En español | If you watch TV or read magazines, you could easily conclude that men seeking treatment for erectile dysfunction (ED) have but one option: pills. The three dominant brands — Cialis, Levitra and Viagra — are locked in an expensive battle for men’s allegiances, and have, through their suggestive advertising, triggered both satire and controversy in the 14 years since the Food and Drug Administration approved Viagra. See also: Keep track of your health records — easily. But steamy commercials aside, what if the pills don’t work for you, as is the case in 25 to 30 percent of men with ED, or they stop working after a few years — a common problem for men whose ED is caused by an underlying cardiovascular condition? “A lot of patients think that pills will give them complete restoration,” says Ajay Nehra, M. D., a urology professor at the Mayo Clinic College of Medicine in Rochester, Minn. But many patients instead find that even if they take the pills, they are “not the same” sexually as they were before the onset of their ED, he says. metoprolol er 50 You’ve seen those erectile-dysfunction drug ads on TV and online—even former Bears coach Mike Ditka barks at you to “get back in the game” in a Levitra commercial. Erection issues are plenty common, even in guys who aren’t as old as the famous Viagra pitchman, former senator Bob Dole. Seven percent of 18- to 29-year-old men and 9 percent of 30- to 39-year-olds are unable to achieve orgasm, according to a study in the . The class of drugs that Levitra, Viagra, Stendra, and Cialis belong to are called PDE5 inhibitors. They work by relaxing tight blood vessels, allowing more blood to surge into the penis and cause an erection, says Gregory Bales, M. D., an associate professor of urology at the University of Chicago. The little pills do the trick for more than two-thirds of men with erectile dysfunction (ED). 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Alternative or complementary treatments might include such things as nutritional supplements, herbal remedies, acupuncture, and talk therapy. Many of these haven’t been studied as significantly as other medications for effectiveness, and some, like nutritional supplements, can have side effects based on their ingredients. So if you’re considering an alternative form of treatment for ED, talk to your doctor before getting started. There are several supplements that have been shown to help increase blood flow and therefore may help with ED in some cases. A study showed that when these two supplements were used together, men had a significant improvement in sexual function without any side effects. According to a 10-year study of more than 25,000 men, those who ate a diet high in flavonoid-rich foods were less likely to have ED. Whether that means flavonoid supplements can help with ED still needs to be studied. There seems to be a link between severe zinc deficiency and men who have low testosterone. When you’re living with erectile dysfunction (ED), you’ll consider doing just about anything to get your sex life back on track. “There is a huge placebo effect with erectile dysfunction,” he says. Even becoming a human pin-cushion for a treatment like acupuncture -- bring it on. Eric Laborde, MD, a spokesman for the American Urological Association, is skeptical. “I could give you anything and tell you it’ll work and it will in the short term.” For that reason, he says, what little studies that have been done on herbal remedies are less than convincing. On the other hand, Geo Espinosa, director of the Integrative Urological Center at NYU Langone Medical Center, says there are some natural alternatives to popular ED medicines. Take them with your doctor’s OK, and they can help you get and keep an erection. “It’s not like you go into the forest and just eat a leaf,” he says. 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