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First of all, L-arginine can be administered even with other PDE5is such as sildenafil, vardenafil, and avanafil

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Moreover, the gut-muscle axis is being elucidated, with evidence suggesting that gut-derived hormones like Ghrelin may not only stimulate appetite but also have direct anti-inflammatory and anabolic effects on skeletal muscle, with potential secondary benefits for vascular health (133) (As shown in Figure 5 )

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In the study, published in the August 2005 issue of Chemical Monthly, taking a daily supplement of 2g of L-Carnitine was found to increase the relative mRNA levels of these enzymes in pregnant women

L-Carnitine, Examine.com