Men's Health

A Strong scientific evidence

• Pygeum : Pygeum (P. africanum bark extract) has been observed to moderately improve urinary symptoms associated with enlargement of the prostate gland or prostate inflammation. Numerous human studies report that pygeum significantly reduces urinary hesitancy, urinary frequency, the number of times patients need to wake up at night to urinate, and pain with urination in men who experience mild-to-moderate symptoms. However, pygeum does not appear to reduce the size of the prostate gland or reverse the process of benign prostatic hypertrophy.
• Avoid if allergic or hypersensitive to pygeum.
• Saw palmetto : Numerous human trials report that saw palmetto (Serenoa repens) improves symptoms of benign prostatic hyperplasia (BPH), such as nighttime urination and urinary flow, and overall quality of life, although it may not greatly reduce the size of the prostate. Although the quality of these studies has been variable, overall they suggest effectiveness.
• Avoid if allergic or hypersensitive to saw palmetto. Avoid prior to some surgical or dental procedures. Use cautiously with bleeding disorders, hormone-sensitive conditions, gastrointestinal disorders, and high blood pressure. Use cautiously if taking drugs that thin the blood such as warfarin (Coumadin®), hormonal agents such as finasteride (Proscar®, Propecia®) or birth control pills, and blood pressure-altering agents.

B Good scientific evidence

• Beta-sitosterol : Beta-sitosterol and beta-sitosterol glucoside have been used to treat symptoms of benign prostatic hyperplasia (BPH). Additional clinical study is needed before a firm recommendation can be made.
• Avoid if allergic to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis, ileostomy, neurodegenerative disorders, diverticular disease (bulging of the colon), short bowel syndrome, celiac disease, or sitosterolemia. Use cautiously with a history of gallstones.
• Selenium : There is evidence that low selenium levels are associated with an increased risk of prostate cancer. In human studies, initial evidence has suggested that selenium supplementation reduces the risk of developing prostate cancer in men with normal baseline PSA (prostate-specific antigen) levels and low selenium blood levels. Selenium deficiency may be diagnosed by measuring selenium in the blood; the normal level is 70 nanograms per milliliter (ng/ml) in blood plasma (liquid component) or 90ng/ml in red blood cells. Laboratory studies have reported several potential mechanisms for selenium's beneficial effects in prostate cancer, including a decrease in androgen receptors and PSA production, the inhibition of angiogenesis (the growth of new blood vessels in tumors), and increased antioxidant effects, including cancer cell apoptosis (cell death). There is ongoing research in this area.
• Avoid if allergic or sensitive to products containing selenium. Avoid with history of nonmelanoma skin cancer.

C Unclear or conflicting scientific evidence

Note: PC-SPES ® has been recalled from the U.S. market and should not be used. Based on safety concerns associated with PC-SPES®, no dosage is recommended.

• Acupressure, shiatsu : Results from preliminary study suggest a benefit of pelvic massage in the treatment of sexual dysfunction. Additional studies are needed.
• With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. Serious long-term complications have not been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
• Acupuncture : Acupuncture is commonly used throughout the world. While limited evidence suggests that benefits may be possible, there is currently insufficient available human evidence to recommend either for or against acupuncture for prostatitis.
• A few clinical studies have suggested that acupuncture may help individuals suffering from erectile dysfunction (ED). The results found that acupuncture may be an effective treatment option in more than two-thirds of patients with ED caused by psychological factors, including stress, anxiety, and depression.
• Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, medical conditions of unknown origins, or infections. Acupuncture should not be applied to the chest in patients with lung diseases or on any area that may rely on muscle tone to provide stability. Avoid use in infants, young children, or in patients with needle phobias. Use cautiously with bleeding disorders, neurological disorders, seizure disorders, or diabetes. Use cautiously in elderly or medically compromised patients. Use cautiously in patients who will drive or operate heavy machinery after acupuncture. Use cautiously if taking anticoagulants.
• African wild potato : The African wild potato is native to South Africa. It is a bitter plant used for a wide variety of medical conditions. African wild potato may be a potentially effective treatment option for benign prostatic hyperplasia. Additional study is needed to make a firm conclusion.
• Avoid if allergic to African wild potato or any species of the Hypoxidaceae family. Use cautiously with diabetes, liver disease or damage, HIV/AIDS, or kidney disease or damage.
