Male enhancement pills: do they work?

You may have seen flashy ads plastered up in health supplement stores or clickable online ads promoting “all-natural” products that promise a bigger penis, better erections, and improved sexual performance.

Otherwise known as male enhancement pills, these over-the-counter (OTC) supplements are different from products approved by the U.S. Food and Drug Administration (FDA) like Viagra, in that they do not require a prescription. That, and there’s little to no science validating the sexual health claims being marketed.

If you’re dealing with erectile dysfunction, it might be tempting to skip the awkward talk with a healthcare professional required to access the prescription product and opt for one of the many alternative male enhancement pills on the market. 

However, it’s important to keep in mind that not only do most male enhancement pills not work, but they could also be harmful to your health. Here’s what you need to know.

Also advertised as sexual health supplements, male enhancement pills are OTC products (meaning non-prescription) that you can easily get online, at local pharmacies, and even in gas stations. 

Packed with varying combinations of herbs, vitamins, and other ingredients, male enhancement pills claim to enhance erections, amp up your libido, and in some cases, increase penis size. Some of the ingredients in these products are, as marketed, natural and mostly safe to consume at low doses, including:

• Ashwagandha

• Ginkgo biloba

• Ginseng

• Horny goat weed

• L-arginine

• Maca

• Saw palmetto

• Yohimbine

Male enhancement pills may contain a mixture of these ingredients plus a whole slew of others. Some, like ginseng and L-arginine, have been shown in scientific studies to potentially improve conditions like ED. 

Others are ineffective and could potentially be dangerous. For example, high doses of horny goat weed have been linked to breathing problems and irregular heartbeat in some people.

The short answer? Probably not. Dietary supplements, including male enhancement pills, are not regulated by the FDA, meaning that they are not subject to the same rigorous testing standards as other medical products.

There’s no scientific evidence of any OTC male enhancement pills enlarging your penis, although early research shows promise for certain ingredients being helpful for ED. Studies have found that L-arginine, for instance, can improve blood flow; since ED is typically a result of impacted blood flow to the penis, L-arginine is a naturally occurring ingredient that could benefit sexual health.

If a male enhancement pill does seem to work, it could be due to the “other” ingredients present, like sildenafil (the active ingredient in Viagra). While this may seem like a good thing, consuming products such as sildenafil without a stamp of approval from a healthcare provider could have serious health consequences.

As mentioned, dietary supplements are not regulated by the FDA. While this doesn’t make every single male enhancement product out there dangerous, it doesn’t mean they’re safe either.

First off, some products contain “hidden” ingredients they shouldn’t. The FDA has put out many warnings in recent years about this. Among multiple others, NUX and Rhino pills are examples of sexual enhancement products flagged by the FDA for containing sildenafil – an ingredient that should only be used under the direction of a licensed healthcare provider.

This is because, when mixed with other medications (like nitrates), sildenafil can cause unintended side effects like dangerously low blood pressure. Sildenafil can also interact with seemingly innocuous things like alcohol and grapefruit juice. 

Even ingredients clearly listed on male enhancement pill labels can cause anything from unpleasant to severe reactions. Side effects of yohimbine, for example, include anxiety, dizziness, high blood pressure, heart attacks, and seizures.

The other issue with male enhancement pills is dosage. Unlike FDA-approved medications, sexual health supplements don’t always indicate how much of each ingredient they contain (not to mention the dosages of undisclosed ingredients). This may be harmless for some, but for people already taking prescription medication or those who have other health conditions, this could be especially dangerous.

Due to such quality and safety concerns, some studies cite OTC sexual enhancement products as “a major health risk.” More than 350 types of sexual health supplements have been identified by the FDA as containing hidden or questionable ingredients. For people who have high blood pressure or are taking heart medication, unknowingly combining male enhancement pills that contain sildenafil or similar ingredients could cause a stroke and even be fatal.

Unfortunately, there’s no magic pill to cure ED. The good news is there are lots of treatment options for it. 

Keep in mind that there are no FDA-approved products out there for penis enlargement, but the ones listed below are all considered safe and effective treatments for ED.

• Sildenafil (Viagra): Approved back in 1998, sildenafil was the first medication approved by the FDA to treat ED. Like the other drugs listed below, sildenafil falls into a class of medications known as PDE5 inhibitors. These drugs help people get and maintain erections by increasing blood flow to the penis.  

• Tadalafil (Cialis): Tadalafil is another PDE5 inhibitor used to bolster erections and is, for the most part, just as effective as Viagra. The main difference between the two is tadalafil lasts longer – up to 36 hours – while sildenafil lasts about five hours.

• Avanafil (Stendra): Avanafil is the newest and fastest-acting PDE5 inhibitor, with effects kicking in after about 15 minutes (sildenafil takes about 30 minutes).

• Vardenafil (Levitra, Staxyn): Vardenafil is similar in structure to sildenafil but is much more potent. This means that it can be prescribed at a lower dose, reducing the potential for side effects. 

• Penile injections: For those who can’t take oral ED medications or if they’re ineffective, another option is penile injections. The only FDA-approved injection for ED is Caverject, which contains an ingredient called alprostadil that enables blood to flow into the penis more easily. 

There are also plenty of things you can do on a daily basis that can help bolster your erections. While they won’t instantly boost your sex life, when combined, they help alleviate some of the root causes of erectile problems. 

• Eat a healthy diet: Studies have found that eating heart-healthy foods plays a role in maintaining overall health – and that includes sexual health. Sticking to diets rich in fruit, vegetables, fish, nuts, whole grains, and healthy sources of fat (like the Mediterranean diet) is linked to a lower risk of developing ED. Foods that could potentially worsen ED and should be avoided or limited include red meat, fried food, sugary beverages, and refined or processed foods.

• Exercise: Getting regular exercise, especially moderate-intensity aerobic physical activities like cycling or swimming, can help improve erectile function. Exercise keeps blood vessels healthy and improves blood flow – key factors when it comes to ED. Research has found exercise used in tandem with medication shows the most benefits for ED.

• Counseling or sex therapy: ED can also have a psychological component to it. Having open conversations with sexual partners and working with a licensed therapist can improve self-esteem, reduce stress, and boost sexual intimacy. More research is needed, but studies indicate mental health treatments show promise in alleviating psychological ED.

Unlike OTC male enhancement pills, FDA-approved medications for ED are only available with a prescription. Common side effects of ED medications include dizziness, diarrhea, headache, facial flushing, upset stomach, and vision problems. If you have an erection that lasts four or more hours, seek emergency medical attention immediately.

Whether you live with ED or are just starting to experience symptoms, the first step is talking to a healthcare provider. They can recommend a treatment plan based on your symptoms, medical history, and sexual health goals. In most cases, a combination of treatments – including medication and lifestyle changes like exercise and eating healthy – are the most effective for ED. Now, it’s easier than ever to access discreet treatment online with the licensed healthcare providers at Ro. They will perform a thorough health evaluation and, if appropriate, prescribe ED medication that will be shipped right to your door. 

The bottom line when it comes to male enhancement pills? Your safest best bet is to stick to FDA-approved products and steer clear of ones that have “male,” “max,” or “mega” on the label.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

December 18, 2023

Written by

Anna Brooks

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.