Doctors call it erectile insufficiency; guys know it as a soft-on.
Either way, the problem has a range of causes, from atherosclerosis to
antidepressant medications -- and it plagues us by the millions.
Of course we rarely admit to the humiliating condition -- which explains
my astonishment at lunch in Dallas some months ago, when a middle-aged lawyer friend suddenly brought it up, so to speak. Grinning excitedly, he told me of a wondrous experience: He'd begun taking ginkgo biloba extract, hoping to improve his mental acuity, but discovered instead that the popular herbal supplement sharpened something else altogether. After years of suffering from what he called "iffy" erections, there was now some real starch in his member, for which he was certain he had ginkgo biloba to thank. The guy was so delighted to share this news that he even paid for lunch.
"I'm just as dumb as ever," my friend said, "but I've got no more
problems with hard-ons."
I was intrigued, and skeptical. Ginkgo biloba sounds like a breakfast
order from Jar Jar Binks. But in fact, it is probably the most
commonly consumed herbal medicine in the world. Europeans spend an estimated half a billion dollars a year on it; more than 11 million Americans regularly pop ginkgo biloba in pill form.
Nor is it new. An extract from the fan-shaped leaves of the ancient
ginkgo, or maidenhair tree (the world's oldest living species of tree),
ginkgo biloba is mentioned in Chinese pharmacopeias from 3,000 years ago.
Its primary proven power is to boost circulation, although no one quite
understands how the extract's active molecules, called flavonoids and
terpenoids, actually do their work. It is also an anti-oxidant, and thus
holds some promise as an anti-aging supplement, too.
Right now, the herb is most commonly used to improve brain function,
particularly for relieving symptoms of dementia, including Alzheimer's
disease. Ginkgo biloba also is recommended by physicians, herbalists and
naturopaths for a wide variety of complaints, from tinnitis (ringing in the
ears) to headache, allergy, Raynaud's syndrome and even depression.
But restoring penile function? Theoretically, the extract should ease some
symptoms of sexual dysfunction in men and women, since lack of adequate
blood flow to the genital organs is a root cause of impaired performance in
both sexes. However, my lunch partner was touting hard results. If he was
right, a vastly under-appreciated "natural," non-prescription alternative
to Viagra has been sitting on pharmacy and health-food store shelves, timidly promoted by most manufacturers as an aid to alertness and short-term memory.
One outfit, Pharmaton of Ridgefield, Conn., blandly describes its
product, Ginkoba, as "America's #1 supplement for memory and
concentration." That's like recommending Chateau Margaux as a digestive aid.
I decided to investigate.
A quick cyberspace query to Profnet, which can mobilize world-class
authorities on topics from chinchillas to Chichen Itza, elicited a
small avalanche of replies. Clearly, lots of people are thinking about ginkgo
The first expert I spoke with was Charles Fetrow, a doctor of pharmacology at St. Francis Medical Center in Pittsburgh, and author of "The Professional's Handbook of Alternative and Complementary Medicine."
Fetrow is not a ginkgo partisan; he cautioned there have been very few
scientific studies of the substance as a treatment for sexual dysfunction,
and warned against amateur experimentation with it. Still, "I think there's
great potential," he said. "The animal studies are all very consistent.
They all show -- and we're not sure why -- some form of increased profusion of blood into the tissue."
Unlike Viagra, ginkgo biloba has yet to be implicated in any deaths, and
is generally without reported side effects, except for mild gastrointestinal
problems and occasional allergic reactions. But anyone taking it should talk to their doctor, because it does interfere with the blood's ability to clot, and may dangerously interact with certain anesthetics. Also, users should avoid extracts taken from ginkgo seeds (manufactured principally in Japan), which contain a toxin that can cause convulsions and coma.
Next I heard from William Warnock, a naturopath who practices in
Shelburne, Vt. Warnock said he often observes ginkgo biloba's tonic
effect on sexual dysfunction indirectly. Patients rarely come to him
complaining of the problem -- although women are more apt to than men, he said. Instead, Warnock might prescribe the extract to help his patients
think more clearly, or enhance their memory, or for circulatory conditions,
allergies or depression. Only later do they happily discover, as did my
lawyer buddy, sometimes dramatic improvement in their sexual performance.
The naturopath also said that, unlike other herbs such as St. John's wort, his patients do not "accommodate" to ginkgo biloba; that is, steady
dosage increases are not necessary to achieve the desired effect.
In fact, said Warnock, who usually recommends a dosage of about 160
mg a day, "ginkgo's effects can be slow in coming, at least six weeks in
some cases, but they gradually increase over time. I tell my patients that
it could be a matter of years before they feel its full effect."