• Arginine : Early studies propose that men with low nitrate levels in their blood or urine may find arginine supplements to be useful for managing erectile dysfunction (ED). A randomized, controlled clinical trial reported improvements in patients with mild to moderate ED following the use of a combination of L-arginine, glutamate, and yohimbine hydrochloride. Notably, yohimbine hydrochloride is an FDA-approved therapy for this condition, and the effects caused by arginine alone in this combination therapy are difficult to determine. It is not clear what doses of arginine may be safe or effective in treating this condition, and comparisons have not been made with other agents used for ED.
• Avoid if allergic to arginine, or with a history of stroke, or liver or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (such as warfarin or Coumadin®) and blood pressure drugs, or herbs or supplements with similar effects. Blood potassium levels should be monitored if using arginine.
• Calcium : Calcium is the most abundant mineral in the human body. It is currently unclear if calcium may help reduce the risk of prostate cancer. Study results are mixed. The lack of agreement among these studies suggests complex interactions among risk factors for prostate cancer. Until the relationship between calcium and prostate cancer is clarified, it is reasonable for men to consume recommended intakes according to the Food and Nutrition Board of the Institute of Medicine. Treatment of prostate cancer should only be done under the supervision of a qualified healthcare professional.
• Avoid if allergic to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in the urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation (where the ventricles of the heart contract in unsynchronized rhythm), kidney stones, kidney disease, or sarcoidosis. Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (the absence of hydrochloric acid in gastric juices) or irregular heartbeats.
• Carnitine : L-carnitine, carnitine, or acetyl-L-carnitine, is an amino acid (a building block for proteins). High concentrations of carnitine are found in muscle tissue. Preliminary studies suggest that addition of acetyl-L-carnitine (in combination with propionyl-L-carnitine, another form of carnitine) helped sildenafil (Viagra®) work better for patients with ED. However, more rigorous trials should be performed.
• Caution is advised when taking L-carnitine supplements, as adverse effects including drug interactions are possible.
• Clove : A small amount of human research reports that a combination cream with clove and other herbs may be helpful in the treatment of premature ejaculation. However, well-designed studies of the effectiveness of clove alone are needed before a conclusion can be drawn.
• Avoid if allergic to Balsam of Peru, clove, eugenol, or some licorice and tobacco (clove cigarette) products. Avoid with bleeding disorders and in pediatric patients. Avoid use of undiluted clove oil on the skin. Use cautiously with seizure disorders and kidney or liver dysfunction. Avoid if pregnant or breastfeeding.
• Coenzyme Q10 : Limited available study using a combination that included CoQ10 did not find a significant effect on PSA levels in patients with prostate cancer. Although PSA levels may be an indicator of cancer, it is unclear whether CoQ10 would have any effect on cancer treatment of prevention. More study is needed in this area. There is early evidence that supports the use of CoQ10 for increasing sperm count and motility in patients with idiopathic asthenozoospermia. Better studies are needed before a conclusion can be made.
• Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs.
• Coleus : Coleus (Coleus forskohlii) has been used in Asian traditional medicine for over 2,000 years. A component of coleus, called forskolin, was studied in humans in addition to prostaglandin E1, a drug commonly used in erectile dysfunction. Positive effects were seen with the forskolin and progstaglandin when the prostaglandin alone did not work for ED.
• Caution is advised when taking coleus supplements, as numerous adverse effects including drug interactions with blood pressure-lowering medications are possible.
• Cordyceps : Cordyceps sinensis is a fungus found mainly in China, Nepal, and Tibet. There is currently not enough available scientific evidence regarding the use of Cordyceps for sexual dysfunction. High quality clinical research is needed in this area.
• Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, prostate conditions, bleeding disorders, or if taking anticoagulant medications, immunosuppressive medications, or if on hormonal replacement therapy or oral contraceptives. Avoid with myelogenous-type cancers. Avoid if pregnant or breastfeeding.
• Danshen : Danshen (Salvia miltiorrhiza) is widely used in traditional Chinese medicine (TCM), often in combination with other herbs. Limited available study found that danshen combined with routine Western medicine was less effective than warming needle moxibustion for the treatment of chronic prostatitis. More studies are warranted in this area.
• Avoid if allergic or hypersensitive to danshen. Use cautiously with sedatives or hypolipidemics, cardiac glycosides, CYP-metabolized agents, nitrate ester, steroidal agents, and some anti-inflammatories (such as ibuprofen). Use cautiously with altered immune states, arrhythmia, compromised liver function, or a history of glaucoma, stroke, or ulcers. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin, or hypotensives, including ACE inhibitors such as captopri, Sophora subprostrata root, or herba serissae. Avoid with bleeding disorders or low blood pressure, and following cerebal ischemia.
