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This is particularly significant given a string of recent investigations revealing that some “natural” supplements contain active pharmaceutical ingredients.13,40–43 Patients should also be counseled that these ingredient concerns are not unique to herbal or natural supplements targeted at ED. The PubMed search, which included the ingredients as well as the term “erectile dysfunction,” yielded 413 studies mentioning these active ingredients, of which 68 (16%) involved human subjects, 181 (44%) involved animal models, 45 (11%) were in vitro studies, and 119 (29%) were other types of studies (eg, case reports, review articles). A total of 21 active and 6 inactive ingredients were identified across the 6 supplements, and the supplements had an average of 8.2 ± 4.3 ingredients (range 2–13). This was the first time, however, that a program installed unwanted software during UNINSTALL. 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