As such, AMS™ LGX 700® IPP insertion and postoperative vacuum device treatment is a safe and highly satisfactory combination approach to maintain penile size. The remaining 20 men formed the control group and received only penile implants. Of these, 15 (enhancement group) also underwent venous ligation of the posterior coronary plexus, deep dorsal veins, and cavernous veins. The deceptive marketing and sale of Rhino pills have led to lawsuits and legal actions against manufacturers and retailers. These undeclared pharmaceuticals can pose serious health risks, especially for individuals taking nitrates for heart conditions or those with underlying health issues. The FDA has issued multiple warnings and taken enforcement actions against manufacturers and distributors of Rhino pills. The satisfaction level of the subjects on penile appearance and sexual life at 12 and 24 weeks post-injection significantly increased in both groups compared to that at baseline. Data including penile girth; 5-scale satisfaction regarding penile appearance and sexual life; and self-estimated IELT, PEDT, and PEP measurements at baseline and at 12 and 24 weeks for all subjects were expressed as mean±SD. During the study period, treatment-related AEs were assessed through vital signs, physical examination, and medical history obtained at each visit. Globally, antibiotics comprise the largest class of counterfeit medications, but in Europe, PDE-5i are the most commonly counterfeited medicines (7). The large market for counterfeit medications is not equally distributed in size or class of medications worldwide. Some sources estimate that the market for counterfeit medications ranges between 75 and 200 billion dollars (5,6). Regardless, it is clear that counterfeit medications have reached an industrial level scale. Despite these potential dangers, the market for counterfeit products has grown astronomically. Making Informed Choices About Sexual Health Dietary supplements (DSs), which are a mixture of active ingredients, are mainly sold online. While the supplements mentioned above may not harm you (except for products sold as “herbal Viagra”), you are urged to consult us before trying them. In fact, the HA concentration of the filler in this study was 23 mg/mL, which was higher than the 20 mg/mL HA concentration in previous studies, and the cross-linking degree was 12%, which was higher than the 6%–10% reported in previous studies. Although the mechanisms of tissue expansion of the two fillers are different, there was no significant difference in the effects and stability of the two fillers in this study, consistent with the results of previous studies 13,14,15. Another new type of scrotal incision implantation involves making a 1- to 2-cm longitudinal incision in the upper scrotum on the left or right base of the penis. The distal end of the penile implant can be aligned with the episcleral and glans sulcus connections before alignment. The subcutaneous surface of the glans is then exposed through penile intussusception, further exposing the coronal sulcus. The penis is then stripped before further dissection of the distal Dartos and Buck's fasciae to expose a shiny white membrane. The growing market for male genital esthetics has brought new surgical procedures, devices, and implants. Dietary supplements for sexual enhancement were most used among males aged 20–29 years, with a decreasing trend according to age advancement, even though the prevalence of erectile dysfunction (ED) increasing in correlation to age has been previously reported 22,23,24. Male enhancement pills encompass a broad class of dietary supplements marketed to support erectile function, libido, or overall male sexual health. Adverse event experiences among male users of sexual enhancement supplements were observed, contrary to the current situation where there have been no public notices regarding adverse injuries related to these supplement products. In this study, we explored why there have been no safety alerts about adverse events related to sexual enhancement supplements among males, while alerts about weight loss supplements among females have been occasionally launched. In male-male sexual activity, which primarily involves oral (mouth-to-genital) and anal (anal-genital) sex, the size of the penis is closely linked to sexual satisfaction. These aspects are unique to penile enlargement surgery for the treatment of female sexual dysfunction. A 2002 study surveying perceptions of penis size among 375 sexually active women found that 32% of women thought penis length was less significant than penis girth. A 2020 study evaluating orgasm and overall sexual function and habits among 303 American women noted that 41% of women with stable sexual partners were at risk for female sexual dysfunction. Herbal supplements rarely discuss possible risks, such as allergies, as they’re not expected to under the law. Every drug the FDA clears is monitored after it goes on the market, with healthcare professionals reporting any concerning data or case studies. With this enzyme blocked, the blood vessels relax, letting more blood into the penis and making it easier to both get an erection and maintain one. The first is that honest businesses only have limited evidence their ingredients work as advertised, with little money available for the extensive testing needed to make medical claims. And there’s no shortage of herbal supplements that claim to be able to help with that, usually through vague promises of increasing testosterone or increasing vitality. In conclusion, this