Yohimbe and erectile dysfunction
Yohimbe is a herbal medication made from the bark of an African tree (Corynanthe yohimbe or Pausinystalia yohimbe). One of the components of yohimbe, named yohimbine, was the primary prescription medication used for the treatment of impotence in the US before the introduction of sildenafil (Viagra).
Yohimbine is an indole alkaloid that comprises about 1 percent of the volume of yohimbe bark. Other indole alkaloids contained in yohimbe bark are: isoyohimbine, allo-yohimbine (dihydroyohimbine), yohimbinine, yohimbane, yohimbenine, corynanthein, and others (Betz et al., 1995; Budavari, 1996; Leung and Foster, 1996).
Yohimbine is also found in other, mostly related plants such as Pausinystalia macroceras and Pausinystalia tillesii, Indian snakeroot (Rauwolfia serpentina), quebracho (Aspidosperma quebracho-blanco), and Pausinystalia lane-poolei (pamprana, igbepo).
While sildenafil citrate may be the medication of choice for standard erectile dysfunction, yohimbe has a wider systemic effect (and many, many unwanted side effects).
This is the case because yohimbine, and unrefined yohimbe, do not just act on the male organ but also make those who ingest it heavily agitated. There is a sexual component in this agitation, which is not available from ingesting sildenafil citrate.
Therefore, while sildenafil citrate may be the preferred choice of prescribing doctors because of fewer side effects, yohimbine and yohimbe are not just older alternatives but earn their place in the materia medica in their own right.
Earlier versions of this article contained the following paragraphs:
“Furthermore, the real promise of yohimbe actually is not its value as a medication for erectile dysfunction in men who indeed suffer from the condition, but its power to enhance sexuality in healthy subjects. Yohimbe is a potent supplement with significant psychoactive and stimulant effects. It has the clear potential to give new meaning to the lives of men at mid-life and beyond. Yohimbe restores pride and enjoyment. For performance and sheer vitality, men at 50 who have ingested yohimbe can compete with much younger men. Forget such esoteric practices as tantra yoga and the tao of love. All you need is yohimbe.
“Because of its potent stimulant properties, some regulatory bodies may sooner or later prohibit yohimbe. It has largely escaped strict prohibition in some regions because its primary user base has historically been mid-life adults seeking sexual enhancement, rather than recreational youth drug users.”
I retract the above enthusiastic statement, and I stopped taking yohimbe or yohimbine several years ago. The reason for my abandoning yohimbe and yohimbine was the severe side effects. Yohimbine may feel stimulating when you take it the first few times, but the side effects are so strong that it feels as if it harms overall health. Among the severe side effects are heart palpitations, insomnia, and blood pressure irregularities.
And just like other potent stimulants, yohimbine can make you crash when the effect wanes. You can feel high on Sunday, but on Monday, you aren't good for anything (and certainly not for sex).
As predicted a few years ago, yohimbine and yohimbe are now controlled or restricted substances in many countries (e.g., Australia), and I am sure others will follow.
Several years ago, I switched from yohimbe to Tongkat Ali. Tongkat ali doesn't cause excitation like yohimbe and yohimbine, but it also isn't accompanied by insomnia, heart palpitations, and other severe side effects.
As a matter of fact, not only the sexuality-enhancing effects of Tongkat Ali, but also its positive effect on overall health, have been studied in scientific trials.
The following is from earlier versions of this article:
“How do yohimbe and yohimbine feel? If you have enough experience with them to be aware of slight symptoms, you will know that yohimbine is taking over when you notice increased salivation. There will be a tendency for an accelerated heartbeat, mostly affected by mental stimulation. There will not necessarily be an increased heartbeat from physical exercise.