• DHEA : DHEA (Dehydroepiandrosterone) is a hormone made in the human body and secreted by the adrenal glands. DHEA serves as a precursor to male and female sex hormones. The results of studies vary on the use of DHEA in erectile dysfunction and sexual function, in both men and women. Better research is necessary before a clear conclusion can be drawn.
• Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders. Use cautiously if taking anticoagulants, or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before surgery or dental or diagnostic procedures with bleeding risk, and do not use immediately after these procedures.
• Ephedra : Early small studies suggest that ephedra may increase sexual arousal. Further well-designed research is needed to confirm these results.
• The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths from the use of ephedra and/or ephedra containing products. Avoid use in individuals younger than 18 years old. Avoid use for prolonged periods (longer than seven days) due to risk of abuse or toxicity. Discontinue use at least one week prior to major surgery or diagnostic procedures. Use cautiously with cardiovascular disease, including structural heart disease, arrhythmia, coronary artery disease, high blood pressure, cerebrovascular disease, and a history of stroke or transient ischemic attack. Use cautiously with depression, anxiety disorders, anorexia/bulimia, a history of suicidal ideation, insomnia, tremors, urinary retention, enlarged prostate, diabetes, kidney disease, glaucoma, thyroid disease, and peptic ulcer disease. Use cautiously with monoamine oxidase inhibitor (MAOI) or stimulant use. Avoid if pregnant or breastfeeding.
• Flaxseed and flaxseed oil : Flaxseed (Linum usitatissimum) and its derivative flaxseed oil/linseed oil are rich sources of the essential fatty acid alpha-linolenic acid, which is a biologic precursor to omega-3 fatty acids such as eicosapentaenoic acid. There is limited high quality research of the effects of flaxseed or alpha-linolenic acid (which is in flaxseed) on prostate cancer risk. This area remains controversial as there is some data reporting possible increased risk of prostate cancer with alpha linolenic acid. Prostate cancer should be treated by a medical oncologist.
• Flaxseed has been well-tolerated in studies for up to four months. Avoid if allergic to flaxseed, flaxseed oil or other plants of the Linaceae family. Avoid large amounts of flaxseed by mouth and mix with plenty of water or liquid. Avoid flaxseed (not flaxseed oil) with history of esophageal stricture, ileus, gastrointestinal stricture or bowel obstruction. Avoid with history of acute or chronic diarrhea, irritable bowel syndrome, diverticulitis, or inflammatory bowel disease. Avoid topical flaxseed with open wounds or abraded skin surfaces. Use cautiously with history of a bleeding disorder or with drugs that cause bleeding (like anticoagulants and non-steroidal anti-inflammatories (like aspirin, warfarin, Advil®)), high triglyceride levels, diabetes, mania, seizures or asthma. Avoid ingestion of immature flaxseed pods.
• Ginkgo biloba : Ginkgo biloba has been used medicinally for thousands of years. Recently it has been used and studied for the treatment of sexual dysfunction in men and women. In general, studies are small and not well-designed. Additional research is needed before a recommendation can be made.
• Avoid if allergic or hypersensitive to members of the Ginkgoaceae family. If allergic to mango rind, poison sumac, poison ivy, poison oak, or cashews, then allergy to ginkgo is possible. Avoid if taking anticoagulants, due to an increased risk of bleeding. Ginkgo should be stopped two to three weeks before surgical procedures. Use cautiously with seizures or in children. Ginkgo seeds are dangerous and should be avoided. Skin irritation and itching may also occur due to ginkgo allergies.
• Ginseng : For more than 2,000 years ginseng root has been valued in Chinese medicine. Preliminary evidence indicates that Panax ginseng may be effective in improving the signs and symptoms of erectile dysfunction. However, additional research is warranted in this area.
• Researchers have found that a topical herbal combination containing Panax ginseng may increase the effects of standard treatment for premature ejaculation. However, additional studies using ginseng alone are needed.
• Avoid if allergic to ginseng or other plants in the Araliaceae family. Avoid with bleeding disorders, leukemia, or liver disorders. Avoid if taking anticoagulants or antiplatelet drugs. Use cautiously with gastrointestinal disorders, high blood pressure, hormone-dependent conditions (such as breast cancer or prostate cancer), sleep disorders, attention-deficit hyperactivity disorders (ADHD), irregular heartbeat, heart disease, diabetes, joint or muscle disorders (such as arthritis or fibromyalgia), eye disorders, or psychological disorders. Use cautiously if taking ACE inhibitors, antihyperlipidemics, antineoplastics, cytotoxic drugs, central nervous system stimulants (including caffeine), diuretics, glucocorticoids, HIV protease inhibitors, monoamine oxidase inhibitors (MAOIs), morphine, mitomycin C, sodium channel blockers, nifedipine, agents that increase photosensitivity, or drugs that are broken down by the liver. Use cautiously if undergoing chemotherapy or radiation therapy.
