There are countless "male enhancement" products available over the counter and undoubtedly you have both heard and seen commercials for them. The question is, do any of them work?


Many of the male enhancement products contain the same ingredients so it is prudent to look over the actual ingredients in the products. I will list a few things you can look out for...


Yohimbe

The most popular over the counter ingredient for use in erectile dysfunction simply because it is the most effective. It has been around since the 1930's and has a lot a data and evidence backing it's efficacy. The problem lies with it's possible side effects.


Researchers believe yohimbe works by stimulating the release of a neurotransmitter known as norepinephrine. This neurotransmitter (among other things) increases blood flow to the penis resulting in an erection. Yohimbe also can increase central excitatory impulses to the genitals. Other mechanisms have been proposed but these are the most likely culprits for its efficacy. The usual dose in the trials for yohimbe have been anywhere from 10-50 mg per dose.


In terms of side effects, yohimbe can be very dangerous to people with high blood pressure and heart problems. Yohimbe can raise blood pressure and heart rate and therefore must be used in extreme caution in patients with contraindications. Always check with your medical provider before starting supplements.


DHEA

DHEA is a very common over the counter ingredient and goes by the full name of Dehydroepiandrosterone. It is actually a hormone that is produced in each and every one of our own bodies. Think of it as a building block (or precursor) to both male and female sex hormones (testosterone and estrogen). Since DHEA is a hormone and can actually raise certain hormone levels in the body, it is banned in almost every athletic league.


DHEA has been shown to be effective for multiple indications in clinical trials, including erectile dysfunction. The usual dose in the trials were 50-100 mg daily.


It is certainly our recommendation that if this supplement is to be taken or tried, it should be with the knowledge of your primary care provider. DHEA use can cause a host of side effects including prostate enlargement, acne, mood changes and a possible increase in certain cancers. The long term side effects aren't well known but it would certainly be a good idea for your medical provider to know that you are taking the supplement.

Going back to effectiveness, DHEA is probably one of the more studied over the counter supplements. Research has shown that DHEA levels in men with erectile dysfunction are lower than in men without a problem. Supplementation may certainly benefit those with ED so it is worth discussing with your medical provider.


Tribulus

The jury is still out on this supplement. It has actually been used for thousands of years for multiple indications. The problem is the conflicting evidence it has for erectile dysfunction. Most every study in which it is included couldn't make a determination as to whether the product helped to induce or maintain an erection. It has generally been reported to be fairly well tolerated so side effects and drug interactions aren't a huge concern.


Deer Antler

Deer antler has been historically known as a "energy booster" and possible "libido booster".  In many cultures it has been used in various preparations from soup, to capsules and even topical creams, so it certainly has a reputation as being an aphrodisiac and having overall health benefits. Analysis of deer antler has shown there are traces of hormones in the antlers which may be the supposed mechanism for potential benefits. There is however, no clear evidence that it boosts libido and in fact, there have been a few trials denouncing it's effects for erectile dysfunction. 


In terms of a drug interaction with lisinopril, nothing that I saw had a drug interaction. The only thing you really need to be wary of is the possibility of hypotension, or low blood pressure. Many erectile dysfunction drugs can lower blood pressure and in combination with lisinopril, may cause dizziness or drowsiness.