“Rather, the capacity for physical exercise will probably be enhanced for many people, with a pulse frequency ordinary for the chosen exercise. Some users have mentioned that they sweat less when on yohimbe, but for me, excessive sweating is more likely. Scientific studies have shown that yohimbine typically raises blood pressure and heart rate due to its sympathomimetic effects. While one may feel anxious or agitated, this is often accompanied by actual cardiovascular stimulation. A yohimbine overdose is associated with dangerous hypertension, tachycardia, and severe agitation, rather than low blood pressure.
“Yohimbe will not make you desire a sexual partner whom you would not desire when not on yohimbe. Rather the opposite. But you can become mentally very fixed on a partner you actually do desire.
“Yohimbe and yohimbine will make those who have ingested them easier to stimulate sexually. Yohimbe works mentally and physically towards this end, with both aspects strongly interacting. Men who normally have problems having an erection will feel a mental stimulation from the fact that an erection comes easily.
“Yohimbe definitely increases erectile rigidity, and may increase erectile capacity.
“As promoters of ginkgo biloba claim that that herb improves blood flow to the extremities, I have tried it in combination with yohimbe, but I have never felt a definite benefit from the added ginkgo biloba.
“For many people, sleep will be impossible for many hours (up to 20 hours) after having ingested yohimbe bark, or yohimbine, the pharmaceutical product. Melatonin will not induce sleep when on yohimbe or yohimbine. Kava-kava is also completely useless for coming down from yohimbe or yohimbine. I have tried a Valerian tea from a generous dosage of the herb (one tablespoon or more). It doesn't work either. Mixing yohimbine with benzodiazepines like Valium is dangerous and medically inadvisable; it does not safely induce sleep and can create unpredictable interactions between a stimulant and a central nervous system depressant. Beta-blockers can help against palpitations but will not induce sleep either.
“It took me years until I found out what to take to reliably go to sleep after ingesting yohimbe, the bark, or yohimbine, the pharmaceutical.
“Apart from sleeplessness, yohimbe and yohimbine can have other uncomfortable side effects in many people, and one should always first check one's tolerance with very small dosages. Proper yohimbe is a powerful substance, nothing like supplements such as ginkgo biloba, vitamin C, or royal jelly. One can clearly overdose on yohimbe.
“I recommend yohimbine, the pharmaceutical, over yohimbe, the bark.
“The problem with bark products is that you never know how potent it actually is. While most yohimbe bark products are on the weak side, you can occasionally get one that knocks you off your feet. With the most potent yohimbe bark products we know and have tested ourselves, even half the recommended dosage is too much for most people. They'll be worried about how to get off the yohimbe, rather than be concerned with sexual pleasure.
“The great advantage of pharmaceutical yohimbine over plain yohimbe bark products is that with the pharmaceutical, you know what amount of yohimbine you are ingesting. But yohimbine is a prescription medication in most places around the world.
“As is the case with most medications, one will, after a while, develop a certain tolerance for yohimbine. You can expect that after prolonged use, you can easily ingest double the amount you ingested initially, and you will likely have fewer problems with side effects. Unfortunately, for the desired sexual effect, you will probably still need a dosage at which side effects, such as nervousness, will again occur. You can't have the roses without the thorns.
“Nevertheless, the pro-sexual effect of yohimbine doesn't wear off in the same way the pro-sexual effect of neurophysiological agents does. Sexuality-enhancing neurophysiological agents are usually medications for Parkinson's Disease, and the fact that their therapeutic effect loses strength with time is what limits the value of these medications. In this instance, we are not primarily talking about sexual enhancement. For people who need dopamine-supporting medications such as bromocriptine, their loss of therapeutic effect is often a severe medical setback.
“While for the sexuality-enhancing effect of yohimbine, one will need a dosage high enough to also cause a certain degree of nervousness, one can try to keep the nervousness side effect under control by avoiding most other stimulants in combination with yohimbe or yohimbine. Especially coffee and tea seem to bring out the bad in yohimbine while suppressing the good. And mind you, most commercial soft drinks (not just the black ones such as Coke and Pepsi) are heavily caffeinated.”