• Green tea : Green tea (Camelia sinensis) is reported to have antioxidant- and immune-stimulating properties. Limited human study reported minimal benefit using green tea extract capsules for the treatment of hormone-refractory prostate cancer. Further research is needed before a clear conclusion can be reached.
• Caution is advised when drinking green tea, as adverse effects, including an increased risk of bleeding and drug interactions, are possible. Caffeine-free products are available.
• Horny goat weed : Horny goat weed has been traditionally used to increase fertility. Early study suggests that horny goat weed may be of benefit for sexual dysfunction in renal failure patients. Additional study is needed in this area.
• Avoid if allergic/hypersensitive to horny goat weed (Epimedium grandiflorum), its constituents, or related plants in the Berberidaceae family. Use cautiously with tachyarrhythmia, decreased blood pressure, frequent nosebleeds, musculoskeletal disorders, bipolar disorder, immune function disorders, homocysteine disorders, hypothyroid conditions, and cardiovascular disease. Use cautiously if taking anticoagulant or antiplatelet (blood thinning) medications, antihypertensive (blood pressure) medications, antidepressants (MAOIs), interleukins, or cholesterol-lowering medications. Avoid with hormone-sensitive conditions or if taking estrogen or oral contraception. According to traditional Chinese medicine (TCM), avoid in patients with "fire from yin deficiency" (people with too much "yang" or heat, masculinity, and activity, based on Chinese philosophy). Avoid if pregnant or breastfeeding.
• Hypnotherapy, hypnosis : There is inconclusive evidence from preliminary research on the use of hypnotherapy for erectile dysfunction. Additional study is needed before a firm conclusion can be drawn.
• Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders. Use cautiously with seizure disorders.
• Lycopene : High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Early studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. Laboratory studies have reported that lycopene inhibits the growth of prostate cancer cells. Patients diagnosed with benign prostatic hypertrophy or enlarged prostate may be at an increased risk of developing prostate cancer and may benefit from taking lycopene supplements. Further studies are necessary before lycopene may be recommended.
• Avoid if allergic to tomatoes or to lycopene.
• Maca : Maca (Lepidium meyenii) is a vegetable that has been cultivated as a root crop for at least 2,000 years. It can be found wild in Peru, Bolivia, Paraguay, and Argentina, but has primarily been cultivated in the highlands of the Peruvian Andes. Traditionally in Peru, maca has been used as a male aphrodisiac to increase sexual desire. Maca may improve sexual desire in healthy men independent of changes in mood, or serum testosterone (male hormone), and estradiol (female hormone) levels. Higher quality studies are needed in this area, in both men and women.
• Avoid if allergic/hypersensitive to maca (Lepidium meyenii), any of its constituents, or other members of the Brassicaceae family, formerly Cruciferae (broccoli, brussel sprouts, cabbage, or cauliflower). Use cautiously with anticoagulation therapy, hypertension, hormone responsive cancers such as breast cancer, or prostate cancer, and if using oral contraceptives or stimulants. Avoid if pregnant or breastfeeding.
• Modified citrus pectin : Pectins are gel-forming polysaccharides from plant cell walls, especially apple and citrus fruits. Modified citrus pectin may reduce the metastasis (spread to other areas of the body) of certain types of cancers, including lung, prostate, and breast cancer. More research is needed in this area, especially with other types of cancer and with other criteria for prostate cancer progression.
• Avoid if allergic or hypersensitive to modified citrus pectin. MCP may cause gastrointestinal discomfort in patients allergic or sensitive to MCP. Use cautiously if taking chelating medications or if under treatment for cancer. Use cautiously if taking oral drugs, herbs, or supplements as MCP may reduce or slow their absorption. Use cautiously in geriatric patients or patients with gastrointestinal disorders.
• Muira puama : Muira puama (Ptychopetalum olacoides) has long been used by Brazilian native people as a treatment for impotence (erectile dysfunction). Relaxation of the corpus cavernosum can be related to penile erection. Preliminary case series suggest usefulness. Well-designed human trials of muira puama, as well as safety data, are necessary.
