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March 26, 1999
Web posted at: 11:22 a.m. EST (1622 GMT)

ATLANTA (CNN) -- Researchers say half of all men over the age of 40 develop some problem with erections. The popular drug Viagra, which celebrates the first anniversary of its FDA approval Saturday, has helped many. But dozens of dietary and herbal competitors have hit the market in the past year, leaving consumers wondering: Do they work?

Many natural impotence remedies contain yohimbe, others are made with ginseng or ginkgo biloba. All are herbs that for years natural healers have recommended to fight impotence.

Urologist Irwin Goldstein, of Boston University School of Medicine, advised consumers not to get their hopes up over these herbal remedies.

"Have low expectations is the best I can say," Goldstein said. "Have low expectations because there is no data."

Even herbalist James Duke is critical of some natural remedies for impotence. In his book, "The Green Pharmacy," Duke called ginseng "overrated" as an aphrodisiac and pointed out yohimbe's side effects of anxiety, increased heart rate and hallucinations.

Viagra, made by Pfizer Inc., comes with some risks and also can cause side effects. Some users have experienced vision problems or headaches. These drawbacks may be helping drive the search for an herbal alternative.

One of the latest herbal impotence remedies is an amino acid called l-arginine, or arginine. It is supposed to work by enhancing the circulation.

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"Since the main problem in impotence is actually a problem with circulation of the blood vessels in the penis, l-arginine holds great promise for men with physical impotence," according to Dr. Wooden Merrell of Beth Israel Medical Center in New York.

But Merrell conceded no large clinical studies have proven arginine is effective against impotence. That coupled with the fact that erectile dysfunction can result from serious medical conditions has urologists concerned.

"Impotence can be managed," Goldstein said. He suggested it was important to determine the cause of the problem when developing a treatment. "Let's say if it's a diabetic problem, with control of blood sugar, if it's related to hypertensive medications to changing those medicines, if there's depression to treatment of depression," Goldstein said.