Avoiding common pitfalls of men’s supplement use

At least one-third of Australian men use dietary supplements. The promise of a fast, effective and discrete solution for minor health concerns, or more serious problems that they may be too embarrassed to talk about, is understandably attractive. But men need help to understand the importance of an accurate diagnosis and adherence to proven therapies, the risk of drug interactions, and how to choose complementary treatments wisely.

The potential for harm from the use of supplements and complementary medicines is highlighted by two recent safety warnings.

The Victorian Department of Health and Aged Care recently issued a warning about Penisol, a product promoted as an Ayurvedic medicine and claimed to improve erectile dysfunction, increase libido and enhance sexual function. The warning was issued after a user was found to have a high blood level and subsequent testing showed the product contained more than 1000-times the level of lead that is acceptable by the Therapeutic Goods Administration (TGA).

Penisol is not listed or registered as a complementary medicine by the TGA but it is possible to purchase it online and import it from overseas. As an unlisted complementary medicine, Penisol does not have an AUST L or AUST R number. This is something people should look for when purchasing complementary medicines as assurance that the product is registered with the TGA.

TGA registration is not a guarantee of product quality or safety though. An examination of herbal products sold globally showed that 79% of a selection of products available in Australia (at least some of which were listed by the TGA) were adulterated. Another investigation revealed contamination of more than half of a selection of Chinese medicines available in Australia. The list of contaminants was extensive:

• Poisons (brucine, strychnine

• Heavy metals (arsenic, lead, cadmium)

• Pharmaceuticals (analgesics, anticoagulants, antihistamines, anti-inflammatories, stimulants, anantibiotic, a phosphodiesterase type 5 (PDE5) inhibitor)

• Animal products (leopard, viper, frog,cow, goat, sheep, rat, cat, dog)

The general belief that dietary supplements and other complementary medicines are safe because they are ‘natural substances’ is sometimes inaccurate.

The Food and Drug Administration (FDA) in the United States includes approximately 20 honey products on its list of tainted sexual enhancement products. The list of over 350 products “includes only a small fraction of the potentially dangerous products marketed to consumers online and in stores”. All the listed honey products contain the phosphodiesterase type-5 (PDE5) inhibitors Taladafil, Sildenafil or both.

Honey has a long history as a human food and medicine but its ability to enhance male sexual performance is not proven (although it might have some potential). Spiking it with a PDE5 inhibitor would certainly increase its likelihood of living up to the products’ claims.

Contamination of a normally safe and natural product like honey, with PDE5 inhibitors, presents the dangerous prospect of interaction with nitrates for those who take them. The contamination may also endanger people with various cardiovascular problems, for whom PDE5 inhibitors are contraindicated.

It’s not just contamination of supplements or complementary medicines that poses a health risk. The use of off-the-shelf products, that are readily available without consultation of a health professional, circumvents investigation and diagnosis of a potential underlying health problem. For men with erectile dysfunction, buying honey over the internet might mean that underlying cardiovascular disease is missed. Given that erectile dysfunction is predictive of adverse cardiovascular events like heart attack and stroke, anyone who has problems getting or maintaining an erection should talk to their doctor about it.

Another potential problem with the use of supplements is that ineffective products may be chosen in place of treatments with proven efficacy. This may not only prolong the duration of an ailment but might lead to worsening of the underlying disease.

It’s not only people taking supplements to treat health problems who need to be cautious. The global wellness industry is growing at a rate of around 10% as people embrace fitness, veganism and wellness tourism. Protein powders account for a large proportion of the sports nutrition market, which is growing at a rate of 8.5% and was valued at over US$40 billion in 2021. Of a selection of 112 protein powders available (either over the counter or online) in Australia, six of them (5%) were contaminated by androgens, placing users at risk of infertility and other adverse health consequences.

Pharmacists appreciate the importance of their role in helping people select effective and safe products. Their responsibility to cater to their customer’s choice, provide evidence-based advice, and prevent harm from the products sold in pharmacies is a challenging one, just in practical terms, The potential for ethical conflict complicates this issue further.

“THE GLOBAL WELLNESS INDUSTRY IS GROWING AT A RATE OF AROUND 10% AS PEOPLE EMBRACE FITNESS, VEGANISM AND WELLNESS TOURISM.”

Of course, online purchases of supplements circumvent the regulatory provisions and expert advice that is offered in pharmacies. Men need to understand the risks of supplements and know of the guidance and reassurance that can be provided if they discuss their supplement use with health professionals. The growing use of supplements and other wellness products, and the numerous cases of dangerous contamination of supplements used by men, makes education of health professionals and the public more important than ever.