Evidence-Based Review: Supplements for Male Sexual Function - Integrative Medicine Functional Medicine Perspective San Antonio TX
- John Kim
- Dec 31, 2025
- 11 min read
Edited by Yoon Hang Kim MD MPH
About Dr. Kim
Dr. Yoon Hang "John" Kim is a board-certified integrative medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil and holds certifications in preventive medicine, medical acupuncture, and integrative/holistic medicine. Through his telemedicine practice, Dr. Kim specializes in autoimmune conditions, chronic pain, integrative oncology, and complex conditions including fibromyalgia, chronic fatigue, MCAS, and mold toxicity. He is the author of three books and more than 20 articles, and has helped establish integrative medicine programs at institutions nationwide.
Professional: www.yoonhangkim.com | Clinical: www.directintegrativecare.com
Evidence-Based Review: Supplements for Male Sexual Function - Integrative Medicine Functional Medicine Perspective San Antonio TX
Introduction
Erectile dysfunction affects an estimated 150 million men globally, with projections suggesting approximately 322 million men will be affected by 2025. The prevalence increases significantly with age—from 2–9% in men aged 40–49 years to 50–100% in men over 70. Beyond ED, concerns like low libido and hormonal shifts are common and can significantly impact quality of life.
While PDE-5 inhibitors like sildenafil remain first-line therapy, many patients seek natural alternatives due to side effects, cost, drug interactions, or personal preference. This review synthesizes current clinical evidence from systematic reviews, meta-analyses, and randomized controlled trials examining supplements for male sexual function.
As with any integrative approach, realistic expectations and shared decision-making remain essential. In my practice, I focus on identifying root causes of dysfunction and creating personalized treatment plans—considering physical, metabolic, hormonal, and even emotional factors that influence sexual vitality.
Panax Ginseng: The Strongest Evidence Base
Korean red ginseng (Panax ginseng) has the most robust evidence among herbal supplements for erectile dysfunction. A 2025 systematic review and meta-analysis of 14 RCTs involving 1,227 men published in the Journal of Herbal Medicine demonstrated significant improvements across multiple domains of sexual function.
Key Findings
The meta-analysis found significant effects on erectile function (SMD = 1.20, 95% CI: 0.64–1.76), orgasmic function (SMD = 1.09), sexual desire (SMD = 1.02), intercourse satisfaction (SMD = 1.48), and overall satisfaction (SMD = 0.93). Notably, ginseng also improved serum testosterone levels (SMD = 0.54, 95% CI: 0.04–1.05).
The 2022 Cochrane systematic review concluded that ginseng may enhance men's self-reported capacity for sexual intercourse with little to no effect on adverse events. A double-blind, placebo-controlled trial with 143 patients found significant improvements across all five IIEF domains after 8 weeks of 2,000 mg/day tissue-cultured mountain ginseng extract.
How It Works
Ginsenosides are believed to enhance nitric oxide synthesis in the corpus cavernosum and improve penile blood flow. Additional mechanisms include antioxidant effects, modulation of the hypothalamic-pituitary-gonadal axis, and direct effects on vascular smooth muscle relaxation.
Practical Recommendations
Typical dosing ranges from 900–3,000 mg/day of standardized Korean red ginseng extract for 4–12 weeks. Side effects are generally mild, including headache and gastrointestinal discomfort. Evidence quality remains moderate—ginseng shouldn't be considered equivalent to PDE-5 inhibitors, but it's a reasonable option for men seeking natural support.
L-Arginine: The Nitric Oxide Precursor
L-arginine is the physiological substrate for nitric oxide synthase, making it a logical choice for ED given NO's central role in penile erection. A 2019 systematic review and meta-analysis of 10 RCTs involving 540 patients demonstrated that arginine supplementation significantly improved erectile dysfunction compared to placebo.
Clinical Evidence
The meta-analysis found that L-arginine at dosages of 1,500–5,000 mg/day significantly improved ED (OR 3.37, 95% CI: 1.29–8.77, p = 0.01). Significant improvements were observed in IIEF subdomain scores for erectile function, intercourse satisfaction, orgasmic function, and overall satisfaction—though sexual desire scores remained unchanged.
A 2022 multicentre, double-blind RCT published in the Journal of Endocrinological Investigation examined high-dose L-arginine (6 g/day) for 3 months in patients with vasculogenic ED. Results showed significant improvements in IIEF-6 scores (p < 0.0001) and cavernous arteries peak systolic flow velocity in patients with mild-moderate ED. Notably, 74% of patients improved their ED severity category.