newly developed PLA filler caused significant penile enlargement for up to 18 months and was well tolerated without serious adverse effects. In 2017, among 23 patients who underwent single-treatment PLA injections with a mean volume of 20 mL for penile girth enhancement, the mean circumference increased by 2.2 ± 0.2 cm at 3 months. Additionally, the researchers propose that the importance of penis size is further magnified by its prominence in the prevailing male gay culture, highlighting its role in shaping sexual dynamics and identity within this community.” In addition, a Canadian study found that penis size tends to be larger in gay than in heterosexual men, with a preference for larger sizes noted within the gay community. However, sexual enhancers of plant origin have gained popularity over recent years, as natural substances are often regarded as a safer alternative to modern medications and are easily acquired without prescription. The products, which are often sold on the internet, can be dangerous to health, and we therefore warn consumers against using them. At the Danish Medicines Agency, we routinely analyse products that we suspect contain active pharmaceutical ingredients which are not declared in the product information. Combination products, which contained animal and botanical preparations such as Gymnema sylvestre, white kidney bean, Coleus Forskohlii, chitosan, and Salacia species, consisted of 49.1% animals and botanicals.This product as per FDA website has the undeclared ingredient “Sildenafil” and FDA has issued warning Patient reported he is also using “Mojo Risen” which has been shown to contain Noracetildenafil as confirmed by FDA laboratory analysis.Therefore, the primary purpose of this review was to conduct a literature search to evaluate the efficacy of surgical and nonsurgical treatments for penile enlargement.Moreover, many ingredients whose efficacy was demonstrated by clinical trials were dosed under the mED, raising several doubts about their real impact on sexual function.For example, studies suggest that ginseng and L-arginine may contribute to better stamina and overall sexual health.After the procedure, a mild compressive dressing was applied to the penis and left in place overnight.An institutional review board-approved study listed by clinicaltrials.gov and presented at the International Society of Sexual Medicine. How to Talk About ED Naturally for Better Relationships Tribulus, zinc, and vitamin D have supportive mechanistic data but limited high‑quality trials specific to erectile outcomes. Vitamin D receptors are expressed in penile smooth muscle, and deficiency has been linked to endothelial dysfunction. A balanced diet rich in fruits, vegetables, and whole grains may enhance the supplement's efficacy.What does the current research say about long‑term safety? Individual response times vary based on baseline health, age, and adherence to lifestyle recommendations.Are there any dietary restrictions while taking the pill? Thank a Doctor The most common adulterants found in sexual enhancement supplements are phosphodiesterase type five inhibitors (PDE5i), known as sildenafil, vardenafil, tadalafil, and their analogs 2,6. A similar situation has been seen in the USA, with 45.5% of adulterated dietary supplements being marketed for sexual enhancement, according to a warning released by the FDA, from 2007 to 2016 . It is necessary to inform the public about the risk of sexual enhancement supplement use and also prepare a place for consultation on media channels that younger people are more familiar with, in order to monitor adverse events while also preserving their privacy. The prevalence of sexual enhancement supplement use among males was 23.0%. Dozens of safety alerts for sexual enhancement and weight loss dietary supplements have been launched from the government not only in Japan but also overseas. This is often due to hypertension caused by hidden pharmaceutical ingredients like sildenafil, which affects blood vessel dilation. Many such pills have been recalled by the FDA due to dangerous ingredients and undeclared prescription drugs. More concerning is that some contain undisclosed prescription medications, which can pose severe health risks. While ingredients like L-arginine and ginseng may offer mild benefits, most pills lack sufficient clinical research to support their effectiveness. Zinc, for instance, plays a crucial role in testosterone production and overall reproductive health. Sexual health is a complex interplay of physical, psychological, and emotional factors that require comprehensive, professional approach. They can offer personalized advice, conduct necessary health screenings, and recommend evidence-based treatments tailored to individual needs. Self-medicating with unverified OTC remedies masks potential critical health problems and delays necessary treatment. This trial demonstrated that autologous fat is suitable for penile enlargement and has few adverse effects. One case of penile hematoma and one case of glans numbness were reported, both of which resolved without medical intervention. The blood then flows into the penis and is prevented from flowing out using a constriction ring at the base of the penis, thereby facilitating the maintenance of an erection during sexual activity. The off-label use of these products in patients who want to enhance their penile function should be approached with caution. Meanwhile, a 2014 Mexican study regarding sexual dysfunction in young women highlighted that partner penile thickness/size was significant