Sex and the Supplement: Dietary Supplement Ingredients for Male Sexual Health

Photo © Shutterstock.com/VGstockstudio

Dietary supplements for sexual pleasure and procreation-so-called “intimacy products”-make up a big business that brought in an estimated $84.3 million from July 2016 to July 2017, according to the market research firm SPINS.¹ Of those sales, $77.7 million was for products intended for men specifically. 

Today’s sex health ingredients for men come from processing and extraction of various components of nature, including barks, roots, and stigmas. Where some of these sexual health ingredients seem to enhance the body in vascular ways, others seem to operate by truly different methods. We explore a few of the top-selling male sexual health ingredients for their science, but also for their recent market challenges.
 

Pycnogenol and Friends

Though it’s considered a potent antioxidant all on its own, Pycnogenol may be of greater use in the company of other ingredients, at least when it comes to erectile health. Research suggests that pine bark extract can increase the body’s production of eNOS (endothelial nitric oxide synthase)^2,3, an enzyme that helps to relax blood vessels in, among other parts of the human body, the penis.⁴ Proper blood flow is a good indicator of proper erectile health. eNOS doesn’t benefit blood flow on its own, either. It must convert into nitric oxide, a process that requires plentiful stores of L-arginine.

Understandably, interested parties are exploring the potential health benefits of combining Pycnogenol and L-arginine in a single formula. Horphag Research (Geneva), the exclusive global supplier of Pycnogenol, created Prelox, its own patented blend of Pycnogenol and L-arginine. It’s been associated with self-reported improvements in erectile function compared to placebo when used over one or more months, with greater perceived improvements over time.⁵ A product named Edicare, a licensed product by Horphag Research, shows potential to improve self-reports of erectile function but also to increase sperm concentration in otherwise infertile men.⁶ The effect may be due to Pycnogenol’s antioxidant status, which researchers believe could help to reduce sperm damage. Earlier this year, the same product was deemed useful for erectile function but also for managing lower urinary tract infections to an extent greater than saw palmetto-perhaps because of Pycnogenol’s ability to combat oxidative stresses in the bladder.⁷ More trials are warranted.

As science continues on Pycnogenol mixes, more options for synergistic benefits are becoming available in this space. L-arginine is impressing in a number of sexual health studies without Pycnogenol.^8,9 On the other side, Horphag Research just introduced a Prelox formula containing L-citrulline and French oak extract (already deemed beneficial for erectile function and sperm quality^10,11 and a women’s alternative called Lady Prelox that’s now on the market.

Maca

A scattering of unique studies have hinted at maca’s potential use for sex health. Beyond the established idea that the Peruvian root can stimulate male libido, and some limited data to support maca for erectile function¹², researchers are actively looking at other sexual health parameters. 

Recent findings from the Czech Republic hint at potential benefits for sperm health (a trend towards increased concentration and motility), and they say they plan to explore maca’s use on men diagnosed with oligozoospermia (low sperm counts).¹³ Perhaps more extensively, though, research is mounting on maca for the female libido, with numerous ongoing trials for maca use to ameliorate sexual dysfunction onset by psychiatric medications or menopause.

As long as maca remains of interest to consumers, manufacturers should take care in where they source their maca extracts and powders. Convincing data draws differences between nutritional profiles of maca plant from one variety to another.^14,15,16 Maca ingredient supplier Naturex (Avignon, France), for example, is committed to batch-to-batch consistencies in identity and content of amino acids, which global category manager Leslie Lannebere says are important for its maca extract’s demonstrated sexual efficacy.
 

Fruit Polyphenols

Again trusting in the nitric oxide effect, growing research supports consumption of polyphenols for improved vascular health and thereby, hopefully, erectile health. Numerous reviews draw a connection between dietary polyphenols and an improved vascular state, and research is even targeting populations with erectile function. 

