Dietary supplements are commonly used among athletes. The Australian Institute of Sport (AIS) groups supplements into 4 categories, being group D considered by the World Anti-Doping Agency (WADA) as prohibited supplements. The online availability of four doping substances: oxandrolone, dehydroepiandrosterone (DHEA), androstenedione and Tribulus terrestris, purchased from Spain, Puerto Rico, Canada, USA, Ukraine and Russia was evaluated. The characteristics of the websites, the countries the webs sold to, the pharmaceutical forms offered and the recommendations for its use were analyzed by using a computer tool designed ad hoc. There were significant differences between countries in the number of webpages that sold the products (Chi-square test, p<0.05). Oxandrolone was available for purchase mainly in Spain (27.12%) and Ukraine (26.58%), coming from websites dedicated to sports (77.26%). For DHEA, most of the pages were located in Canada (23.34%) and Russia (21.44%). Tribulus terrestris was the compound with the highest number of web pages. In the case of androstenedione, none of the pages for its sale requested prescription. Products such as androstenedione or DHEA are claimed to enhance sports performance or for sports use without providing details. The results showed that a limited number of Internet sites request prescriptions. Most of the doping substances are purchased from the country where they are requested. Athletes should be encouraged to consult health professionals about which supplements are suitable for their type of training and sports objectives.

Background: The management of erectile dysfunction (ED) shows several grey zones and new treatments for reduce the percentage of patients who discontinued the treatment are required. Here, we aim to evaluate the role of a natural mixture of named Icarifil (L-Citrulline, L-Carnitine, Eruca vesicaria, Panax ginseng, Tribulus terrestris, Turnera diffusa, Taurine, Vitamin E, Zinc) in the management of patients with ED. Methods: From September 2022 to March 2023, all patients attending 3 urological institutions due to ED were randomized to receive: Icarifil 1 sachet every 24 h (Group 1) or Icarifil 1 sachet + tadalafil 5 mg 1 tablet every 24 h (Group 2) or tadalafil 5 mg 1 tablet daily (Group 3), for 3 months. All patients underwent urologic visit and dedicated questionnaires (IIEF-5, SEP-2, SEP-3) at the enrollment and at the follow-up evaluation (3 months). Patient Reported Outcomes (PROs) at the follow-up evaluation were used. Primary endpoint was the difference in the questionnaires at the follow-up visit when compared with enrollment among the study groups. Results: In the per-protocol analysis, 52 patients in the Group 1, 55 in the Group 2 and 57 in Group 3 have been analyzed. At the follow-up evaluation, IIEF-5 have been improved in all the 3 Groups between enrollment and follow-up evaluation, but a statistically significant difference has been reported between Group 2 (+7.4) versus Group 1 (+4.1) or 3 (+5.1), (p&lt;0.001; p&lt;0.001). Moreover, 47 patients (94.0%) in the Group 2 showed an improvement in the SEP questionnaires, when compared with the baseline, while 29 in the Group 1 (56.9%) and 42 in the Group 3 (82.3%) with a statistically significant difference (p=0.004; p=0.003) among the Groups. The PROs analysis reported a better efficacy and patients’ satisfaction in Group 2 when compared with Group 1 or 3. Conclusions: In conclusion, Icarifil is able to improve penile erectile function in mild–moderate ED and it is able to significantly improve the clinical efficacy of tadalafil 5 mg daily use. Icarifil could be represent an interesting alternative treatment in patients experiencing adverse effects or with contraindications for chronic treatment with PDE5-is.