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There’s no shortage of male enhancement pills online, but these dietary supplements aren’t regulated by the U.S. Food and Drug Administration (FDA)—and that means there’s no guarantee you’re getting what the label claims. Stree Overlord Male Enhancement is just one of these pills. Stree Overlord, sometimes mistakenly called Stree Overload or Street Overlord, is a male enhancement supplement produced by the Japanese company Mayo Kaisha Pharmacy Expert Ltd. (Natural Medicines, 2020).
There’s also a Stree Overlord Strong version that claims to be a penis enlargement pill. The pills, which are listed in many online supplement and sex shops, claim to use completely natural ingredients to help men get and maintain an erection that will “exceed Viagra and Cialis.”
Like Cialis (generic name tadalafil; see Important Safety Information) and Viagra (generic name sildenafil; see Important Safety Information), Stree Overlord is intended to be taken before sex. Though it’s marketed as a general male aphrodisiac and doesn’t claim to treat erectile dysfunction. The FDA has found that Stree Overlord is not completely natural and includes undeclared sildenafil, the same active ingredient used in the prescription drug Viagra. The presence of sildenafil in unregulated quantities has been found in other male enhancement pills, such as Black Ant (FDA, 2015).
Sildenafil is a powerful chemical, and its unregulated inclusion in pills is dangerous. There’s no knowing the quantity or quality of sildenafil in these pills, meaning they may cause serious potential side effects that can even be deadly when taken in doses that are too high, taken by people with certain health conditions, and when unwittingly combined with certain medications.
Viagra, generic sildenafil, and other similar medications (such as tadalafil and vardenafil) are not available over-the-counter in the United States. The FDA requires that healthcare providers issue prescriptions for these medications. That’s because sildenafil may cause serious side effects and may interact negatively with certain medications such as nitrates (like nitroglycerin), erythromycin, ritonavir, and blood pressure medications. Combining these medications can be deadly.
Common side effects of sildenafil include headache, nausea, flushing, abnormal vision, congestion, dizziness, and back and joint pain. There’s also the risk of priapism, a painful and persistent erection that may require medical attention (FDA, 2014).
What is erectile dysfunction?
Erectile dysfunction, more commonly known as ED, is a condition characterized by the inability to get or maintain an erection long enough to have penetrative sex. You may still have ED and be able to get an erection, just not every time you want to have sex (NIH, 2017). And while it’s hard for researchers to get an accurate picture of just how many people experience ED, there’s no doubt that it’s common. While estimates are that roughly 8% of men 20–29 and 11% of men age 30–39 have erectile dysfunction, one study found that just 58% of participants with ED had ever sought help from a medical professional for the condition, so the true numbers of men experiencing this common condition are likely even higher (Rosen, 2004).
Although Viagra, or “the little blue pill,” reigns supreme in people’s minds as the go-to ED medication, it’s far from the only ED medication out there. Other common medications include Cialis (generic name tadalafil) and Levitra (generic name vardenafil). All of these ED treatments belong to a class of drugs called phosphodiesterase-5 inhibitors (PDE-5 inhibitors), which improve blood flow to the penis and make it easier to get an erection.
Natural alternatives to Viagra exist, but many need more research to prove they’re effective at treating erectile problems. Horny goat weed contains a compound that inhibits PDE5, like ED drugs (Dell-Agli, 2008). Red or Korean ginseng has shown promise in treating ED, one meta-analysis found, but more research is needed (Borrelli, 2018).
Yohimbine helped men with less severe erectile dysfunction successfully get and keep an erection, but the study was very small, meaning that more research is needed to see if it can be recommended as an effective treatment (Guay, 2002). Maca may be able to increase sex drive, but past studies haven’t found that it’s able to affect testosterone levels (Gonzales, 2002).
Although these come from natural plants, supplements are not regulated by the FDA, which means there’s no guarantee you’re getting what’s listed on the label. If you choose to take a dietary supplement, it’s important to buy from a company you trust.
Current therapies for people with ED include (Stein, 2014):
- Vacuum constriction devices (VCD), also called vacuum erectile devices (VED), are typically used for patients who experience ED following prostate cancer treatment. They use negative pressure to improve blood flow to the penis.
- Penile implants also improve blood flow to the penis, but they do this by delivering drugs that relax blood vessels. This is a surgical option that places a reservoir of the drug inside the body to relax the blood vessels in the scrotum. The implants can be squeezed for a dose of these drugs in anticipation of sex.
