My initial preference for sexual enhancement has been yohimbine. This was in times when Viagra was not yet available.

My next phase were dopaminergics. I have written extensively about the use of dopaminergics in sexual enhancement.

Before, after, and in between the above, I had tried, off and on, all kinds of hormonal therapies. I didn't have any success with them.

In June and July 2003, I have been using only a combination of tongkat ali and cheap Indian sildenafil citrate (generic Viagra, see www.sildenafil.net).

This doesn't mean that I would have turned against yohimbine and dopaminergics. These medications do work. But they all work in different ways. And I assume that it lies in the dialectical nature of our sexuality that all sexual enhancement medications loose some of their kick as we get used to them. Just as routine can be a grave for sexual excitement, routinely used sexual enhancement medications tend to loose their effectiveness.

I mentioned that sexual enhancement medications work in different ways. First of all, one has to differentiate between medications that work on penile plumbing and those that work on the neurological wiring.

Erectile failure in most cases is a localized vascular problem: blood vessels have to supply a sufficient amount of blood to the corpora cavernosa and the corpus spongiosum, and drainage has to be avoided. This is all rather mechanical, and it can be achieved pharmacologically either by sildenafil citrate or yohimbine.

When Viagra was not available yet, yohimbine was the only oral drug to specifically treat erectile shortcomings. Another option was injectable prostaglandin E1 (alprostadil). Alprostadil is now available as cream.

Other medications were (and are) useful for sexual enhancement only when there were (or are) no erectile but only neurological sexual problems. If the problem is vascular, no dose of a libido enhancer will not induce an erection.

A large number of people are not sufficiently aware of the duality of penile plumbing and neurological wiring. And except for yohimbine, there is no sexual enhancement medication that would work on both components.

Yohimbine does, as the adrenalin which yohimbine displaces from abdominal alpha-2 adrenergic receptors (which, among other things, regulate penile blood flow) reoccur systemically as neurological stimulant.

However, the strong sympathetic impulse caused by systemic adrenaline (in the form of norepinephrine) makes it difficult for the parasympathetic nerve system to take over at the point of orgasm, which, with regular usage of yohimbine, makes for weak ejaculations and orgasms that are no match for the pre-orgasmic excitement.

But sex with a firm erection aided by yohimbine is still better than no erection, which normally means: no proper sex.

Therefore, Viagra (and generic sildenafil citrate), or any other medication that fixes penile plumbing, is a necessity for many men above 40, and for most above 50 or 60.

And only when there are no plumbing problems do other medications (those that work on libido) become relevant.

By and large, there are two groups of pharmaceutical agents that work on libido: those that effect neurotransmitters, and those that target the endocrine (hormonal) system. I say "by and large" because the two systems are intertwined. Drugs that elevate the neurotransmitter dopamine (dopaminergics) also suppress the hormone prolactin. Prolactin not only regulates lactation in women but also keeps testosterone in check in men and women. Typically, less prolactin means more testosterone. Furthermore, some hormones can act as neurotransmitters and vice versa; norepinephrine, C8H13NO3, is both a hormone and a neurotransmitter.

The neurotransmitter system reacts much faster than the hormonal system, and you feel this when you take pharmacological agents that act on it. When an effective dosage of any neurotransmitter modifying medications kicks in, you feel it. With most dopaminergics, there is a slight nausea, or at least a desire to lie down. And there is a clear window of opportunity for improved sex, which usually is the first few hours during which a neurotransmitter drug is active (for apomorphine, this window of opportunity is the shortest; for cabergoline, it is the longest).

When you use neurotransmitters to improve sex, you always know that you have taken something.

This is not the case with drugs that work on the endocrine system, unless a huge overdose is consumed (for example when women take a testosterone dosage that was formulated for men). Usually, endocrine medications cannot be felt directly. Whether you use growth hormone injections, testosterone cream, Andriol capsules, Proviron, methyltestosterone, anastrozole, or clomiphene, there is no clear onset, and now clear end-of-efficacy time.

In me and many other users, any testosterone-raising medication can cause an outburst of anger (if there is an event that triggers it). The outburst may happen after 2 hours, or after 4, or after 8… or not at all, if nothing happens that would give me reason to get angry. But let me drive a car in a Third World country where people typically do not follow any traffic rules, and not even traffic common sense! If I have taken testosterone-raising medications, I will not be able to keep my calm.

The case is similar, but still more erratic with libido. Medications that work on the endocrine system can be extremely sexualizing, but it is very hard to plan this effect.