for female sexual dysfunction. The third group of male patients undergoes cosmetic penile contour surgery and repair for congenital and acquired causes of penile damage.22,26,32 These men seek various enlargement methods to increase the size and girth of their penises. Even males with average-sized penises wished to have larger penises, with studies revealing that males are often dissatisfied with their penile look, which is correlated with the frequency they overestimate their penis size. Many myths exist regarding male enhancement, including the belief that size is the primary determinant of sexual satisfaction and that aging inevitably leads to a decline in performance. The number male enhancement pill often aggregates these ranges into a single tablet, but the exact amounts are rarely disclosed in public labels, underscoring the need for transparent labeling and professional guidance.Interactions with other medications can lead to potentially life-threatening conditions.These non FDA approved products with unknown ingredients are widely accessible for purchase ranging from local food, drug stores and to the internet.A 2021 double‑blind RCT with 120 healthy men receiving 750 mg of Tribulus daily for 12 weeks reported no significant change in total testosterone, free testosterone, or sexual desire scores compared with placebo.Given the increasing emphasis on physical appearance, “small penis anxiety” (SPA) must be recognized and treated appropriately.Although it was a small proportion, there were males who did not want doctors and someone at the consultation services to know about their use (9.8% and 5.5%, respectively).Poor sleep reduces testosterone production and impairs endothelial function, while hypertension and atherosclerosis diminish blood flow to the corpora cavernosa. This study did not specify circumferential parameters, but with the confirmed lack of longitudinal tissue expansion, it can be inferred that circumferential expansion was also lacking. The vacuum erection device involves inserting the penis into a cylinder and applying a vacuum to create negative pressure. Overall, prospective studies with long-term follow-up and reproducible results are lacking in this field. The average penile girth measured before and after treatment was 9.5 and 12.1 cm, respectively. In 2003, Yacobi et al. employed a series of subcutaneous injections of liquid silicone as the primary enhancement procedure in 324 men under local anesthesia. Many Rhino pills contain unregulated and potentially harmful substances. The presence of hidden drugs like sildenafil can interfere with medications taken for hypertension, significantly increasing the risk of stroke or heart attack. Nausea and stomach discomfort are common, likely due to a combination of poor-quality ingredients and the body's reaction to hidden pharmaceutical substances. Several studies have demonstrated the therapeutic efficacy of glans penis augmentation using HA filler for premature ejaculation (PE) 3,23; however, the effect on ejaculation of PGE using HA filler without injection into the glans is unknown. Another interesting aspect of this study is that PGE improved clinical symptoms related to ejaculation in several patients. The properties of HA fillers and the results of previous studies and the current study are summarized in Table 4. This was considered to be due to the difference in the properties of the HA filler used in this study and in previous studies. The HA filler used in this study had a higher degree of cross-linking and HA concentration than the HA fillers used in previous studies, thus increasing the viscosity and cohesivity of the filler, which in turn increases the longevity and tissue volume of the injection site . Penile girth In order to evaluate the potential efficacy of DS formulations, we analyzed the products marketed in Italy using a scoring approach. Therefore, the combination of the various active ingredients, especially in relation to the daily dose, leaves doubts about the real effectiveness. Dan is a long-time freelance writer focusing on technology, science, health, and medicine, with a lifelong interest in physics, biology, and medicine. While gas station sex pills can be tempting, they’re far less regulated than prescription medication. People with eye problems, for example, may need to choose the right medication as some have rare vision-related side effects. Health Complications and Side Effects This regulatory gap allows manufacturers to sell products with minimal oversight, putting consumers at risk. One of the biggest challenges in addressing the Rhino pill issue is the lack of stringent regulation in the dietary supplement industry. Many of these products are advertised as "all-natural" or "herbal," misleading consumers into believing they are safe and free from synthetic drugs. Quantities of active ingredients are also highly variable, as seen in Table 2. Furthermore, 11.5% of patients being evaluated for a PDE-5i prescription had a new underlying disease detected (26). Currently, evidence suggests that ED is not only correlated with cardiovascular disease due to shared medical comorbidities, but is, in fact, an independent risk factor for cardiovascular disease. The Second Princeton Consensus on sexual dysfunction and cardiac risk stated that all men with ED, even in the absence of manifesting cardiac symptoms should be regarded as having potential risks for cardiovascular disease (24). Before PDE-5i are prescribed, patients must be evaluated for potential drug interactions and warned of the absolute