I then spoke with Dr. Stephen B. Karch in Las Vegas, a specialist in
cardiac pathology and author of "The Consumer's Guide to Herbal Medicine."
"If you look at the old Chinese herbalist stuff, they all call ginkgo an
aphrodisiac," Karch told me. "That makes perfectly good sense, because
ginkgo enhances nitric oxide production, and that's one of the things that
leads to an erection. Nitric oxide is what's called a messenger. It tells
certain blood vessels they have to relax. That, by the way, would be an
immediate effect of ginkgo."
He added, "Ginkgo also improves syndromes related to hardening of the arteries in the legs. Now it goes without saying that if you have arterial disease of the leg, the arterial complex supplying the genitals is probably also involved. At least that's the experience at autopsy."
Karch said a third major area where ginkgo has been shown to relieve
sexual dysfunction is among men and women who take antidepressants,
particularly so-called SSRIs, or selective serotonin reuptake inhibitors. He
recommended to my attention "Ginkgo Biloba for Antidepressant-Induced Sexual Dysfunction," an article by San Francisco psychiatrist Alan J. Cohen that appeared last year in the Journal of Sex & Marital Therapy.
In the paper, Cohen and co-author Barbara Bartlik wrote that among
63 SSRI patients given an average daily dosage of 207 mg of the extract for four weeks, 91 percent of the women and 76 percent of the men reported that "Ginkgo biloba generally had a positive effect on all four phases of the sexual response cycle: desire, excitement (erection and lubrication), orgasm and resolution (afterglow)."
According to Cohen, the study began serendipitously in 1994 when one
of his geriatric patients, a Holocaust survivor, said he'd heard about
ginkgo's ability to enhance energy and brain function, and wished to try the
herb. Besides suffering deep anxiety, the patient also had recently
experienced sexual problems. "It looked OK to me," said Cohen. "In
fact, I was amazed at the number of European studies going on. It seemed to
be a legitimate substance for any number of problems."
Including, Cohen would discover, sexual dysfunction: "My patient came back after a month and said everything was great, and
by the way, the sexual problem was gone as well. I decided to tell the rest
of my patients about it. Sexual dysfunction is a huge problem in my practice,
as it is with anybody treating patients with these antidepressants. The
pharmaceutical industry underplays the problem. I see it in 50 to 70
percent of my cases."
Among the patients participating in Cohen's study was "Nancy," who
is in her early 50s and suffers from thyroid disease-induced depression.
"When Cohen first told me to try ginkgo, I thought the guy was nuts,"
she recalled. "I said, 'Hey, you've got to be kidding me.' But ginkgo is really, really good. I've been on five different antidepressants, and they all caused sexual dysfunction, but ginkgo helped with each of them. I'm too young to let that part of my life go down the drain," she continued. "When Dr. Cohen asked me to be in a new study which would mean I'd go off ginkgo for three months, I said, 'I don't think so.'"
So then why haven't the big herbal supplement manufacturers or
pharmaceutical companies cashed in on ginkgo biloba's evident erotic promise? Why do they stick with the brain-food pitch, especially since the herb is largely unregulated, outside Food and Drug Administration control?
Susun Weed, an herbalist who has published widely on alternative and complementary medicines and women's health, believes that an outdated
marketing mind-set is at play: Herbs such as ginkgo that do more than one
thing make the big companies' marketing departments nervous. "They think
such claims might confuse people," Weed surmised. "Also, herbs are trying to
become more legitimate, so they think it is better for them to play down
their multiple personalities."
Karch suggests two possibilities. "First of all," he said, "this effect sounds too good to be true. No. 2, the situation with ginkgo is very confusing. A drug company probably would like to isolate the active ingredient, and then patent it. But so far, we don't know enough to do that."
Or maybe gingko's moment already is at hand. Cohen said his research
has turned up a number of Web sites that offer allegedly sex-enhancing
concoctions featuring ginkgo as an ingredient. The word is out.
He also discovered the United States has already granted 46 patents of
various types having to do with ginkgo. One of the most
recent ones, a medical-use patent that claims ginkgo both reverses sexual
dysfunction and enhances normal sexual function, belongs to Cohen.
"I thought this was big news when I discovered it," he said. "I thought it was really important, and so did my patients. I still believe that."
So does my friend the Dallas lawyer, who reports a life full of fun these days.
"You should tell the world about this," he advised me, "but not my wife. I got her thinking I can't get it up and that's the way I want to keep it."