You may want to think twice before picking up a "male enhancement" product. Here's what experts have to say about ginkgo biloba, saw palmetto, and other alternative treatments.

Want to get savvier in the sack? There are plenty of things you can try — healthy lifestyle changes, prescription drugs, alternative treatments.

The National Institutes of Health (NIH) estimates that about 5 percent of 40-year-old males and 25 percent of 65-year-olds experience erectile dysfunction long term.

However, it’s not uncommon for men to also experience situational erection problems. In fact, these sexual flubs aren’t considered “unusual” unless they occur more than once out of every five times.

Since only men with long-term erectile dysfunction should take ED drugs, will alternative ED treatments work for the rest of them?

"Psychological causes account for about 90 percent of occasional impotence, and any safe alternative treatment that gives a man confidence may help," says urologist Bruce Gilbert, MD, PhD, director of reproductive and sexual medicine at the North Shore-Long Island Jewish Health System in New York.

What’s safe — and which ones actually make a difference?

"The problem with alternative treatments for any medical problem, including erectile dysfunction, is that until you have about 20 well-controlled studies over several years, you really don't know what you are working with," cautions Richard Harris, MD, a urologist at Gottlieb Memorial Hospital, part of the Loyola University Health System in Chicago.

Ginkgo biloba. Ginkgo is an herb that is used in Chinese medicine that’s thought to improve blood flow. "Any ED treatment that improves blood flow may help," explains Dr. Harris. "An erection is just blood in and blood out." However, the evidence that ginkgo can improve blood flow in ED is limited, and most experts say the jury is still out. In addition, ginkgo can increase the risk for bleeding problems if combined with certain medications, such as warfarin (Coumadin).

Bottom line: It may help, but talk to your doctor before trying it.

L-arginine. L-arginine is an important amino acid that the body needs to build proteins. Because L-arginine has been shown to improve blood flow, some alternative practitioners have recommended that the supplements be used to treat ED. The Natural Medicines Comprehensive Database, which is a reliable authority on alternative medicines, says L-arginine is possibly effective for treating erectile dysfunction. But Harris warns that "although this supplement could improve blood flow, side effects can be dangerous." L-arginine can cause an allergic reaction or worsen asthma in some people; it can also lower blood pressure.

Bottom line: Just like ginkgo biloba, you should speak with your doctor before trying this alternative treatment.

Acupuncture. Acupuncture has been used for centuries to treat ED and impotence in China. A recent review of studies on acupuncture for erectile dysfunction was published in the British Journal of Urology International. After reviewing four studies, the authors concluded that there was not sufficient evidence to say that acupuncture worked. However, some experts believe it's worth trying. "Acupuncture can work," says Gilbert. "It probably works best to treat the psychological component of ED. There is very little downside to trying it."

Bottom line: Give it a shot.

Saw palmetto. Saw palmetto comes from the fruit of a small palm tree. It has been used to treat symptoms in men with an enlarged prostate gland, such as difficulty urinating, and it has been recommended to treat ED caused by an enlarged prostate. However, several recent clinical trials did not show that saw palmetto works any better on an enlarged prostate than a placebo does. "There is no evidence that saw palmetto should be used to treat erectile dysfunction," says Dr. Gilbert. Like ginkgo biloba, saw palmetto can interact with some prescription medications.

Bottom line: You may not see the results you were hoping for.

DHEA. DHEA, or dehydroepiandrosterone, is a natural hormone that the body uses to make the male hormone testosterone. DHEA and testosterone decrease with age, just as ED increases with age, so it seems that taking DHEA might protect against ED. But Harris says that "it is unlikely that taking DHEA would raise your testosterone enough to make much difference." DHEA should not be used by people with liver problems; it also has many side effects.

Bottom line: Don't try this one unless your doctor is willing to supervise.

Yohimbine. This chemical is found in the bark of an African tree called yohimbe. It has been used as a male aphrodisiac in Africa, and under medical supervision it has been used as a prescription drug to treat ED. Supplements made from yohimbe bark are also available without a prescription, but they can be life-threatening if used at high doses, according to the Natural Medicines Comprehensive Database. The supplement can interact in a harmful way with certain drugs, such as blood pressure medications, and should be avoided by anyone with liver, kidney, heart, or diabetes problems or problems with anxiety or depression. Like DHEA, yohimbine should not be taken without a doctor's supervision.

Bottom line: "The latest studies on yohimbine show that it is probably no better than a placebo," says Gilbert.

"Most of these alternative treatments have been around for a long time," says Harris. "If any of them really worked well for ED, doctors would be using them." Therapy and counseling may also help men whose erectile dysfunction may be linked to psychological issues such as stress, anxiety, or relationship problems.

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