Is Yohimbe safe and effective for treating sexual dysfunction or weight loss?

Yohimbe for Sexual Dysfunction and Weight Loss

Yohimbe is not recommended for the treatment of erectile dysfunction or weight loss due to lack of proven efficacy and potentially serious cardiovascular and neurological side effects. 1, 2

Guideline-Based Recommendation

The American Urological Association explicitly states that yohimbine should not be used for erectile dysfunction treatment, based on insufficient evidence of efficacy and concerning safety profile. 1 This recommendation supersedes historical use of the compound, which was grandfathered by the FDA in 1976 without controlled trials demonstrating efficacy. 1

Safety Concerns

Cardiovascular Risks

• Yohimbine causes elevations in both systolic and diastolic blood pressure and increases heart rate (tachycardia). 1, 2
• These effects are particularly dangerous in patients with pre-existing cardiovascular conditions. 2
• A documented case report from 2022 describes intracranial hemorrhage following a single dose of yohimbine in a patient taking clonidine, resulting in persistent neurological deficits requiring rehabilitation. 3

Neurological and Psychiatric Effects

• Irritability, increased motor activity, and tremors are common side effects. 1, 2
• Anxiety and a "wound-up feeling" have been reported in clinical use. 4
• The compound can cause excessive sweating and increased urinary frequency. 4, 5

Drug Interactions

• Chronic clonidine use down-regulates alpha-2 receptors, potentially potentiating yohimbine's dangerous effects. 3
• Concurrent use with norepinephrine reuptake inhibitors (bupropion, desvenlafaxine) can worsen sympathomimetic responses. 3

Efficacy Evidence

For Erectile Dysfunction

• Only one small study has used acceptable efficacy outcome measures, making conclusions about effectiveness impossible. 1
• A 1998 study of high-dose yohimbine (100 mg daily) in 22 men with organic erectile dysfunction showed no significant difference compared to placebo. 6
• While some reviews suggest "modest efficacy" over placebo, particularly in psychogenic erectile dysfunction, the evidence base is weak and consists of poorly designed trials. 5, 7
• The enhanced libido effect observed in rats has never been confirmed in humans. 1

For Weight Loss

• No evidence was identified supporting yohimbine's use for weight loss in the provided literature.

Perioperative Considerations

Yohimbine should be discontinued at least 2 weeks before surgery due to its blood pressure effects. 2

Supplement Quality Issues

A critical caveat: the FDA does not strictly regulate dietary supplements containing yohimbine. 3 Studies have demonstrated:

• Variation in actual ingredient content versus labeled quantities 3
• Contamination of some herbal products with therapeutic levels of PDE5 inhibitors 1
• Inconsistent product potency both within and between brands 1

Clinical Bottom Line

Given the lack of proven efficacy, potentially serious cardiovascular and neurological adverse effects, dangerous drug interactions, and unreliable supplement quality, yohimbine should not be prescribed or recommended for any indication in clinical practice. 1, 2 For erectile dysfunction, evidence-based alternatives including PDE5 inhibitors should be used instead. 1