hiltl DM, Schipp B. A multicentric, placebo-controlled, double-blind clinical trial of ß-sitosterol (phytosterol) for the treatment of benign prostatic hyperplasia. Br J Urol 1997;80:427–32.
4. Horii A, Iwai S, Maekawa M, Tsujita M. Clinical evaluation of Cernilton in the treatment of the benign prostatic hypertrophy. Hinyokika Kiyo 1985;31:739–45 (in Japanese).
5. Ueda K, Jinno H, Tsujimura S. Clinical evaluation of Cernilton® on benign prostatic hyperplasia. Hinyokika Kiyo 1985;31:187–91 [in Japanese].
6. Hayashi J, Mitsui H, Yamakawa G, et al. Clinical evaluation of Cernilton in benign prostatic hypertrophy. Hinyokika Kiyo 1986;32:135–41 [in Japanese].
7. Buck AC, Cox R, Rees RW, et al. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, cernilton. A double-blind, placebo-controlled study. Br J Urol 1990;66:398–404.
8. Becker H, Ebeling L. Conservative therapy of benign prostatic hyperplasia (BPH) with Cernilton. Urologe (B) 1988;28:301–6 [in German].
9. Maekawa M, Kishimoto T, Yasumoto R, et al. Clinical evaluation of Cernilton on benign prostatic hypertrophy—a multiple center double-blind study with Paraprost. Hinyokika Kiyo 1990;36:495–516 [in Japanese].
10. Dutkiewicz S. Usefulness of Cernilton® in the treatment of benign prostatic hyperplasia. Int Urol Nephrol 1996;28:49–53.
11. Damrau F. Benign prostatic hypertrophy: amino acid therapy for symptomatic relief. J Am Geriatr Soc 1962;10:426–30.
12. Feinblatt HM, Gant JC. Palliative treatment of benign prostatic hypertrophy: value of glycine, alanine, glutamic acid combination. J Maine Med Assoc 1958;46:99–102.
13. Hart JP, Cooper WL. Vitamin F in the treatment of prostatic hypertrophy. Report Number 1, Lee Foundation for Nutritional Research, Milwaukee, Wisconsin, 1941.
14. Bush IM, Berman E, Nourkayhan S, et al. Zinc and the prostate. Presented at the annual meeting of the American Medical Association Chicago, 1974.
15. Fahim MS, Fahim Z, Der R, Harman J. Zinc treatment for reduction of hyperplasia of prostate. Fed Proc 1976;35(3):361.
16. Schneider HJ, Honold E, Mashur T. Treatment of benign prostatic hyperplasia. Results of a surveillance study in the practices of urological specialists using a combined plant-base preparation. Fortschr Med 1995;113:37–40.
17. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urologe 1994;334:90–5.
18. Bach D, Ebeling L. Long-term drug treatment of benign prostatic hyperplasia—results of a prospective 3-year multicenter study using Sabal extract IDS 89. Phytomedicine 1996;3:105–11.
19. Carraro JC, Raynaud JP, Koch G, et al. Comparison of phytotherapy (Permixon®) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate 1996;29:231–40.
20. Braeckman J, Bruhwyler J, Vandekerckhove K, Géczy J. Efficacy and safety of the extract of Serenoa repens in the treatment of benign prostatic hyperplasia: therapeutic equivalence between twice and once daily dosage forms. Phytotherapy Res 1997;11:558–63.
21. Wilt TJ, Ishani A, Stark G, et al. Saw palmetto extracts for treatment of benign prostatic hyperplasia. A systematic review. JAMA 1998;280:1604–9.
22. Bent S, Kane C, Shinohara K, et al. Saw palmetto for benign prostatic hyperplasia. N Engl J Med 2006;354:557–66.
23. Durak I, Yilmaz E, Devrim E, et al. Consumption of aqueous garlic extract leads to significant improvement in patients with benign prostatic hyperplasia and prostate cancer. Nutr Res 2003;23:199–204.
24. Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: a review of 25 years of published experience. Curr Ther Res 1995;56:796–817.
25. Koch E, Biber A. Pharmacological effects of sabal and urtica extracts as a basis for a rational medication of benign prostatic hyperplasia. Urologe 1994;334:90–5.
26. Metzker H, Kieser M, Hölscher U. Efficacy of a combined Sabal-Urtica preparation in the treatment of benign prostatic hyperplasia (BPH). Urologe B 1996;36:292–300.
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