• PC-SPES : Studies of PC-SPES® have reported improvements in patients with prostate cancer. Overall, these studies found prostate-specificantigen (PSA) levels to fall by greater than 50% in most patients, improvements in bone scans and x-rays, reductions in pain scores, and improvements in quality of life. In addition, PC-SPES® extracts were reported to cause cell death (apoptosis) or to slow the growth of cancer cell lines. Because of these complicated circumstances, and the fact that PC-SPES® has never been compared to placebo or standard cancer treatments in a well-reported study, the question of effectiveness remains unclear.
• Physical therapy : The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Currently, it is unclear if physical therapy is beneficial for patients with chronic prostatitis.
• Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported.
• Pomegranate : Pomegranate juice has received publicity for being possibly helpful for prostate cancer. In laboratory study, flavonoid compounds from pomegranate fruit have been shown to have anticancer activity against prostate cancer cells. The scientific evidence is limited in this area, and further research is necessary before a clear conclusion can be drawn. Pomegranate juice has also been studied in the treatment of mild to moderate erectile dysfunction. Early study is unclear, and therefore more studies are needed.
• Avoid if allergic to pomegranate. Avoid with diarrhea or high or low blood pressure. Avoid taking pomegranate fruit husk with oil or fats to treat parasites. Pomegranate root or stem bark should only be used under the supervision of a qualified healthcare professional. Use cautiously with liver damage or disease.
• Psychotherapy : Individual, couples, or group psychotherapy may be helpful for men with erectile dysfunction. However, prescription medication may be needed to alleviate symptoms.
• Psychotherapy cannot always fix mental or emotional conditions. Psychiatric drugs are sometimes needed. In some cases symptoms may worsen if the proper medication is not taken. Not all therapists are qualified to work with all problems. Use cautiously with serious mental illness or some medical conditions because some forms of psychotherapy may stir up strong emotional feelings and expression.
• Pycnogenol® : Pycnogenol® is the patented trade name for a water extract of the bark of the French maritime pine (Pinus pinaster spp. atlantica), which is grown in coastal southwest France. Pycnogenol® has shown a protective effect on blood vessels. Pycnogenol®, in combination with L-arginine, may cause an improvement in sexual function in men with ED. It is not known what effect each of the individual compounds may have directly on this condition. Further research is needed. Caution is advised when taking Pycnogenol®, as it may increase the chances of bleeding in sensitive individuals, such as those taking blood thinning drugs such as warfarin (Coumadin®).
• Quercetin : There is some evidence that quercetin, a bioflavonoid and antioxidant, may be useful for the treatment of chronic prostatitis (inflammation of the prostate). Further research is needed to confirm these results. Quercetin is reported safe in recommended dosages.
• Quercetin is generally considered safe when taken at doses normally found in foods. Avoid if allergic to quercetin. Possible eye, skin, gastrointestinal, or respiratory tract infection can occur.
• Red clover : Red clover is a legume that has plant-based chemicals that are similar to estrogen. Red clover isoflavones may have estrogen-like properties in the body, and have been proposed as a possible therapy in prostate cancer. Well designed human research is lacking in this area. There is also only limited study of red clover for benign prostatic hypertrophy. More research is needed before a firm conclusion can be made.
• Avoid if allergic to red clover or other isoflavones. Use cautiously if taking hormone replacement therapy (HRT). Use cautiously with a history of a bleeding disorder or if taking drugs that thin the blood.
• Saw palmetto : There is not enough scientific evidence to recommend the product PC-SPES® (which contains saw palmetto) for prostate cancer. PC-SPES® also contains seven other herbs (Chrysanthemum morifolium, Isatis indigotica, Glycyrrhiza glabra, Ganoderma lucidum, Panax pseudo-ginseng, Rabdosia rubescens, and Scutellaria baicalensis). It has been a popular treatment for prostate cancer, but the U.S. Food and Drug Administration (FDA) has issued a warning not to use PC-SPES® because it contains the anticoagulant chemical warfarin and may cause bleeding.
• A prospective, randomized, open label, one-year study was designed to assess the safety and efficacy of saw palmetto and finasteride in the treatment of men diagnosed with category III prostatitis/chronic pelvic pain (CP/CPPS). CP/CPPS treated with saw palmetto had no appreciable long-term improvement. In contrast, patients treated with finasteride had significant and durable improvement in multiple parameters except for voiding.