The Pycnogenol Combination
A 2023 meta-analysis in Frontiers in Endocrinology examined the combination of L-arginine with Pycnogenol (French maritime pine bark extract). The combination produced significant improvements across all IIEF domains—erectile function (MD 8.9), intercourse satisfaction (MD 4.96), orgasmic function, overall satisfaction, and sexual desire. The synergy likely stems from Pycnogenol's ability to enhance endothelial NO synthase activity while L-arginine provides the substrate.
Practical Recommendations
Effective doses range from 2,500–6,000 mg/day, often divided into multiple doses. L-arginine works best for mild-moderate ED and in patients with vascular etiology. The adverse effect rate was 8.3% (vs 2.3% for placebo), primarily gastrointestinal symptoms. Consider combining with Pycnogenol (40–120 mg/day) for enhanced efficacy.
Ashwagandha: The Stress-Libido Connection
Ashwagandha (Withania somnifera) is increasingly recognized for its effects on male sexual function, particularly when stress is a contributing factor. This is where I find it most useful in clinical practice.
Chronic stress and elevated cortisol can disrupt hormonal balance, suppress testosterone production, and dampen libido. Ashwagandha's adaptogenic properties help modulate the stress response, which can indirectly support sexual function.
Clinical Evidence
A 2022 randomized, double-blind, placebo-controlled study published in Health Science Reports examined ashwagandha root extract (600 mg/day) in 50 adult males with low sexual desire for 8 weeks. Results showed significant improvements in total DISF-M scores (mean difference −9.8; 95% CI: −10.73 to −8.87; p < 0.0001). Serum testosterone levels also increased significantly (mean difference −66.52 ng/dL; p < 0.0001).
A 2019 crossover study in aging, overweight males found that 8 weeks of ashwagandha extract was associated with an 18% greater increase in DHEA-S (p = 0.005) and 14.7% greater increase in testosterone (p = 0.010) compared to placebo.
An earlier pilot study in psychogenic ED demonstrated that ashwagandha (2,000 mg TID for 60 days) improved erectile function and sexual satisfaction in men with psychologically-mediated dysfunction.
How It Works
Ashwagandha's withanolides have structural similarity to testosterone and may influence GnRH expression via GABA receptor modulation. Its cortisol-lowering effects may indirectly support testosterone production by reducing HPA axis suppression of the reproductive axis. By supporting healthy stress hormone levels, ashwagandha addresses one of the most overlooked contributors to sexual dysfunction.
Practical Recommendations
Standard dosing is 300–600 mg/day of standardized root extract (typically KSM-66 or Sensoril formulations) for 8–12 weeks. Ashwagandha is particularly suited for men with stress-related low libido, suboptimal testosterone within normal range, or concurrent anxiety and fatigue.
Tribulus Terrestris: Traditional Use Meets Modern Research
Tribulus terrestris has been used traditionally as an aphrodisiac across multiple cultures. The 2023 meta-analysis in Nutrients identified Tribulus as one of the supplements able to improve male sexual function based on pooled RCT data.
Clinical Evidence
While much of the robust data comes from female studies, male-specific research shows promising results. The meta-analysis identified Tribulus as demonstrating significant effects on erectile function compared to placebo, though evidence quality remains low to moderate due to heterogeneous study designs.
The active constituent protodioscin is believed to influence the hypothalamic-pituitary axis, though direct testosterone elevation has not been consistently demonstrated in human studies. Some researchers suggest the mechanism may involve increased sensitivity to androgens rather than elevated levels.
Practical Recommendations
Typical dosing ranges from 250–750 mg/day of standardized extract for 4–12 weeks. Side effects are generally mild gastrointestinal symptoms. Given the limited high-quality human data specifically in men, I consider Tribulus an adjunctive therapy rather than primary treatment.
Maca: Andean Adaptogen for Desire
Maca (Lepidium meyenii) is an Andean cruciferous plant traditionally used to enhance fertility and libido. What's interesting about maca is that its effects appear to be hormone-independent—it improves desire without significantly changing testosterone levels.
Clinical Evidence
A 2023 RCT published in the World Journal of Men's Health examined maca in patients with late-onset hypogonadism symptoms. After 12 weeks of 3,000 mg/day, significant improvements were observed in AMS (Aging Males' Symptoms), IIEF, and IPSS scores compared to placebo. The ADAM positive rate significantly decreased (p < 0.0001) in the maca group.
An earlier systematic review of 4 RCTs found limited but positive evidence for maca improving sexual desire in healthy men and erectile function in men with mild ED (IIEF-5 MD 1.13, 95% CI: 0.64–1.61, p < 0.0001).
A pilot study examining SSRI-induced sexual dysfunction found that 3.0 g/day of maca produced significant improvements in ASEX scores, with particular benefits for libido—making it a useful option for patients on antidepressants.
