A Systematic Review and Evidence-Based Analysis of Ingredients in Popular Male Testosterone and Erectile Dysfunction Supplements

Low testosterone (low T), also known as male hypogonadism, and erectile dysfunction (ED) remains two of the most prevalent issues affecting men. Numerous clinical therapies exist for the treatment of these conditions, but many men have searched for alternative solutions to self-treat. Over-the-counter dietary supplements are a “simpler” option to bypass the doctor and often viewed as a “safer” approach. Less than 25% of patients initiated their dietary supplement following a healthcare visit, highlighting patients’ desire to self-treat.^1,2

Dietary supplement use has boomed in the last decade with over 52% of Americans describing the use of at least one product in the last 30 days.³ However, due to limited FDA oversight, the evaluation of safety and efficacy in supplement products has remained stagnant.⁴

The nutrients contained in supplements play a role in many physiologic reactions. In theory, a patient’s deficiency can be corrected with a supplement product, and ideally, the utilization of that nutrient can be re-balanced. On the contrary, there is the possibility that consuming supplements can lead to excess nutrients leading to imbalance. The potential for nutritional imbalance may lead to physiologic derangements and actually cause harm.⁵ The possibility of supplements affecting harm is important because most products contain more than eight unique ingredients and their action together may be impossible to predict.

At present, no study exists to quantify the evidence available for low T and ED supplements. The goal of our study was to uncover the evidence backing the most popular ingredients in supplement products for low T and ED.⁶ We searched for the most popular products from the online retailers which make up the vast majority of online sales. Surprisingly, not a single whole product was found to have published evidence in a randomized control trial. Using our adapted scoring system, we discovered that evidence is strongly lacking for the majority of ingredients.

A lack of evidence is not to say there is no hope for the use of supplements. We show that 19% of ingredients received an A grade, demonstrating that they have positive evidence in multiple studies. It should be noted that the quality of the studies was not assessed in this study, but these findings maintain the message that therapeutic potential is present. The present healthcare realm we exist in relies on evidence to maximally benefit patients and minimize risks. The principal message is that rigorous studies should evaluate supplements so patients can comfortably rely on them.

Written by: Manish Kuchakulla, Medical Student, University of Miami Miller School of Medicine, Miami, Florida

References:

1. Bailey, Regan L., Jaime J. Gahche, Paige E. Miller, Paul R. Thomas, and Johanna T. Dwyer. "Why US adults use dietary supplements." JAMA internal medicine 173, no. 5 (2013): 355-361.
2. Balasubramanian, Adithya, Nannan Thirumavalavan, Ashwin Srivatsav, Justin Yu, James M. Hotaling, Larry I. Lipshultz, and Alexander W. Pastuszak. "An analysis of popular online erectile dysfunction supplements." The journal of sexual medicine 16, no. 6 (2019): 843-852.
3. Kantor, Elizabeth D., Colin D. Rehm, Mengmeng Du, Emily White, and Edward L. Giovannucci. "Trends in dietary supplement use among US adults from 1999-2012." Jama 316, no. 14 (2016): 1464-1474.
4. Publishing, Harvard Health. “Supplements: A Scorecard.” Harvard Health. Accessed May 12, 2020. https://www.health.harvard.edu/staying-healthy/supplements-a-scorecard.
5. Henkel, Ralf, Inderpreet Singh Sandhu, and Ashok Agarwal. "The excessive use of antioxidant therapy: A possible cause of male infertility?." Andrologia 51, no. 1 (2019): e13162.
6. Kuchakulla, Manish, Manish Narasimman, Yash Soni, Joon Yau Leong, Premal Patel, and Ranjith Ramasamy. "A systematic review and evidence-based analysis of ingredients in popular male testosterone and erectile dysfunction supplements." International Journal of Impotence Research (2020): 1-7.

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