Alternative Treatment for Erectile Dysfunction: a Growing Arsenal in Men's Health - Beyond the Abstract

This review article was invited by Current Urology Reports as part of a topical collection on Men’s Health. Erectile dysfunction (ED) is one of the most prevalent sexual health conditions, with an estimated 18 million men affected in the USA alone.1 In addition to standard treatments as recommended by the American Urological Association (AUA), alternative medicine is becoming more popular and accessible, with many patients seeking these treatments for ED. Providers should have an understanding of the literature behind these investigational therapies in order to set appropriate expectations and give recommendations regarding off-label treatment.

Low-intensity extracorporeal shockwave therapy has received increased attention over the last decade with numerous studies attempting to demonstrate its effectiveness as a non-invasive treatment for ED. The most recent meta-analyses have demonstrated a statistically significant improvement in international index of erectile function (IIEF) scores between treatment and sham for men with vasculogenic ED.2,3 More work is needed for developing standardized and validated treatment protocols.

Our review of intracavernosal injection therapies has found that while there is growing evidence suggesting a possible benefit of stem cells for the management of erectile dysfunction, there is little data supporting the efficacy of platelet-rich plasma. Prospective clinical trials to evaluate platelet-rich plasma for treating erectile dysfunction are greatly needed, as this modality is currently being offered off-label at many standalone men’s health clinics.4

There has been ongoing interest in the role of amino acid supplements as a monotherapy, and in combination with PDE5i for the treatment of erectile dysfunction. L-arginine has reported success in improving erectile function and may be a good option for patients in combination with PDE5i before progressing to more invasive options. It may also be beneficial for men seeking a more “natural” treatment for their ED.

There are many “natural solutions” and interventions for ED available on the market that are not necessarily FDA approved or recommended by the AUA or Sexual Medicine Society. Our review highlights the possible clinical uses, efficacy, and support for alternative therapies with existing and emerging literature in ED treatment. The writers of this review hope that readers may utilize the information presented here as a scaffold to initiate further investigation into the presented modalities, and for quick reference in clinical scenarios.

Written by: Wade Muncey, Twitter: @WadeMuncey; Nicholas Sellke; Tyler Kim; Kirtishri Mishra; Nannan Thirumavalavan; Aram Loeb, Twitter: @AramLoeb

Case Western Reserve University School of Medicine, Cleveland, OH, USA., Case Western Reserve University School of Medicine, Cleveland, OH, USA.


  1. Selvin, Elizabeth, Arthur L. Burnett, and Elizabeth A. Platz. "Prevalence and risk factors for erectile dysfunction in the US." The American journal of medicine 120, no. 2 (2007): 151-157.
  2. Campbell, Jeffrey D., Bruce J. Trock, Adam R. Oppenheim, Ifeanyichukwu Anusionwu, Ronak A. Gor, and Arthur L. Burnett. "Meta-analysis of randomized controlled trials that assess the efficacy of low-intensity shockwave therapy for the treatment of erectile dysfunction." Therapeutic advances in urology 11 (2019): 1756287219838364.
  3. Sokolakis, Ioannis, and Georgios Hatzichristodoulou. "Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials." International journal of impotence research 31, no. 3 (2019): 177-194.
  4. Houman, Justin J., Sriram V. Eleswarapu, and Jesse N. Mills. "Current and future trends in men’s health clinics." Translational Andrology and Urology 9, no. Suppl 2 (2020): S116.

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