Practical Recommendations
Effective doses range from 1,500–3,000 mg/day of dried maca root powder for 8–12 weeks. Benefits for sexual desire may appear as early as 8 weeks. Maca is particularly suited for improving desire and may help with SSRI-induced sexual dysfunction.
Fenugreek: Testosterone Support and Libido
Fenugreek (Trigonella foenum-graecum) has emerged as a promising option for supporting testosterone levels and male sexual function, with several well-designed RCTs demonstrating efficacy.
Clinical Evidence
A 2020 meta-analysis found that fenugreek extract has a significant positive effect on total serum testosterone levels. A 2016 double-blind RCT of Testofen (standardized fenugreek extract) in 120 healthy men aged 43–70 demonstrated significant decreases in AMS scores and improvements in sexual function—including morning erections and frequency of sexual activity—after 12 weeks of 600 mg/day.
An earlier RCT in 60 healthy males found that 600 mg/day of Testofen for 6 weeks produced significant improvements in sexual arousal and orgasm, with 81% reporting improvement in libido and 63% improvement in sexual performance quality.
A 2018 study in the World Journal of Men's Health examining a mixed extract of fenugreek and Lespedeza cuneata in testosterone deficiency syndrome found significant improvements in total and free testosterone, as well as erectile function.
How It Works
Fenugreek saponins may inhibit aromatase and 5α-reductase, reducing conversion of testosterone to estrogen and DHT respectively. This preserves bioavailable testosterone. Diosgenin, a steroidal saponin in fenugreek, serves as a precursor for steroid hormone synthesis.
Practical Recommendations
Standard dosing is 500–600 mg/day of standardized fenugreek extract for 6–12 weeks. Fenugreek is particularly suited for aging males with symptoms of androgen decline and men interested in both sexual function and exercise performance benefits.
Saffron: Rapid Onset for Erectile Function
Saffron (Crocus sativus) has shown particularly promising results for erectile dysfunction, with some studies demonstrating improvements in as little as 10 days. This rapid onset makes it unique among the supplements reviewed.
Clinical Evidence
A 2018 meta-analysis found that saffron had a significantly positive effect on all dimensions of the IIEF questionnaire: erectile function (MD = 5.36), orgasmic function (MD = 1.12), overall satisfaction (MD = 1.23), intercourse satisfaction (MD = 2.18), and sexual desire (MD = 0.78)—all statistically significant.
A 2022 double-blind, placebo-controlled RCT in 62 men with ED found that 30 mg/day of saffron for 6 weeks produced improvements in erectile function scores of 6.14 points (95% CI: 4.97–7.30)—exceeding the minimal clinically important difference. The adverse event profile was similar to placebo.
Notably, a pilot study found that just 10 days of saffron (200 mg/day) produced significant improvements in IIEF-15 total scores (22.15 to 39.20, p < 0.001) with increased number and duration of erectile events on nocturnal penile tumescence testing.
SSRI-Induced Sexual Dysfunction: A 4-week RCT in men with fluoxetine-related sexual dysfunction found that saffron (30 mg/day) produced significantly greater improvements in erectile function (p < 0.001) and intercourse satisfaction compared to placebo. This makes saffron particularly attractive for patients on antidepressants.
How It Works
Saffron's active components (crocin, crocetin, and safranal) possess antioxidant, anti-inflammatory, and neuromodulatory properties. The serotonergic effects may explain efficacy in SSRI-induced dysfunction. Antioxidant activity may protect endothelial function and support NO bioavailability.
Practical Recommendations
Effective doses are 15–30 mg twice daily (30–60 mg/day total) for 4–10 weeks. Saffron appears particularly suited for SSRI-induced sexual dysfunction and mild ED. Cautions include potential interactions with serotonergic medications. Doses above 5 g/day are considered unsafe.
Antioxidant Supplementation: The Emerging Evidence
A 2025 meta-analysis published in the World Journal of Men's Health examined 23 double-blind, placebo-controlled trials involving 1,583 men with ED treated with various antioxidant supplements for a median of 12 weeks.
The pooled analysis found that antioxidant supplementation significantly improved erectile function with a mean difference of 5.5 points (95% CI: 3.7–7.3; p < 0.001) on the IIEF-EF scale. In subgroup analyses, Pycnogenol and L-arginine combinations showed the most significant benefits.
This reinforces what we understand about ED pathophysiology—oxidative stress and endothelial dysfunction play significant roles, and vascular health is foundational to sexual function. Maintaining a diet rich in antioxidants supports these pathways.
Important Caveats and Clinical Considerations
Evidence Quality: While these supplements show promising results, evidence quality remains predominantly low to moderate. None should be considered equivalent to PDE-5 inhibitors for established ED.
Placebo Response: Sexual function studies consistently show substantial placebo effects (up to 40%), which complicates interpretation of modest treatment effects.
