Ginkgo Biloba
Ginkgo biloba Extract (EGb 761) for Sexual Dysfunction
Evidence grade 2 of 5, Thin. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- Not FDA approved; prescription drug in parts of Europe, supplement in the US
Reference only. Not medical advice.
What can go wrong
The principal risk is bleeding: ginkgo inhibits platelet-activating factor and has been associated with spontaneous and surgical hemorrhage, especially combined with aspirin, NSAIDs, or anticoagulants. It should be stopped before surgery. Rare seizures have been linked to ginkgotoxin in seeds (not standardized leaf extract). Mild GI upset and headache occur.
This is something to take to a clinician. The Atlas can tell you what is known about ginkgo biloba in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
Ginkgo biloba extract is standardized to flavone glycosides and terpene lactones and is marketed for circulation, cognition, and, in men's health, for antidepressant-induced sexual dysfunction. The excitement traces to Cohen & Bartlik's 1998 open-label report claiming ~84% improvement in SSRI-related sexual dysfunction. Subsequent double-blind, placebo-controlled trials (Kang 2002; Wheatley 2004) found no significant benefit over placebo, a textbook case of an open-label signal collapsing under rigorous control. Ginkgo's antiplatelet activity is its most clinically relevant real effect and its main safety concern.
A promising open-label report on SSRI sexual side effects that placebo-controlled trials erased.
What people take it for
These are the reasons people give for taking it. They are not effects it has been shown to have.
How it is supposed to work
Ginkgo constituents promote vasodilation partly via nitric-oxide pathways and inhibit platelet-activating factor, which is the rationale for a circulation-based erectile claim. Antioxidant activity is also invoked. However, these mechanisms have not produced reproducible clinical benefit for sexual function in controlled trials.
The open-label trap
Sexual function is highly placebo-responsive, and the original ginkgo enthusiasm came from an uncontrolled study where expectation and regression to the mean can masquerade as drug effect. When Kang (2002) and Wheatley (2004) added a placebo arm, both ginkgo and placebo improved similarly, meaning the botanical added nothing attributable to itself. A 2021 systematic review concluded ginkgo has no effect on antidepressant-users' sexual function.
What people get wrong
Often saidGinkgo reverses SSRI sexual side effects
ActuallyThe 84% figure came from an open-label study; controlled trials found no benefit over placebo.
Often saidIt is a harmless herb
ActuallyIts antiplatelet effect is real and can raise bleeding risk, particularly with blood thinners or before surgery.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
Set against the alternatives
For antidepressant-induced sexual dysfunction, evidence-based options include dose adjustment, switching agents (e.g., bupropion), or adding a PDE5 inhibitor for men, all better supported than ginkgo.
What we do not know
- Is there any responder subgroup, or is the sexual-function effect simply placebo?
- Does ginkgo add anything to PDE5 therapy?
The market for this
What follows describes how this is bought and sold. It is not a buying guide and it is not an endorsement of any seller.
Quality hinges on using a genuine standardized leaf extract (EGb 761-type) rather than crude leaf powder; adulteration with added rutin/quercetin to hit flavonoid specs and low genuine ginkgolide content are documented issues in commodity ginkgo.
At a glance
- Standardized extract
- EGb 761 (24% flavone glycosides, 6% terpenes)
- Origin story
- Cohen & Bartlik 1998 open-label ~84% response
- Reality check
- Kang 2002, Wheatley 2004 placebo-controlled: no benefit
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Ginkgo Biloba. A short entry is not a safe entry.
- Timeline. We have not built the dated record of research and regulatory events.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- Children and teenagers. We have not checked what is known about younger people.
- Where we land. We have not taken a position on this yet.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Cohen & Bartlik, J Sex Marital Ther (open-label)1998
Reported ~84% improvement in antidepressant-induced sexual dysfunction; uncontrolled
Kang et al., Hum Psychopharmacol (RCT)2002
No significant difference from placebo at 2, 4, 8 weeks
Wheatley, triple-blind placebo-controlled trial2004
No benefit over placebo for antidepressant sexual dysfunction
Systematic review of ginkgo and sexual function2021
Evidence indicates no effect on sexual function in antidepressant users