Various epidemiological studies link consuming polyphenol-rich foods to improved vascular health^17,18, and more recently erectile health¹⁹, but few intervention trials exist and precise mechanisms of action are unknown.^20,21 Much of the recent interest stems from a two-year study finding improvement in erectile subjects when subjects consumed a Mediterranean diet, especially rich in polyphenols thanks to plant-based foods, such as fruits and herbs.²²

Although few clinical trials are available, Nexira (Rouen, France) aims to narrow the gap with its recently completed clinical trial on men consuming EnoStim, the company’s concentrated extract of apple and grape polyphenols enriched with saffron. The company recently announced the new study results at this September’s SupplySide West trade show. 

According to Nexira, the four-week unpublished study conducted on 94 men over the age of 45 found that a 300-mg dose of EnoStim, taken twice daily, helped improve penile erection. Specifically, researchers determined that, after just three weeks of supplementation, 54% of subjects saw their scores improve per the standardized Erection Hardness Score test. In addition, 46% of subjects saw improvements per the International Index of Erectile Function test. By the end of the study, 71% of subjects said they would recommend using EnoStim, 66% said they were satisfied with EnoStim and experienced better erections thanks to EnoStim, and 58% said they felt more confident engaging in intercourse if using EnoStim. 

Nexira says EnoStim works by stimulating nitric oxide production and, therefore, blood flow. Part of this effect is due to EnoStim’s antioxidant properties. “Nitric oxide has a short lifespan and is easily degraded by superoxide free radicals,” the company explains in a press release. “As shown in an in vivo study, the antioxidant molecules in Nexira’s proprietary formulation demonstrated the potential to specifically protect nitric oxide by decreasing oxidative stress by 74%.” The company notes that previous studies indicate that the ingredients in EnoStim may be able to increase blood flow by up to 50%.

Saffron

In light of positive studies on saffron for erectile health (and there are quite a few), saffron suppliers like to note that a pending European health claim (ID 2427) exists for saffron, seeking claims of “Stimulates the libido” and “Improves erection, contributes to the increase of sperm volume, and relaxes muscles.” Curiously, however, the original application, filed in 2008, hasn’t moved since. Research has continued, and consistent popularity of saffron within the category could benefit from equally impressive research on saffron for the aging brain. 
 

Fenugreek

Not just a spice, fenugreek seed (Trigonella foenum-graecum) is popularly sought after for its potential sexual benefits. When consumed in extract form, fenugreek may increase human testosterone levels, and the end result is likely to improve libido. 

A few studies have honed in on fenugreek supplementation for men with or without andropause, and the results suggest improvement in libido and associated sexual function. Earlier this year, results of a clinical study by fenugreek seed extract supplier Cepham Inc. (Piscataway, NJ) suggested that the company’s ingredient was associated with improved testosterone levels, libido, and sperm count.²³ Seeing the greater potential for increased testosterone, Cepham says it is now working on a study to assess how fenugreek seed consumption can, via testosterone, influence more physical factors, such as grip strength.

A friendly reminder: fenugreek is popularly sold for both male and female sexual health. GE Nutrients Inc. (Gencor; Irvine, CA) promotes its fenugreek extract as a Libifem for women and Testofen for men. The ingredient is backed by much of its own research.
 

Tongkat Ali

A decent number of studies back the use of tongkat ali (Eurycoma longifolia) for a variety of male sexual health factors. Since the Asian root is associated with increased conversion of pregnenolone to a variety of hormones in the body, including testosterone, it’s no wonder why numerous studies have linked tongkat ali consumption to increased levels of free testosterone in sub-fertile men.²⁴

Whether tongkat ali’s testosterone boost can lead to other benefits is less understood. A few studies have looked at this and with some positive results thus far. HP Ingredients (Bradenton, FL) has a few of its own tongkat ali studies to mention, with noted supplementation improvements such as better scores on the erection hardness scale, increased sexual satisfaction, and better libido. The company’s branded extract LJ100 is standardized to guarantee batch-by-batch consistency in select active constituents.
 