You can have a sexual schedule when you take yohimbine or dopaminergics. I will reliably have an erection some one-and-one-half hours after ingesting some 10 to 20 mg of yohimbine. I just have to scratch my member, and voila, here we go.

Likewise, when on apomorphine, bromocriptine, or cabergoline, I will feel more excitement during intercourse than when in a sober state. The dopaminergics usually only exert their effect when already at it; at the dosages that I use, they do little for pre-intercourse desire. But Parkinson's patients who use much higher dosages, and do so constantly, often are in a constant state of sexual alert.

Viagra isn't as reliable for erections as yohimbine. When I take Viagra without dopaminergics or endocrine agents, I may not have the libido impulse to cause a hard erection. I may just have an enlarged but still flaccid penis, and not much drive to pursue intercourse.

Tongkat ali is an endocrine agent, not a vascular modifier. Endocrine agents have a subtle effect on libido. To describe it, I have to reach back a few decades.

I remember the time when I was 12 or 13 years old. Often, before falling asleep, I could daydream along for half an hour or an hour, just imagining sexual scenarios. There was a girl, two or three years my senior, and heavy-bodied, and I imagined I were to abduct her to an old farmhouse, and lock her up, and just observe her through a peephole until she were to pee.

I could just recall this fantasy, night after night, and imagine and re-imagine explicit details, and the excitement wouldn't wane. Night after night, week after week. Never bored.

I could still get lost in masturbation fantasies until the end of my 20's, but in my 30's and 40's, they were no more. As I grew older, sex moved from between the ears to between the groins. While at a younger age, erections came from imagination, they later required physical sensation.

Enter the tongkat ali.

What I first noticed was that during routine sex with an established partner, my mind began wondering off to strange ideas. That I was a perverse school headmaster who would punish pupils arriving delayed by squeezing some private parts. Or that I was a cruel Chinese emperor with a harem of 1000 concubines. Those who couldn't bring me to orgasm would be executed. And I really had them work to save their lives.PAll of that during standard intercourse with a dear lady with whom I otherwise have a rather practical relationship.

Now, this has been going on for weeks. The settings of my fantasies change, but what remains the same is that I really can indulge in them for about half an hour, while at intercourse with a routine sex partner who is completely absent from the scenario that I imagine.

This is how I feel tongkat ali's impact on my endocrine system. And I love it.

Or rather: this is how I feel a gram of the 1:50 extract I obtain from Sumatra Pasak Bumi (website: pasakbumi.com). I had earlier tried other tongkat ali products, but their effect had been nondescript. Please see my article on tongkat ali dosage for what I consider effective and non-effective amounts.

Because tongkat ali is not a switch-on switch-off sexual stimulant, I believe it is best to take it on a daily basis for about two or three weeks, and then to rest it for about a week. I usually take it some time around noon, as a single 1-gram dosage. Initially I felt a specific hotheadedness after about an hour, but this effect has since subsided.

I cannot say that after 2 hours, or 4 hours, or even after 8 hours I would have great sex. I cannot willfully switch it on. Great sex on tongkat ali comes sporadic. Could be later in the day, or even just the next morning.

I always take the tongkat ali with sildenafil citrate (generic Viagra, 50 mg). I don't have the blood vessel stability to go without it. I tried, after another participant in our tongkat ali trial reported that the tongkat ali allows him to go without the Viagra, but when I left it out of my cocktail, my erection clearly wasn't of the usual sildenafil-aided quality.

By all indications, tongkat ali is a hormonal stimulant, and hormonal stimulants, including testosterone, have a weak track record when it comes to aiding erections. Tongkat ali is no exception.

I have a good number of girlfriends. I enjoy variation, and I do not intend to go without it, especially as it has taken me a lot of efforts to arrange everything in a manner that would allow me this lifestyle.

But I believe that the greatest benefit from tongkat ali will be enjoyed by people who are in a rather steady and monogamous relationship. If I have enough imagination, I don't need variation. As a matter of fact, my imaginations blossom brighter with a routine partner who knows my physical preferences and doesn't need verbal attention before or during intercourse. With a routine partner, I just can dive into an ocean of fantasies, without need to resurface for rather practical matters.

On the other hand, when on tongkat ali, the strangeness of a new partner, too, can be turned into sexual excitement. In that case it's not so much the indulging in fantasies but the idea of conscious role play. The roles may not be as weird as my fantasies with a routine partner, but they are still different from normal, sober life.

So, whatever the setting, tongkat ali clearly supports the imaginative part of sexual interaction.