The 'elephant root trick' refers to Butea superba, a traditional Thai herbal remedy increasingly marketed online as a natural treatment for erectile dysfunction. Whilst this climbing vine has been used in Southeast Asian traditional medicine for centuries, it lacks robust clinical evidence and is not licensed as a medicine in the UK. Products containing Butea superba are sold as food supplements, subject to minimal regulation, and the MHRA has repeatedly warned about unlicensed ED products containing undeclared pharmaceutical ingredients. Before considering any herbal remedy, it is essential to understand the limited evidence, potential risks, and the availability of proven NHS treatments. If you are experiencing erectile dysfunction, consult your GP for proper assessment and access to safe, evidence-based therapies.

What Is the Elephant Root Trick for Erectile Dysfunction?

The so-called 'elephant root trick' refers to the use of Butea superba, a traditional herbal remedy originating from Thailand and other parts of Southeast Asia. This climbing vine, also known as red kwao krua, has been used in traditional medicine for centuries, purportedly to enhance male sexual function and treat erectile dysfunction (ED).

In recent years, Butea superba has gained attention through online marketing and social media, often promoted as a 'natural' alternative to pharmaceutical treatments for ED. These claims typically suggest that the herb can improve erectile function, increase libido, and enhance sexual performance without the side effects associated with conventional medications. However, it is important to distinguish between traditional use and scientifically validated treatments.

The term 'trick' is misleading, as it implies a simple, quick solution to what is often a complex medical condition with multiple underlying causes. Erectile dysfunction can result from cardiovascular disease, diabetes, hormonal imbalances, psychological factors, or medication side effects. Whilst herbal remedies may appeal to those seeking alternatives to prescription medications, they are not regulated to the same standards as licensed medicines in the UK.

Butea superba has no marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA) and is not registered under the Traditional Herbal Registration (THR) scheme. Products containing Butea superba are typically sold as food supplements, which are not assessed for efficacy and are subject to far less stringent regulation than licensed medicines. The MHRA has issued repeated warnings about unlicensed 'herbal' erectile dysfunction products sold online, many of which have been found to contain undeclared pharmaceutical ingredients, including PDE5 inhibitors, posing serious health risks.

Before considering any herbal supplement for ED, it is essential to understand the limited evidence base, potential risks, and the availability of proven, NHS-approved treatments. Self-treatment without proper medical assessment may delay diagnosis of serious underlying conditions and expose individuals to unregulated products of uncertain quality and safety. If you are experiencing erectile dysfunction, consult your GP for a proper assessment and access to evidence-based treatments.

How Does Elephant Root (Butea Superba) Work?

Butea superba contains various bioactive compounds, including flavonoids and plant sterols. Proponents claim these may influence sexual function, but the mechanisms remain poorly understood and are not supported by robust human evidence.

Some animal studies have investigated the effects of Butea superba extracts on testosterone levels and erectile tissue, with preliminary findings suggesting possible effects in rodent models. Proposed mechanisms include potential effects on androgen pathways and nitric oxide production—the latter being relevant to blood flow to the penis, a key physiological requirement for achieving and maintaining an erection. However, these remain unproven hypotheses based on limited preclinical data.

The translation of animal study findings to human physiology is not straightforward. The doses used in animal research often far exceed what would be considered safe or practical in humans, and the metabolic processing of herbal compounds can differ significantly between species. Furthermore, the quality and concentration of active ingredients in commercially available Butea superba products can vary considerably, as herbal supplements are not subject to the same rigorous manufacturing standards as licensed medicines.

Unlike pharmaceutical treatments for ED—such as PDE5 inhibitors (sildenafil, tadalafil), which have well-characterised pharmacological profiles, established efficacy, and predictable effects—herbal remedies typically contain multiple compounds with potentially complex and variable interactions. This lack of standardisation makes it difficult to predict efficacy or safety on an individual basis. There is no evidence that Butea superba works in the same way as, or is equivalent to, licensed ED medicines.

Clinical Evidence and Safety Concerns

The clinical evidence supporting Butea superba for erectile dysfunction remains limited and of poor quality. Whilst a small number of human studies have been conducted, most suffer from methodological limitations including small sample sizes, lack of proper control groups, and short follow-up periods. These findings have not been consistently replicated in larger, well-designed trials, and no robust evidence supports its use for ED.

Crucially, Butea superba is not licensed as a medicine by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK, nor has it received marketing authorisation from the European Medicines Agency (EMA). This means it has not undergone the rigorous safety and efficacy testing required for approved medications. Products containing Butea superba are typically sold as food supplements, which are subject to far less stringent regulation.

Safety concerns associated with Butea superba and similar unregulated ED products include:

• Adulteration with undeclared pharmaceutical ingredients: The MHRA has repeatedly identified 'herbal' or 'natural' ED products sold online that contain undeclared PDE5 inhibitors (such as sildenafil analogues). These pose serious risks, particularly for men taking nitrates, nicorandil, or riociguat, where the combination can cause dangerous drops in blood pressure

• Product quality and contamination: Unregulated supplements may contain contaminants, incorrect doses, or inconsistent amounts of active compounds

• Drug interactions: Herbal products may interact unpredictably with prescribed medications, including anticoagulants and antihypertensives

• Lack of long-term safety data: The effects of prolonged use have not been adequately studied

• Cardiovascular risks: Any substance affecting blood flow may have cardiovascular implications, particularly in men with pre-existing heart conditions

There have been reports of adverse effects including dizziness, headache, and gastrointestinal disturbances with herbal ED products. Anyone considering herbal remedies for ED should consult their GP or a qualified healthcare professional first. If you experience a suspected side effect from any medicine or supplement, report it via the MHRA Yellow Card scheme at https://yellowcard.mhra.gov.uk/.