Tribulus

Tribulus (Tribulus terrestris) is another plant product intimately tied to hormones. Its demonstrated potential to improve male and female libido and semen parameters, especially quite recently, are likely due to this plant’s hormonal influence.^25,26 But further exploration of the plant’s properties and effects, as well as reports of improvements in erectile health²⁷, lead some researchers to presume that tribulus may impact male sexual health in other ways, such as via endothelium and nitric oxide–dependent mechanisms.²⁸
 

Yohimbe

Yohimbe (Pausinystalia yohimbe) remains a popular dietary supplement for men’s sexual health. It’s backed by a handful of studies befitting its use for erectile function and fear/anxiety, but its reputation needs improving. Last year, researchers sampled yohimbe dietary supplements from major U.S. retailers and found widespread issues of inadequate dosing, improper labeling, and even signs of potential adulteration. Of the 49 yohimbe bark products sampled, some contained zero traces of yohimbine, the active alkaloid in yohimbe upon which its purported health benefits are based.²⁹

The market for yohimbe doesn’t have to remain in this kind of trouble, though. Not long ago, a team of USDA researchers confirmed what they say is an easy and economical laboratory method for detecting and validating yohimbine content in bark extracts using an ultra-HPLC (UHPLC) diode array detector (DAD) in tandem with mass spectrometry.³⁰ 
 

Also read:

Sexy Supplements: Botanical Ingredients for Sex Health

Testosterone Support Still Going Strong in Men’s Supplements?

References:

1. Market value based on SPINSscan natural and specialty outlet data for “Intimacy Products” at 13 quarters ending July 16, 2017.
2. Fitzpatrick D et al., “Endothelium-dependent vascular effects of Pycnogenol,” Journal of Cardiovascular Pharmacology, vol. 32, no. 4 (October 1998): 509–515
3. Nishioka K et al., “Pycnogenol, French maritime pine bark extract, augments endothelium-dependent vasodilation in humans,” Hypertension Research, vol. 30, no. 9 (September 2007): 775–780
4. Toda N et al., “Nitric oxide and penile erectile function,” Pharmacology & Therapeutics, vol. 106, no. 2 (May 2005): 233–266
5. Ledda A et al., “Investigation of a complex extract for mild to moderate erectile dysfunction in a randomized, double-blind, placebo-controlled, parallel-arm study,” BJUI International, vol. 106, no. 7 (October 2010): 1030–1033
6. Kobori Y et al., “Improvement of seminal quality and sexual function of men with oligoasthenoteratozoospermia syndrome following supplementation with L-arginine and Pycnogenol,” Archives of Italian Urology and Andrology, vol. 87, no. 3 (2015): 190–193
7. Yagi H et al., “Effects of a supplement combining Pycnogenol and L-arginine aspartate on lower urinary dysfunction compared with saw palmetto extract,” Journal of Traditional and Complementary Medicine, vol. 7, no. 1 (January 2017): 117–120
8. Barassi A et al., “Levels of L-arginine and L-citrulline in patients with erectile dysfunction of different etiology,” Andrology, vol. 5, no. 2 (March 5, 2017): 256–261
9. Lacchini R et al., “Influence of arginase polymorphisms and arginase levels/activity on the response to erectile dysfunction therapy with sildenafil,” The Pharmacogenomics Journal. Published online April 4, 2017.
10. Stanislavov R et al., “Improvement of erectile function by a combination of French maritime pine bark and roburins with amino acids,” The Italian Journal of Urology and Nephrology, vol. 67, no. 1 (March 2015): 27–32
11. Stanislavov R et al., “Sperm quality in men is improved by supplementation with a combination of L-arginine, L-citrulline, roburins, and Pycnogenol,” The Italian Journal of Urology and Nephrology, vol. 66, no. 4 (December 2014): 217–223
12. Gonzales G et al., “Ethnobiology and Ethnopharmacology of Lepidium meyenii (maca), a plant from the Peruvian Highlands,” Evidence-Based Complementary and Alternative Medicine. Published online October 2, 2011.
13. Melnikovova et al., “Effect of Lepidium meyenii Walp. on semen parameters and serum hormone levels in health adult men: A double-blind, randomized, placebo-controlled pilot study,” Evidence-Based Complementary and Alternative Medicine. Published online September 1, 2015.
14. Rubio et al., “Effect of three different cultivars of Lepidium metenii (maca) on learning and depression in ovariectomized mice,” BMC Complementary & Alternative Medicine. Published online June 23, 2006.
15. Cl’ement C et al., “Secondary metabolites in maca as affected by hypocotyl color, cultivation history, and site,” Agronomy Journal, vol. 102, no. 2 (2009): 431–439
16. Cl’ement C et al., “Influence of colour type and previous cultivation on secondary metabolites in hypocotyls and leaves of maca (Lepidium, meyenii Walpers),” Journal of the Science of Food and Agriculture, vol. 90, no. 5 (April 2010): 861–869
17. Gormaz JG et al., “Potential role of polyphenols in the prevention of cardiovascular diseases: Molecular bases,” Current Medicinal Chemistry, vol. 23, no. 2 (2016): 115–128
18. Murillo AG et al., “The relevance of dietary polyphenols in cardiovascular protection,” Current Pharmaceutical Design. Published online March 29, 2017.
19. Cassidy A et al., “Dietary flavonoid intake and incidence of erectile dysfunction,” The American Journal of Clinical Nutrition. Published online January 13, 2016.
20. Croft KD, “Dietary polyphenols: Antioxidants or not?” Archives of Biochemistry and Biophysics, vol. 591 (April 1, 2016): 120–124
21. Eleazu C et al., “The role of dietary polyphenols in the management of erectile dysfunction-Mechanisms of action,” Biomedicine & Pharmacotherapy, vol. 88 (April 2017): 644–652
22. Esposito K et al., “Mediterranean diet improves erectile function in subjects with the metabolic syndrome,” International Journal of Impotence Research, vol. 18, no. 4 (July–August 2006): 405–410
23. Maheshwari A et al., “Efficacy of Furosap, a novel Trigonella foenun-graecum seed extract, in enhancing testosterone level and improving sperm profile in male volunteers,” International Journal of Medical Sciences, vol. 14, no. 1 (2017): 58–66
24. Thu HE et al., “Eurycoma longifolia as a potential adaptogen of male sexual health: A systematic review of clinical studies,” Chinese Journal of Natural Medicines, vol. 15, no. 1 (January 2017): 71–80
25. Roaiah MF et al., “Pilot study on the effect of botanical medicine (Tribulus terrestris) on serum testosterone level and erectile function in aging males with partial androgen deficiency (PADAM),” Journal of Sex & Marital Therapy, vol. 42, no. 4 (May 18 2016): 297–301
26. Salgado RM et al., “Effect of oral administration of Tribulus terrestris extract on semen quality and body fat index of infertile men,” Andrologia, vol. 49, no. 5 (June 2017)
27. Kamenov Z et al., “Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction: A prospective, randomized, double-blind, placebo-controlled clinical trial,” Maturitas, vol. 99 (May 2017): 20–26
28. Neychev V et al., “Pro-sexual and androgen-enhancing effects of Tribulus terrestris L.: Fact or fiction,” Journal of Ethnopharmacology, vol. 179 (February 17, 2016): 345–355
29. Cohen PA et al., “Pharmaceutical quantities of yohimbine found in dietary supplements in the USA,” Drug Testing and Analysis, vol. 8, no. 3–4 (March–April 2016): 357–369
30. Chen P et al., “Determination of yohimbine in yohimbe bark and related dietary supplements using UHPLC-UV/MS: Single-laboratory validation,” Journal of AO/AC International, vol. 98, no. 4 (July–August 2015): 896–901