• Avoid if allergic or hypersensitive to saw palmetto. Use cautiously with a history of health conditions involving the stomach, liver, heart, or lungs; hormone-sensitive conditions; or bleeding disorders. Use cautiously with drugs that thin the blood or hormonal drugs.
• Soy : Early research has examined the effects of dietary soy intake on prostate cancer development in humans, but results have been inconclusive. Better study is needed before a recommendation can be made.
• Avoid if allergic to soy. Breathing problems or rash may occur in sensitive people. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is not known if soy or soy isoflavones share the same side effects as estrogens, such as increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian, or uterine cancer. Other hormone-sensitive conditions such as endometriosis may also be worsened. Patients taking blood-thinning drugs such as warfarin should check with a doctor and pharmacist before taking soy supplementation.
• Stinging nettle : Stinging nettle is used rather frequently in Europe in the treatment of symptoms associated with benign prostatic hyperplasia (enlarged prostate). Early evidence suggests an improvement in symptoms, such as the alleviation of lower urinary tract symptoms associated with stage I or II BPH, as a result of nettle therapy. Additional study is warranted in this area.
• Avoid if allergic or hypersensitive to nettle, members of the Urticaceae family, or any ingredient of nettle products. Use cautiously with diabetes, bleeding disorders, or low sodium levels in the blood. Use cautiously if taking diuretics or anti-inflammatory drugs. The elderly should also use nettle cautiously.
• Vitamin C (ascorbic acid) : Vitamin C (ascorbic acid) is a water-soluble vitamin that the body needs to form collagen in bones, cartilage, muscle, and blood vessels. It also aids in the absorption of iron. Vitamin C has been used in prostate cancer patients, but there is currently a lack of sufficient evidence to determine its effect in this disease.
• Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis, gout, or a bleeding disorder called paroxysmal nocturnal hemoglobinuria.
• Vitamin E : The role of vitamin E supplementation in the prevention of prostate cancer is controversial. There are numerous laboratory studies that suggest possible anticancer properties. However, the results of population research and human research have been mixed, with some studies reporting benefits and others finding no effects. Vitamin E succinate (one specific form of vitamin E) has been reported in laboratory studies to inhibit the growth of human prostate cancer cells.
• Avoid if allergic to vitamin E. For short periods of time, and in the recommended doses, vitamin E supplementation is generally considered safe. Avoid doses higher than 1,000 milligrams a day. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders.
• Yoga : Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. There is early evidence to support the use of yoga in the treatment of delayed ejaculation in males. Larger well designed and controlled trials are needed to further assess the effects of yoga for sexual health.
• Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, cervical spondylitis, or if at risk for blood clots. Certain yoga breathing techniques should be avoided with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
• Yohimbe bark extract : Yohimbine hydrochloride is a prescription drug that has been shown in multiple human trials to effectively treat erectile dysfunction. Yohimbine hydrochloride has also been suggested to treat sexual side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants. However, although yohimbine is present in yohimbe bark extract, levels are variable and often very low. More study is needed before a conclusion can be made.
• Yohimbine is generally well tolerated in recommended doses. However, many side effects have been reported with yohimbine hydrochloride and may apply to yohimbe bark. Avoid if allergic to yohimbe, any of its components, or yohimbine-containing products. Use cautiously with peptic ulcer disease, kidney disease, high blood pressure, heart disease or if taking drugs that affect blood sugar levels. Avoid with benign prostate hypertrophy (enlarged prostate), anxiety, mania, depression, stress disorders, post-traumatic stress disorders, bipolar disorders, or schizophrenia. Avoid use in children or if pregnant or breastfeeding.
• Zinc : Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Early studies suggest that zinc supplements taken with antibiotics may be more effective than antibiotics alone in reducing pain, urinary symptoms, quality of life, and maximum urethra closure pressure for patients with chronic prostatitis. Further research is needed to confirm these results.
• Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease.

D Fair negative scientific evidence

• Deer velvet : Deer velvet, also referred to as antler velvet, refers to antlers that have been removed in the growth stage when they are covered in soft velvet-like hair. In both traditional and popular use, deer velvet has a reputation as an aphrodisiac that may improve sexual energy by potentially strengthening and balancing the body and restoring overall energy. However, early research suggests that deer velvet is not effective for this condition.
• Vitamin D : Although there was preliminary evidence based on laboratory and limited human studies that high-dose vitamin D was possibly beneficial in the treatment of metastatic prostate cancer, a large study reported that patients taking high-dose calcitriol along with chemotherapy did worse than patients taking chemotherapy alone. Therefore, this treatment should be discouraged.