madman
Super Moderator
Testosterone boosters are heavily marketed on social media and marketplaces to men with claims to significantly increase testosterone. Lax industry regulation has allowed sales of supplements to thrive in the absence of verification of their purported benefits. Our primary objective was to systematically review all data published in the last two decades on testosterone boosters and determine their efficacy. Our outcome of interest was total testosterone increase versus placebo in four different populations: male athletes, men with late-onset hypogonadism infertile men, and healthy men. Following search and screening, 52 studies were included in our review, relating to 27 proposed testosterone boosters: 10 studies of cholecalciferol; 5 zinc/magnesium; 4 Tribulusterrestris and creatine; 3 Eurycoma longifolia and Withania somnifera; 2 betaine, D-aspartic acid, Lepidium meyenii, and isoflavones; while the remainder were single reports. Our findings indicate that most fail to increase total testosterone. The exceptions wereβ-hydroxy β-methylbutyrate and betaine, which can be considered effective for male athletes. Eurycoma longifolia, a blend ofPunica granatum fruit rind and Theobroma cacao seed extracts (Tesnor™) and purified Shilajit extract (PrimaVie™) can be considered possibly effective for men with late-onset hypogonadism; Eurycoma longifolia and Withania somnifera possibly effective for healthy men; and a non-hormonal aromatase inhibitor (Novadex XT™) possibly effective for male athletes.
INTRODUCTION
The term “testosterone booster” (TB) is often employed to refer to a heterogeneous group of herbal or nutrient-based supplements used for the purpose of “naturally” increasing serum testosterone levels[1]. Not all users of TBs who seek this effect have male hypogonadism or symptoms suggestive of low testosterone, some are motivated by the desire to elevate normal serum testosterone levels in orderto improve libido and/or sexual performance, improve performance and/or gain muscle mass [1]
Many TBs are heavily marketed on social media, in men's magazines, and in marketplaces using claims of strong efficacy and are sold over the counter either as pure ingredients or miscellaneous blends [2–5]. The laxity of supplement regulation, by either the European Medication Agency or the Food and Drugs Administration, has allowed the industry to thrive in the absence of verification of the claims attached to their products [6]. Moreover, their long-term history of use and the perceived“natural” origin of some supplements can cause users to believe the potential for significant adverse effects is low, which may not be the case [7, 8].
Only a limited number of systematic reviews have been performed on TBs, but none has reviewed this topic as a whole[9–13]. Some have focused on specific TBs, such as Tribulus Terrestris [13], while others have reviewed the active ingredients contained in the most sold TB products [3].
Prior systematic reviews have omitted less used or novel TBs, and thus, our group performed this systematic review to fill this evidence gap.
CONCLUSIONS
Our extensive systematic review has concluded that most TBs fail to demonstrate their ability to increase sTT under RCT conditions. Notable exceptions were HMB and betaine, which can be considered effective TBs in male athletes. Eurycoma longifolia (“Tongkat Ali”), a proprietary blend of Punica granatum fruit rind andTheobroma cacao seed extracts (Tesnor™), and a patented purified Shilajit extract (PrimaVie™) can be considered as possibly effectiveTBs for men with late-onset hypogonadism; Withania somnifera (“Ashwagandha”) and “Tongkat Ali” possibly effective for healthy men; and a non-hormonal aromatase inhibitor (Novadex XT™) possibly effective for male athletes. Adverse effects were rarely reported. Many studies presented a high risk of bias, while known confounders were not accounted for, as such our conclusions should be interpreted with caution.
INTRODUCTION
The term “testosterone booster” (TB) is often employed to refer to a heterogeneous group of herbal or nutrient-based supplements used for the purpose of “naturally” increasing serum testosterone levels[1]. Not all users of TBs who seek this effect have male hypogonadism or symptoms suggestive of low testosterone, some are motivated by the desire to elevate normal serum testosterone levels in orderto improve libido and/or sexual performance, improve performance and/or gain muscle mass [1]
Many TBs are heavily marketed on social media, in men's magazines, and in marketplaces using claims of strong efficacy and are sold over the counter either as pure ingredients or miscellaneous blends [2–5]. The laxity of supplement regulation, by either the European Medication Agency or the Food and Drugs Administration, has allowed the industry to thrive in the absence of verification of the claims attached to their products [6]. Moreover, their long-term history of use and the perceived“natural” origin of some supplements can cause users to believe the potential for significant adverse effects is low, which may not be the case [7, 8].
Only a limited number of systematic reviews have been performed on TBs, but none has reviewed this topic as a whole[9–13]. Some have focused on specific TBs, such as Tribulus Terrestris [13], while others have reviewed the active ingredients contained in the most sold TB products [3].
Prior systematic reviews have omitted less used or novel TBs, and thus, our group performed this systematic review to fill this evidence gap.
CONCLUSIONS
Our extensive systematic review has concluded that most TBs fail to demonstrate their ability to increase sTT under RCT conditions. Notable exceptions were HMB and betaine, which can be considered effective TBs in male athletes. Eurycoma longifolia (“Tongkat Ali”), a proprietary blend of Punica granatum fruit rind andTheobroma cacao seed extracts (Tesnor™), and a patented purified Shilajit extract (PrimaVie™) can be considered as possibly effectiveTBs for men with late-onset hypogonadism; Withania somnifera (“Ashwagandha”) and “Tongkat Ali” possibly effective for healthy men; and a non-hormonal aromatase inhibitor (Novadex XT™) possibly effective for male athletes. Adverse effects were rarely reported. Many studies presented a high risk of bias, while known confounders were not accounted for, as such our conclusions should be interpreted with caution.