contra-indications. Subsequently, using a 22-gauge or 20-gauge cannula, HA or PLA filler was injected in the respective group of patients, between the Buck's fascia and the dartos fascia, by combining the back-and-forth and fanning techniques. Four entry sites were made on the penile base and distal penile shaft at the 2 o'clock and 10 o'clock positions, respectively. During the study period, assessments before and after the procedure were performed by a single physician, independent of the filler injection at each institution (evaluator-blinded). Additionally, the patients' self-estimated intravaginal ejaculation latency time (IELT) was documented at baseline and 24 weeks after the procedure. Always seek the guidance of a medical professional for any concerns regarding your health or wellness. Concrete steps must be taken to improve the safety and well-being of consumers and to decrease the health related consequences from those products which should only be taken under the advice of a physician. Since these supplements are not regulated by the FDA consumers and vendors considered it safe until proven otherwise. Nevertheless, FDA faces serious obstacles in identifying these products true ingredients in a timely fashion to prevent physical damage being done to general public. The availability of these products through the internet and over the counter in local grocery stores places has a huge clinical challenge to health care. In conclusion, to be effective, a DS should be well-designed to act both acutely on the production of nitric oxide (locally in the penis) and chronically by normalizing the hormonal framework. In fact, we can only state that the various EIs are potentially effective in improving erectile function on average. (III) DS formulations available on the Italian market (most likely in Europe) are of poor functional quality and are mixtures of many ingredients without support from the literature. The research consisted of a preliminary survey to screen targeted participants who use sexual enhancement supplements in males and weight loss supplements in females. Since cases related to weight loss supplements have been occasionally alerted about, unlike ones related to sexual enhancement supplements, females who used weight loss supplements were also surveyed as a counterpart to males who used sexual enhancement supplements. Another report showed that 8.6% of patients who used supplements concomitantly with medicines experienced health damages such as diarrhea, headache, rash, and effects on health examination data . Of these food products, sexual enhancement supplement products accounted for the highest proportion (36.8%) followed by weight loss supplements (31.3%). Among supplements for sexual enhancement, nearly half were adulterated and all adulterated formulations were found to contain unapproved drug ingredients . Always consult healthcare professionals and check medication interactions before trying new supplements. The supplements are typically sold without prescription, bypassing critical medical oversight that ensures patient safety. Rhino pills are marketed as quick solutions for sexual performance issues, promising enhanced erectile function, increased stamina, and improved sexual experiences. Most of the selected sexual enhancers appeared to be safe at therapeutic doses, although mild to severe adverse effects may occur in cases of overdosing or self-medication with unstandardized products. The reason male enhancement products have gained such immense popularity, is because the good ones can actually dramatically change your life. If you’ve looked into male enhancement products, you already know that the amount of information out there can be overwhelming. In addition, the advent and refinement of artificial intelligence, various surgical techniques, and products are anticipated not only to improve male SPA and small penis syndrome but also to enhance treatments related to female sexual function and satisfaction. The study also reported 5 cases of mild, transient acute encephalitis, but no severe acute cerebrovascular accidents. Although HA injections are becoming a popular modality for penile enlargement, relatively few reports of their side effects are available. Satisfaction with penile appearance and sexual life was significantly higher in the HA groups. Signs of inflammation and serious adverse effects were absent in all cases. Regarding injectable treatments for penile girth enhancement, perhaps the foremost area of historical and contemporary research is penile subcutaneous injection therapy. The meds keep the contractile tissue of the penis and its accessory glands from contracting too soon, which would otherwise cause premature ejaculation (7). PDE5 inhibitors alleviate this condition by dilating the arteries in the lungs, just as they do in the penis (6). PH occurs when the blood pressure in the vessels of the lungs is elevated. One of the best-known side effects of PDE5 inhibitors is priapism—an erection that lasts longer than four hours—though this is rare. Dangerously low blood pressure, especially in those with a history of a heart condition You can drink the male enhancement liquid straight from the bottle, but some men prefer mixing the liquid supplement with water or another drink. When shopping for male enhancement products, read the label carefully. Many manufacturers market the products as dietary supplements because the products contain natural ingredients, including vitamins and minerals. Walgreens.com offers male enhancement products from well-known brands as