More Than Mojo: 'Natural' Sex Pills May Contain Viagra Or Worse

The patient was not complaining, by any means. He'd just started a new "natural" sex enhancement supplement, and he reported that it was working terrifically.

But Dr. Pieter Cohen's astute resident at the Somerville Hospital primary care clinic, Dr. Rachael Bedard, had her suspicions, and she brought the patient to his attention. Dr. Cohen, a general internist at Cambridge Health Alliance and a frequent medical mythbuster, sent the pill out to be tested.

"The lab not only found Viagra in it," he recalled. "They also found Cialis, another erectile dysfunction drug, as well as a brand new designer drug, as well as caffeine." So in all, "You've got two prescription drugs that we would never prescribe together, a brand new drug, and caffeine, all in one pill. And that's what our patient was consuming when he thought he was taking a natural sex enhancer." In fact, the supplement, Sex Plus, was "chock full of pharmaceuticals that had nothing to do with nature."

Dr. Bedard sent the findings to the FDA, which did its own testing and ended up issuing this alert late last month. And Dr. Cohen has just co-authored a paper in the Journal of the American Medical Association Internal Medicine — "Adulterated Sexual Enhancement Supplements," subtitled "More Than Mojo" — spreading the word that sex-enhancement supplements advertised as natural may in fact be nothing of the kind. And they may contain brand new designer erectile-dysfunction drugs whose potential dangers are anyone's guess.

His bottom line: "If you want a natural sex enhancer, talk to your doctor about prescription 'yohimbe,' but it may have side effects and it's not very effective. Still, if you want to avoid Viagra, that's the way to go. When it comes to any supplement sold for sexual enhancement, it should be avoided because it's either going to be useless or potentially harmful."

What might be the danger of, say, the drug that Somerville patient was taking?

Viagra is very safe, Dr. Cohen said, "but it's important to know that you're taking it so you can avoid common medications used for heart disease that can cause dangerous drops in blood pressure." Even more alarming, he said, the supplement the patient was taking contained "an entirely new compound, and we have no idea what the potential side effects might be, because it affects the body in ways that are completely unstudied. So that's what I'm most concerned about — an outbreak of a completely novel side effect from these new drugs, and how hard it's going to be for doctors to identify what the culprit is."

If a patient is taking a sex supplement and his blood pressure suddenly drops, the doctor will likely quickly figure out that the supplement must have Viagra in it, he said. "But imagine a situation in which people are getting a particular illness that would never suggest to a doctor that it's from a prescription, so you wouldn't even ask about it and it wouldn't come up."

Just a word of background. I've long had a general "buyer beware" impression that the tens of thousands of substances sold as supplements are surprisingly unregulated compared to pharmaceuticals, but I asked Dr. Cohen to explain how it could be that cocktails like Sex Plus could be freely sold to unsuspecting buyers.

"Basically, when it comes to supplements, everything is assumed to be safe until the FDA proves otherwise," he said. "And not only is everything assumed to be safe, it can be sold to do just about anything as long as it's not sold to 'treat' or 'cure' disease. So this means countless supplements are out there, presumed safe, telling us that they can treat anything under the sun, and the FDA is in the position of needing to remove the most dangerous supplements but can't even get to a small fraction of them."

So, I asked, they can't claim to treat or cure but they can claim anything else? Quite a loophole...

"To call it a loophole would be a gross understatement," he said. "It's more like swiss cheese. In the law, it's called the 'structure/function' claim, and what that means is that if you're saying this improves a function — improves your sexual function — that's perfectly fine, whereas if you said, 'This treats erectile dysfunction,' using the medical words and 'treats,' that would be illegal. So that creates a huge market and expectations that natural products can improve our sex lives, in the case of these types of products, which they can't."

Well, I pointed out, they can if they contain Viagra analogues — not that that's a good thing.

Recent analyses have found not just Viagra-like drugs, Dr. Cohen said. They've also found drugs that have nothing to do with sexual health, such as diabetes drugs and painkillers. And most worrisome of all, he said, "We have over 45 different, entirely brand new chemicals being introduced here, where the consumer is the human guinea pig and we don't even have early clinical trial data to know if it's safe."

Dr. Cohen's full paper, co-authored with Dr. Bastiaan Venhuis, a leading European expert on spiked supplements, is here.