NHS-Approved Treatments for Erectile Dysfunction

The NHS offers several evidence-based treatments for erectile dysfunction, all of which have undergone extensive clinical testing and regulatory approval. The first-line pharmacological treatment typically involves PDE5 inhibitors, which include sildenafil, tadalafil, vardenafil, and avanafil. These medications work by enhancing the natural erectile response to sexual stimulation through inhibition of the enzyme phosphodiesterase type 5, thereby promoting smooth muscle relaxation and increased blood flow to the penis.

According to NICE guidance, PDE5 inhibitors are effective for many men with ED and have well-established safety profiles when used appropriately. Generic sildenafil is widely available on NHS prescription for men with ED, particularly when the condition causes significant distress or is associated with underlying health conditions such as diabetes, cardiovascular disease, or following prostate surgery. Other PDE5 inhibitors may be subject to prescribing restrictions. Sildenafil 50 mg (Viagra Connect) is also available from pharmacies without prescription following assessment by a pharmacist.

Important safety information for PDE5 inhibitors:

• Contraindications: Do not use if you take nitrates (e.g., GTN spray or tablets for angina), nicorandil, or riociguat, as the combination can cause a dangerous drop in blood pressure

• Cautions: Use with care if you take alpha-blockers for prostate problems or high blood pressure; your doctor may need to adjust doses or timing

• Cardiovascular assessment: Your GP will assess whether you are fit for sexual activity, particularly if you have heart disease

• Common side effects: Headache, flushing, indigestion, nasal congestion, and visual disturbances

For detailed safety information, consult the patient information leaflet or the Summary of Product Characteristics (SmPC) available via the electronic medicines compendium (emc) or the British National Formulary (BNF).

For men who cannot use or do not respond to oral medications, alternative treatments include:

• Vacuum erection devices: Mechanical pumps that draw blood into the penis, with a constriction ring maintaining the erection

• Intracavernosal injections: Self-administered injections of alprostadil directly into the penis

• Intraurethral therapy: Alprostadil pellets inserted into the urethra

• Penile implants: Surgical options for men with refractory ED

Beyond pharmacological interventions, addressing underlying causes and lifestyle factors is essential. NICE recommends that management of ED should include assessment and optimisation of cardiovascular risk factors, diabetes control, and review of medications that may contribute to erectile problems. Psychological interventions, including cognitive behavioural therapy or psychosexual counselling, may be appropriate when psychological factors are significant.

Lifestyle modifications that can improve erectile function include smoking cessation, reducing alcohol consumption, increasing physical activity, achieving a healthy weight, and managing stress. These interventions address the underlying vascular and metabolic factors that commonly contribute to ED and offer broader health benefits beyond sexual function.

When to Seek Medical Advice for ED

Erectile dysfunction should not be dismissed as simply a normal part of ageing or an inevitable consequence of stress. It can be an early warning sign of serious underlying health conditions, particularly cardiovascular disease. Men experiencing persistent or recurrent difficulties achieving or maintaining erections sufficient for satisfactory sexual activity (typically for three months or more) should consult their GP for proper assessment.

You should seek medical advice if:

• Erectile difficulties persist for more than a few weeks or are worsening

• ED is causing significant distress or affecting your relationship

• You have other symptoms such as reduced libido, fatigue, or mood changes (which may suggest hormonal problems)

• You have cardiovascular risk factors including high blood pressure, high cholesterol, diabetes, or a history of heart disease

• You experience chest pain, dizziness, or other concerning symptoms during sexual activity

• ED developed after starting a new medication

• You have symptoms of depression or anxiety

Seek emergency medical help immediately if:

• You have an erection lasting more than four hours (priapism)—this is a medical emergency requiring urgent treatment to prevent permanent damage

• You experience severe penile pain or sudden deformity

Your GP will typically conduct a thorough assessment including medical history, physical examination, and relevant investigations. Blood tests may be arranged to check for diabetes (HbA1c or fasting glucose), lipid abnormalities, and testosterone levels (usually measured in the morning; if low, repeat testing and pituitary hormone assessment may be needed). This assessment serves the dual purpose of identifying treatable causes of ED and screening for cardiovascular disease, as erectile dysfunction often precedes coronary events by several years due to the smaller diameter of penile arteries.

Your GP may refer you to a specialist if first-line treatments are unsuccessful, if there is suspected underlying endocrine or cardiovascular disease requiring further investigation, or if you have conditions such as Peyronie's disease.

It is particularly important to avoid self-treatment with unregulated products purchased online, as these may contain undeclared pharmaceutical ingredients, contaminants, or incorrect doses of active substances. Counterfeit or unlicensed ED medications pose serious health risks and have been associated with adverse events. The MHRA regularly issues warnings about such products. For advice on buying medicines safely online, visit the NHS website or MHRA guidance.

Remember that discussing sexual health concerns with your doctor is a routine part of medical practice. GPs are experienced in managing ED sensitively and confidentially, and effective, safe treatments are available through the NHS. Early consultation allows for proper diagnosis, treatment of underlying conditions, and access to evidence-based therapies that can significantly improve quality of life.

For further information, visit the NHS page on erection problems (impotence) or consult NICE Clinical Knowledge Summaries on erectile dysfunction.

Frequently Asked Questions