Product Quality: The 2023 analysis found that 80% of marketed products didn't meet criteria for expected efficacy based on active ingredient doses. I recommend reputable manufacturers using standardized extracts.
Underlying Conditions: ED is often a sentinel marker for cardiovascular disease and metabolic dysfunction. Appropriate medical evaluation should precede or accompany any supplement regimen. A thorough evaluation—including hormone levels and thyroid function—is essential to identify root causes.
Lifestyle Foundation: Exercise, diet, sleep quality, smoking cessation, and weight management remain foundational. Blood pressure, metabolic health, and cardiovascular fitness all directly impact sexual function. Supplements work best as part of a comprehensive approach addressing root causes, not as standalone solutions.
Evidence-Based Review: Supplements for Male Sexual Function - Integrative Medicine Functional Medicine Perspective San Antonio TX
Practical Summary by Presentation
Mild-Moderate Vasculogenic ED: L-arginine (2,500–6,000 mg/day) ± Pycnogenol; Panax ginseng (900–3,000 mg/day)
Stress-Related Low Libido: Ashwagandha (300–600 mg/day); Maca (1,500–3,000 mg/day)
SSRI-Induced Sexual Dysfunction: Saffron (30 mg BID); Maca (3,000 mg/day)
Aging Males Symptoms/Low-Normal Testosterone: Fenugreek (500–600 mg/day); Ashwagandha (300–600 mg/day)
Rapid Onset Needed: Saffron (may show effects within 10 days)
At Direct Integrative Care, Dr. Kim is dedicated to guiding you on your path to wellness through a deeply personalized and supportive approach. We focus on integrative medicine, looking beyond symptoms to uncover the root causes of chronic conditions and develop a treatment plan tailored specifically to your unique health journey. By combining compassionate care with innovative therapies, our goal is to empower you with the knowledge and tools needed to achieve lasting health. We invite you to explore our website to learn more about how our patient-centered practice can help you find balance and vitality.
Yoon Hang Kim MD
Integrative & Functional Medicine Physician
Virtual Practice Serving IA, IL, MO, FL, GA, and TX
Key References
Petre GC et al. Dietary Supplements for Erectile Dysfunction: Analysis of Marketed Products, Systematic Review, Meta-Analysis and Rational Use. Nutrients. 2023;15(17):3677.
Ramasamy R et al. Antioxidant Supplementation for Erectile Dysfunction: Systematic Review and Meta-Analysis. World J Mens Health. 2025;43(1).
Tian Y et al. Efficacy of L-arginine and Pycnogenol in the treatment of male erectile dysfunction: a systematic review and meta-analysis. Front Endocrinol. 2023;14:1211720.
Menafra D et al. Long-term high-dose l-arginine supplementation in patients with vasculogenic erectile dysfunction. J Endocrinol Invest. 2022;45(5):941-961.
Rhim HC et al. The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis. J Sex Med. 2019;16(2):223-234.
Lee HW et al. Ginseng for Erectile Dysfunction: A Cochrane Systematic Review. World J Mens Health. 2022;40(2):264-269.
Chauhan S et al. Effect of standardized root extract of ashwagandha on well-being and sexual performance in adult males. Health Sci Rep. 2022;5(4):e741.
Shin BC et al. Maca (L. meyenii) for improving sexual function: a systematic review. BMC Complement Altern Med. 2010;10:44.
Choi YS et al. Efficacy and Safety of Maca in Patients with Late-Onset Hypogonadism. World J Mens Health. 2023;41(3).
Rao A et al. Testofen reduces age-related symptoms of androgen decrease and improves sexual function. Aging Male. 2016;19:134-142.
Steels E et al. Physiological aspects of male libido enhanced by standardized Trigonella foenum-graecum extract. Phytother Res. 2011;25:1294-1300.
Modabbernia A et al. Effect of saffron on fluoxetine-induced sexual impairment in men. Psychopharmacology. 2012;223(4):381-388.
Shamsa A et al. Evaluation of Crocus sativus L. (saffron) on male erectile dysfunction. Phytomedicine. 2009;16(8):690-693.
Maleki-Saghooni N et al. A systematic review and meta-analysis of clinical trials on saffron effectiveness and safety on erectile dysfunction. Iran J Basic Med Sci. 2018;21(6):554-563.
Herbal dietary supplements for erectile dysfunction: A systematic review and meta-analysis. J Herb Med. 2025.
Disclaimer: This review is for educational purposes only. Consultation with a healthcare professional is essential prior to initiating any supplement for sexual dysfunction. Individual responses vary, and supplements may interact with medications or underlying conditions. Erectile dysfunction can be a marker of significant cardiovascular disease requiring medical evaluation.
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