ExtenZe and Nugenix. Some shoppers want a male enhancement supplement that increases stamina, but some men want a product that only contains natural ingredients. Strict guideline and regulations for erectile dysfunction supplements should be implemented to prevent misuse of medications such as Sildenafil or Tadalafil or medications similar in structure. Patient was encouraged do not use over the counter sexual enhancement products; he was referred to primary care provider regarding consultation for erectile dysfunction. Supplements, when taken as directed and needed, can help improve your overall health. Our content is fact checked by our senior editorial staff to reflect accuracy and ensure our readers get sound information and advice to make the smartest, healthiest choices. FDA-approved treatments and compounded medications offer reliable alternatives that have undergone rigorous testing. However, results can vary widely among individuals, and a comprehensive approach that includes lifestyle changes and medical advice is often the most effective way to achieve desired outcomes. For instance, Ro Sparks, a compounded medication, is reported to start working within 15 minutes, making it a favorable choice for those seeking rapid results. Albeit its use is culturally well accepted, the betel nut is a strongly addictive substance and multiple adverse effects were reported (Table 1). Psychiatric and neurological adverse events reported in the literature are displayed in Table 1; study conditions and co-exposures are also detailed. Nowadays, sexual performance anxiety, which contributes to psychogenic erectile dysfunction, is estimated to affect 9 to 25% of men in the United States, and phytotherapy is often employed as a treatment . Below you’ll find just a small sample of the medical references, citations, and clinical studies we use to help determine which products are worth your money. When it comes to finding the perfect male enhancement pill, there are some considerations that should be most important to you. In total, 17.6% of users had experienced adverse events, but 58.3% of them did not consult about the events with anybody because of the temporality of their symptoms and their sense of shame. By doing thorough research and prioritizing scientifically supported procedures, men can make informed decisions that promote both their health and confidence. The P-LONG study offers a science-backed, safe alternative to risky and unproven methods. Dr. Brandeis advises conducting research, looking for clinical trial data, and checking peer-reviewed studies before considering any product or procedure. In the majority of cases (757 of 776 (97.6%)), supplements contained ingredients that were not declared on the label. A large number of DSs containing different ingredients have been proposed for the treatment of male sexual dysfunction. In particular, 3 supplements (DS 4, 5 and 7) contained 12 ingredients, of which 9 lacked demonstrated efficacy. Prevalence of dietary supplement use according to age group in the preliminary survey. The proportion of current users increased along with age, and this trend was more evident in females. Botanicals and animals were further classified by their major single ingredient, and the rest were named as combination products. When such habits accompany supplementation, additive benefits are plausible, though direct comparative data are sparse. Regular aerobic exercise independently enhances endothelial NO synthase activity, and a Mediterranean‑style diet rich in polyphenols further supports vascular health. For example, men taking phosphodiesterase‑5 inhibitors may experience additive NO‑mediated effects, whereas those on nitrates face contraindications due to potential severe hypotension. Moreover, inter‑individual variability-driven by genetics, baseline nutritional status, and concurrent medications-affects responsiveness. One of the biggest concerns with Rhino pills is the presence of hidden pharmaceutical ingredients, such as sildenafil (the active ingredient in Viagra).Albeit its use is culturally well accepted, the betel nut is a strongly addictive substance and multiple adverse effects were reported (Table 1).At DeanSilverMD.com, we prioritize an integrative approach to health and wellness, focusing on science-based interventions that can complement traditional medical treatments.The research goes back and forth about whether fish oil supplements are really helpful for the heart.This regulatory gap allows manufacturers to sell products with minimal oversight, putting consumers at risk.If you experience these side effects, immediately contact your doctor.Some of these products are actually dubious.Some products have the real medicine in them, and the medicine should be given by prescription only. Additionally, our study is the first to report the impact on ejaculation of PGE using HA filler and is expected to serve as a catalyst for future research on PGE for the treatment of PE. Although a placebo-controlled study allows better evaluation of the clinical effectiveness of a new treatment, there is a higher risk that nontreatment would be deemed ethically unacceptable by an ethics commission. Second, it is possible to criticize the study design, which uses an active control rather than a placebo control. There are numerous known side effects of PDE-5i, some of which may be life threatening. PDE-5i have been shown to be safe medications and may ultimately be available over the counter. Furthermore, as mentioned earlier, embarrassment with potency issues leads patients to