Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

IJIR publishes special/guest-edited issues and topical collections. The peer review process for articles included in topical collections/special issues is the same as the peer review process of the journal in general. Additionally, if the Guest Editors author an article in their topical collection/special issue, they will not handle the peer review process.​

A systematic review and evidence-based analysis of ingredients in popular male testosterone and erectile dysfunction supplements


The objective was to study available evidence for ingredients of popular over-the-counter testosterone and erectile dysfunction (ED) supplements. The top 16 male testosterone and 16 ED supplements in the USA were identified from the most popular online retailers: A1 Supplements, Amazon, Vitamin Shoppe, and Walmart. In total, 37 ingredients were identified and PUBMED online database was reviewed for randomized-controlled trials (RCT) studying their efficacy. Ingredients were categorized based on evidence quantity using an adapted version of the American Heart Association scoring system. In total, 16 ingredients from testosterone supplements and 21 from ED supplements were identified. Tribulus, Eurycoma longifolia, Zinc, L-arginine, Aspartate, Horny goat weed, and Yohimbine were most common. In all, 105 RCTs studying the identified ingredients were found. No whole supplement products have published RCT evidence. 19% of ingredients received an A grade for strong positive evidence with net positive evidence in two or more RCTs. In total, 68% received C or D grades for contradicting, negative, or lacking evidence. Overall, 69% of ingredients in testosterone supplements and 52% of ingredients in ED supplements have published RCT evidence. Many male supplements claim to improve testosterone or ED parameters; however, there is limited evidence, which should be considered when counseling patients.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type



Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2


  1. Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999-2012. JAMA. 2016;316:1464–74.

    Article  Google Scholar 

  2. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001 to 2011. JAMA Intern Med. 2013;173:1465–6.

    Article  Google Scholar 

  3. Chaitoff A, Killeen TC, Nielsen C. Men’s health 2018: BPH, prostate cancer, erectile dysfunction, supplements. Clevel Clin J Med. 2018;85:871–80.

    Article  Google Scholar 

  4. Dwyer JT, Coates PM, Smith MJ. Dietary dupplements: regulatory challenges and research resources. Nutrients. 2018;10:41.

    Article  Google Scholar 

  5. Cui T, Kovell RC, Brooks DC, Terlecki RP. A urologist’s guide to ingredients found in top-selling nutraceuticals for men’s sexual health. J Sex Med. 2015;12:2105–17.

    Article  CAS  Google Scholar 

  6. Balasubramanian A, Thirumavalavan N, Srivatsav A, Yu J, Lipshultz LI, Pastuszak AW. Testosterone imposters: an analysis of popular online testosterone boosting supplements. J Sex Med. 2019;16:203–12.

    Article  Google Scholar 

  7. Rivas AM, Mulkey Z, Lado-Abeal J, Yarbrough S. Diagnosing and managing low serum testosterone. Proc (Bayl Univ Med Cent). 2014;27:321–4.

    Article  Google Scholar 

  8. Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536–59.

    Article  CAS  Google Scholar 

  9. Rew KT, Heidelbaugh JJ. Erectile dysfunction. Am Fam Physician. 2016;94:820–7.

    PubMed  Google Scholar 

  10. Pastuszak AW. Current diagnosis and management of erectile dysfunction. Curr Sex Health Rep. 2014;6:164–76.

    Article  Google Scholar 

  11. Ko EY, Sabanegh ES. The role of over-the-counter supplements for the treatment of male infertility-fact or fiction? J Androl. 2012;33:292–308.

    Article  CAS  Google Scholar 

  12. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Article  Google Scholar 

  13. Budoff MJ, Achenbach S, Blumenthal RS, Carr JJ, Goldin JG, Greenland P, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006;114:1761–91.

    Article  Google Scholar 

  14. Balasubramanian A, Thirumavalavan N, Srivatsav A, Yu J, Hotaling JM, Lipshultz LI, et al. An analysis of popular online erectile dysfunction supplements. J Sex Med. 2019;16:843–52.

    Article  Google Scholar 

  15. LaValley SA, Kiviniemi MT, Gage-Bouchard EA. Where people look for online health information. Health Inf Libr J. 2017;34:146–55.

    Article  Google Scholar 

  16. Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173:355–61.

    Article  CAS  Google Scholar 

  17. Bailey RL. Current regulatory guidelines and resources to support research of dietary supplements in the United States. Crit Rev Food Sci Nutr. 2020;60:298–309.

    Article  Google Scholar 

  18. Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER 3rd. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med. 2013;159:850–1.

    Article  Google Scholar 

  19. Supplements: a scorecard. Harvard Men's Health Watch. 2012;16:1–5.

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ranjith Ramasamy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuchakulla, M., Narasimman, M., Soni, Y. et al. A systematic review and evidence-based analysis of ingredients in popular male testosterone and erectile dysfunction supplements. Int J Impot Res 33, 311–317 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links