- Intraurethral suppositories are medications that patients insert into their urethra 10-30 minutes before sex. The brand-name medication Muse is one example of these, and it uses a vasodilator to relax the blood vessels to help you get and keep an erection.
- Penile support devices, such as Erektor and penile casts, are one nonsurgical option. These devices are customized to a person’s individual anatomy. Erektor stretches the penis when worn in order to increase length and provides support so that the penis remains rigid enough for penetrative sex.
If you have concerns about your sexual health or sexual performance, you can discuss them with your healthcare provider, who can make a recommendation regarding which treatment or device might be right for you.
You should be wary of any company claiming to sell Viagra over-the-counter. Viagra is the brand name for sildenafil citrate, which is also sold as a generic drug, but both of these versions require a prescription. Sildenafil comes with potentially dangerous and even fatal side effects and possible drug interactions–including dangerously low blood pressure, fainting, and priapism (a painful and persistent erection)–which is why you should not take it without a prescription from a licensed healthcare provider (FDA, 2014).
You should also avoid any sources claiming to offer you OTC Viagra because it may not be sildenafil you’re getting. Viagra is one of the most commonly counterfeited drugs in the world. Pfizer, the company that makes brand-name Viagra, found printer ink, amphetamines (“speed”), and metronidazole (an antibiotic) in these fake Viagra pills when they conducted a study in 2011 (Pfizer, n.d.).
If you’re having problems getting or keeping an erection, know that there are plenty of non-prescription treatments for ED as well as prescription options. Steer clear of Stree Overlord or other male enhancement pills that aren’t regulated by the FDA. Discuss your options with a medical professional who can help advise on what treatment is right for you.
- Borrelli, F., Colalto, C., Delfino, D. V., Iriti, M., & Izzo, A. A. (2018). Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis. Drugs, 78(6), 643-673. doi:10.1007/s40265-018-0897-3. Retrieved from https://link.springer.com/article/10.1007%2Fs40265-018-0897-3
- Dell’Agli, M., Galli, G. V., Cero, E. D., Belluti, F., Matera, R., Zironi, E., et al. (2008). Potent Inhibition of Human Phosphodiesterase-5 by Icariin Derivatives. Journal of Natural Products, 71(9), 1513-1517. doi:10.1021/np800049y. Retrieved from https://pubs.acs.org/doi/10.1021/np800049y
- Food and Drug Administration (FDA). (2014, March). Label: VIAGRA (sildenafil citrate) tablets. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/20895s039s042lbl.pdf
- Food and Drug Administration (FDA). (2015, July 31). R Thomas Marketing, LLC – 07/31/2015. Retrieved Aug. 29, 2020 from https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/r-thomas-marketing-llc-07312015
- Gonzales, G. F., Cordova, A., Vega, K., Chung, A., Villena, A., Gonez, C., et al. (2002). Effect of Lepidium meyenii (MACA) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Andrologia, 34(6), 367-372. doi:10.1046/j.1439-0272.2002.00519.x. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12472620/
- Guay, A. T., Spark, R. F., Jacobson, J., Murray, F. T., & Geisser, M. E. (2002). Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial. International Journal of Impotence Research, 14(1), 25-31. doi:10.1038/sj.ijir.3900803. Retrieved from https://www.nature.com/articles/3900803
- National Institutes of Health (NIH). (2017, July 1). Definition & Facts for Erectile Dysfunction. Retrieved Sep. 24, 2020 from https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/definition-facts
- Natural Medicines. (2020). Natural Medicines – Japanese Mayo Kaisha Pharmacy Export Ltd. Retrieved Aug. 29, 2020 from https://naturalmedicines.therapeuticresearch.com/databases/manufacturers/display.aspx?id=5454
- Pfizer. (n.d.). Avoid Counterfeit VIAGRA (sildenafil citrate). Retrieved Aug. 25, 2020 from https://www.viagra.com/getting/avoid-counterfeits
- Rosen, R. C., Fisher, W. A., Eardley, I., Niederberger, C., Nadel, A., & Sand, M. (2004). The multinational Mens Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence oSf erectile dysfunction and related health concerns in the general population. Current Medical Research and Opinion, 20(5), 607–617. doi: 10.1185/030079904125003467. Retrieved from https://pubmed.ncbi.nlm.nih.gov/15171225/
- Stein, M. J., Lin, H., & Wang, R. (2013). New advances in erectile technology. Therapeutic Advances in Urology, 6(1), 15-24. doi:10.1177/1756287213505670. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891291/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.