avoid physician visits. The ease and convenience of purchasing counterfeit PDE-5i products via the Internet have contributed to the growth of the illicit market. Between-group comparisons, including differences in the change in mean penile girth, satisfaction level, PEP score, and self-estimated IELT, were analyzed by analysis of covariance using the injected volume of filler as a covariate. The primary outcome was the difference in the change in mean penile girth in the HA and PLA groups at each follow-up visit. Patients were advised to abstain from sexual intercourse for 4 weeks after the procedure. After the procedure, a mild compressive dressing was applied to the penis and left in place overnight. Depending on the penile size, 15–22 mL of HA or PLA filler was injected. The primary concern is that many of these supplements are not regulated by the FDA, leading to inconsistencies in ingredient quality and labeling accuracy. Conducting thorough research and reading product reviews can help prospective users identify which supplements may be worth trying. In a positive light, many men do find relief and satisfaction from using these products, particularly those that contain clinically supported ingredients. Similarly, Korean red ginseng has been used for centuries to enhance sexual function, with some studies indicating its potential benefits. Certain ingredients, such as L-arginine, have been studied for their potential to improve blood flow, which is critical for achieving and maintaining an erection. Pharmacokinetic studies indicate that oral L‑arginine has low bioavailability (≈30 %) due to first‑pass metabolism. Systematic reviews in 2024 concluded that evidence for a clinically meaningful testosterone increase is weak; reported changes rarely exceed 10 % and are often within assay variability. Nonetheless, academic research has begun to evaluate individual ingredients and some proprietary blends in controlled trials. Understanding what scientific studies actually reveal helps separate plausible mechanisms from marketing hype. Poor sleep reduces testosterone production and impairs endothelial function, while hypertension and atherosclerosis diminish blood flow to the corpora cavernosa. As expected, all the plants involved are libido-enhancing aphrodisiacs altering neurotransmission, although ginseng (P. ginseng and P. quinquefolius) and yohimbe (P. johimbe), and kanna (S. tortuosum) also enhance sexual potency. Dizziness, sleepiness, fatigue, agitation, insomnia, and headaches were reported. Neurological effects included seizures, extrapyramidal symptoms, and withdrawal symptoms. In patients with normal thyroid levels, doses of Male Excel’s desiccated thyroid used daily for hormone replacement are not helpful for weight loss. What other medications might interact with Male Excel’s desiccated thyroid? If you experience these side effects, immediately contact your doctor. Do not use Male Excel’s desiccated thyroid if you have hyperthyroidism, overactive thyroid, uncorrected adrenal problems, or are allergic to any of its ingredients. A total of 41 different active ingredients were used by manufacturers for the various formulations of DSs. Of these, 87 were excluded according to the reasons reported in Figure 1. Level C was assigned if multiple RCTs showed opposing results for the same outcome, and level D was given for ingredients showing negative or no effect on the analyzed outcomes. Medical doctors should be aware of the potential drug interactions with aphrodisiacs and dietary supplements when prescribing a pharmaceutical drug. Aside from sexual enhancement, these plants often have many other therapeutic applications and can be a part of the everyday diet of individuals. Although the consumption of these plants appears safe, further studies should be conducted to better understand their positive and negative effects. Although rare, psychiatric side effects were mostly reported and included anxiety, depression, psychosis, and mania. In addition, although Voacanga africana alkaloids may modulate neuronal excitability and have positive effects in Alzheimer’s disease 287,288, no neurological or psychiatric complications related to the plant were reported. The diabetic medication glibenclamide was also detected in his blood. He passed away two weeks later due to brain injuries caused by severe low blood sugar and a chest infection that led to septicaemia (blood poisoning). Glibenclamide, a prescription medicine used to treat diabetes, was detected in the man’s blood and urine. We are committed to maintaining the highest quality products and the utmost integrity in business practices. It is also important to consider that plants that do not induce psychiatric or neurological adverse effects are not necessarily harmless, and could exhibit another type of toxicity (e.g., cardiovascular, hepatic, and renal toxicity), which was not the focus of the present review. Yohimbe mainly was involved in intoxication cases, but its cardiovascular toxicity is more concerning than its psychiatric and neurological adverse effects. Considering the paucity of data and the frequent co-exposure to other psychoactive substances, conclusions can be hardly drawn regarding the psychiatric/neurological adverse effects of several of the plants included in this article. While all of these medications work in the same way, there are small differences in side effect profiles as well as how long they work and the best time to take them.The vacuum erection device involves inserting the penis into a cylinder and applying a vacuum to create negative pressure.By making minimal alterations to the material, manufacturers have created HA products that are well tolerated by the immune system and exhibit favorable properties of longevity and nonreactivity .Dietary supplements for sexual enhancement were most used among males aged 20–29 years, with a decreasing trend according to age advancement, even though the prevalence of erectile dysfunction (ED) increasing in correlation to age has been previously reported 22,23,24.Counterfeiters do not declare these ingredients or warnings of possible deleterious interactions on their packaging.A modest 2021 RCT in men with low zinc status showed a 6 % rise in serum testosterone after eight weeks of 30 mg daily supplementation, alongside improved sexual desire scores.The large market for counterfeit medications is not equally distributed in size or class of medications worldwide.Psychiatric and neurological side effects included headaches and hypnotic effects and were mild. Stop using Male Excel’s Testosterone Lipoderm Cream and call your healthcare provider immediately if you see any signs and symptoms of puberty in a child or changes in body hair. Anabolic androgenic steroid abuse can lead to serious cardiovascular and psychiatric adverse reactions. If you have any questions or concerns about your health, please talk to a doctor. Based on DEA and state laws, your testosterone treatment plan may require an in-person medical exam. In vitro and in vivo studies demonstrated the plant to be anti-inflammatory, neuroprotective, antitumor, antimicrobial, antistress, antidiabetic and cardioprotective .Observational data from the 2024 NHANES cohort indicated that men with serum 25‑OH vitamin D below 20 ng/mL had a 1.4‑fold higher odds of erectile dysfunction after adjusting for age, BMI, and comorbidities.Many men notice changes in sexual performance as they age, experience higher stress levels, or manage chronic conditions such as hypertension.Advancements in technology have transformed the field of sexual health.Our objective is to inform readers about the complexities surrounding these supplements while promoting safe and effective options for improving sexual health.Many unproven methods to increase penis size are available on the Internet; these include lotions, pills, stretching devices, vacuum pumps, and home massage techniques. Can a single dose of a male enhancement pill replace prescription medication? The majority of trials assess surrogate markers (e.g., penile blood flow, NO metabolites) rather than patient‑reported outcomes like intercourse satisfaction or durability of erection. Vitamin D deficiency has been linked to lower erectile function, and supplementation may improve endothelial health, but RCT evidence specific to ED is sparse. A 2021 double‑blind RCT with 120 healthy men receiving 750 mg of Tribulus daily for 12 weeks reported no significant change in total testosterone, free testosterone, or sexual desire scores compared with placebo. He searches online for over‑the‑counter options and wonders whether a local pharmacy like CVS carries a reliable male enhancement product for humans. A healthy diet, regular exercise, good sleep habits, and lower stress levels all go a long way toward improving your health, as you’ve heard a million times, Dr. Starke says. She adds that the longer you maintain low levels, the more effects you might see, including potential ED. Basically, blood flow issues that affect your system can also raise your risk of ED. Don't use supplements for ED that lack proven benefits and pose a potential risk for harm. That's why it's important to talk with your healthcare professional before you try a new supplement. Erectile dysfunction supplements and other natural remedies have long been used in various cultures. Erectile dysfunction (ED) is the inability to get and/or keep an erection that’s firm enough to have sexual intercourse. This section collects any data citations, data availability statements, or supplementary materials included in this article. Although an ideal penile filler has not yet been established, PGE with HA and PLA filler resulted in significant PGE for 24 weeks post-injection and appears to be safe and stable. As the present study was not specifically designed to evaluate PGE using injectable fillers for the treatment of PE, further studies are needed to demonstrate the therapeutic effect of PGE on PE. Therefore, the current study used active treatment in the control group, as in previous studies. Additionally, even if nontreatment does not harm the patients, it is difficult to conduct a blinded study using saline injection as a placebo control because volume expansion disappears soon in saline-injected patents. In addition, in this study, we found that the effect on ejaculation did not negatively affect satisfaction with sexual life. Indeed, in the initial feasibility study of PGE using HA filler, most patients experienced decreased tactile sensation of the shaft . We aimed to evaluate the efficacy and safety of penile girth enhancement (PGE) using hyaluronic acid (HA) filler with different physical properties from previous studies. Interactions with pharmaceuticals or other herbal supplements are more common and may pose a significant health threat. Most of the sexual enhancers of plant origin included in this review appeared to be safe at therapeutic doses, and few psychiatric and neurological side effects were reported. Excellent tolerability is generally reported after using ashwagandha for weeks at therapeutic doses, with statistically insignificant adverse effects compared to placebo 281,282. In the future, more precise and efficient surgical and nonsurgical therapies may be developed, thereby expanding the range of options for patients with SPA. These technologies aim to achieve enhancements in precision and durability. With these advancements, penis enlargement surgery might become safer and more effective, benefiting from new technologies such as gene editing, stem cell therapy, nanotechnology, 3D printing, and mature biotissue engineering. Innovations such as Penuma and assistive technology for the penile tunica albuginea, along with their potential for tissue engineering, are steering the field toward more promising directions. The use of sex drive enhancers can sometimes lead to psychological dependence, where men feel they cannot perform sexually without the aid of these supplements.No serious adverse events (fibrosis, flap infection, sclerosis, or excision) were reported during the 6-month follow-up period.While skepticism is warranted, certain natural ingredients have shown potential in supporting sexual wellness.If you are serious about improving your sexual health, consult a doctor to explore options that are both effective and safe.However, they did not come as a complete surprise, because these plants have been used for centuries or millennia in traditional medicines and modern medicine has considerably benefited from these ingredients and preparations .Consulting healthcare professionals is crucial, as erectile dysfunction can signal underlying health conditions such as diabetes or cardiovascular issues.Several studies have demonstrated the therapeutic efficacy of glans penis augmentation using HA filler for premature ejaculation (PE) 3,23; however, the effect on ejaculation of PGE using HA filler without injection into the glans is unknown. During intercourse, the penis helps remove foreign bodies and bacteria from the vagina, thereby improving the ability of a woman to withstand infections. Studies have been published worldwide to evaluate and establish normal penile sizes. The normal penis size and the methods of determination of the normal penis size must be defined. Men believe that their actual penis size is significantly smaller than the ideal size (i.e., what they think their penis should be or what they expect it to be after penis enlargement surgery). Fibrous tissue called the tunica albuginea traps the blood in the corpora cavernosa, keeping your erection long enough for sex. PDE5 inhibitors were initially developed to treat chest pain, high blood pressure and heart problems by—you guessed it—improving blood flow. Therefore, strict regulation of these products and standardization of the definition of nutraceuticals are urgently needed. These study findings highlight the adulteration, poor quality and hazard of these nutraceuticals. Erectile dysfunction can be a symptom of serious underlying health issues such as cardiovascular disease, diabetes, or hormonal imbalances. Ingredients like ginseng, L-arginine, and yohimbine might sound promising, but their actual impact on sexual performance remains largely unproven. Researchers found that every tested product contained varying levels of sildenafil citrate, an undisclosed prescription drug ingredient that can cause serious health complications. Further studies were retrieved from the reference list of selected articles and reports from international institutions such as the World Health Organization (WHO), the US Drug Enforcement Administration (DEA), and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The review focused on selected plants and their active ingredients, which were included after a preliminary screening of the literature. In particular, more clinical studies with controlled administrations, to have a better grasp on doses and co-exposures, should be conducted to address this issue. The table below summarizes how single‑use male enhancement pills compare with other common approaches to supporting male sexual health. Single‑use male enhancement pills are classified as dietary supplements under U.S. regulations, meaning they are not required to undergo the rigorous pre‑market evaluation mandated for pharmaceutical agents. The term "male enhancement" is a marketing umbrella that can include ingredients intended to improve erectile function, increase libido, or promote overall reproductive health. Dietary supplements meant for sexual enhancement and improved energy levels in men are testing positive for “hidden ingredients,” according to an FDA health advisory notification. As men navigate the complexities of sexual health, understanding male enhancement pills is crucial for informed decision-making. One of the most persistent male enhancement myths is the belief that size determines sexual satisfaction. More than 75 percent of so-called ‘natural’ supplements tested in one study contained hidden pharmaceuticals that can seriously harm your health. Talk with your healthcare professional before you try a supplement for erectile dysfunction. This clinical brief is a call to action for health care professionals to advocate for patient safety, educate patients, and champion evidence-based therapies approved for the treatment of erectile dysfunction. Here’s what you should know about supplements claiming to enhance your sex life. It's not clear what you could be putting in your body, and there's always the chance it could harm your overall health—including your sexual health. This term is used to describe the natural supplements advertised to boost your erection.