Effect of Tongkat Ali and concurrent training on ED and T levels in ADAM

[madman]

ABSTRACT

Background: Androgen deficiency of aging males (ADAM) largely manifests as sexual symptoms. Erectile dysfunction is one of the most common symptoms of ADAM.

Aim: To ascertain the effect of concurrent training and supplementation with Eurycoma longifolia on erectile function and testosterone levels in men with ADAM, and the association of erectile function with levels of total testosterone.

Methods: 6-month, randomized, double-blind, placebo-controlled four-arm clinical. 45 men (47.38 ± 5.03 years) were randomized into 4 groups (G1: control + placebo; G2: control + Eurycoma longifolia; G3: concurrent training + placebo; G4: concurrent training + Eurycoma longifolia). 22 received a 200 mg supplement of Eurycoma longifolia and 23 underwent the intervention with concurrent training, 3 times a week for 60 min at progressive intensity.

Outcomes: International Index of Erectile Function (IIEF-5), Aging Male Scale (AMS), and total testosterone.

Results: Erectile function demonstrated improvements in both interventions; however, the most significant results were obtained by men allocated to concurrent training + Eurycoma longifolia. Clinical implications: A 200 mg supplement of Eurycoma longifolia and the practice of concurrent training for 6 months significantly improved the erectile function of men with ADAM.

Strengths & limitations: The study’s design stands out as a strength, in addition to the six-month intervention. The main limitation is the study not having groups that used only Eurycoma longifolia and only concurrent training.

Conclusion: The combination of Eurycoma longifolia and concurrent training improved erectile function and increased total testosterone levels in men with ADAM.




1. Introduction

Testosterone is the main natural androgenic anabolic male hormone, and its biological effects include regulating libido, bone mass, body composition distribution, and muscle strength [1]. During the male aging process, testosterone rates are expected to decrease from 1 to 3% per year [2]. ADAM (Androgen Deficiency in the Aging Male) occurs when there is exacerbated decrease associated with somatic, psychological, and sexual signs and symptoms. The sexual symptoms of ADAM are the most recurrent and affect about 60 % of men [3,4]. They include decreased sexual frequency and capacity, sexual desire, beard growth, and erectile dysfunction [5].

This dysfunction involves changes to any of the components of erectile response [6], and there is a consensus on its association with increased risk of cardiovascular diseases [7]. In a longitudinal study, researchers confirmed that low penile blood flow was associated with an increased risk of cardiovascular disease [8]. Studies of the systematic increase in blood flow has demonstrated that the use of herbal supplements [9] and physical exercise is an efficient alternative for improving ADAM and its symptoms, in addition to increasing levels of testosterone and improving erectile dysfunction [4,10,11].

Concurrent training has been studied as a potent agent for improving these aspects [12]. This training method involves aerobic and resistance exercises in the same session, optimizing the benefits [13]. Randomized clinical trials show that Eurycoma longifolia [14–17] is a herbal alternative for the condition. The mechanism of action of this root improves serum testosterone [18].

It is of the utmost importance to seek clinical alternatives to improve the sexual symptoms associated with ADAM and to increase testosterone of the affected men, as these are predictors for cardiovascular diseases and other pathologies and negatively influence the quality of life. Moreover, non-invasive and non-pharmacological measures are better accepted by the patients and they work systemically in other health domains. It is necessary to verify whether there is an association of these sexual domains with the total testosterone indexes. The objective of this study is to ascertain the influence of concurrent training and supplementation with Eurycoma longifolia on erectile function and testosterone in men with ADAM and associate erectile function with total testosterone.




5. Conclusion

It is important to note that one of the study’s limitations was not including two more groups without placebo use to avoid the “placebo effect”. Moreover, the study method should be highlighted: it was the first controlled, randomized study to evaluate the influence of EL and concurrent training on the erectile function of men with ADAM. Finally, this study showed the benefits of Eurycoma longifolia supplementation and the practice of a concurrent training protocol on sexual health and total testosterone in men with ADAM. The action of Eurycoma longifolia was best observed in the fourth month of use, while the best result for concurrent training was observed in the sixth month. When the two interventions were associated, the improvements were superior to isolated use. These findings are important for professionals who work with this population, as this non-pharmacological treatment proved to be positive and had no side effects. It can be applied to improve total testosterone, erectile dysfunction, and, consequently, quality of life of middle-aged men with ADAM.

 

[Nelson Vergel]

I wonder who funded this study

 

[madman]

Funding

This study was financed in part by the Coordenaçao ˜ de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.



2.7. Supplementation

Eurycoma longifolia capsules were produced by a local compounding pharmacy. The capsules had the same visual characteristics, so there was no distinction between the products (Eurycoma longifolia or placebo). The product label was not specific and included only the University’s name, dosage, and the participant’s name. The placebo capsules contained starch while the Eurycoma longifolia capsules contained 200 mg of standardized dry extract (2-dihydro-18-dedihydrolongilactone: 0.32 % (w/w); 9-hydroxycanthin-6-one 0.49 % (w/w); Eurycomanone: 1.21 % (w/w); total protein: 26.3 %; total polysaccharaide: 28.8 % ⋅ glycosaponin: 44.2 %). All participants were instructed to take the supplementation in the morning, after breakfast, in order to avoid any discomfort. There were no reports of discomfort during the study.

 

[madman]

Table 1

2-way RM-ANOVA for comparison of the sexual function domains of the four groups in the four moments of the study. (n = 38). BL - baseline; 1 month - after one month of intervention; 4 months - after four months of intervention; 6 months - after six months of intervention. G1: control + placebo; G2: control + Eurycoma longifolia; G3: concurrent training + placebo; G4: concurrent training + Eurycoma longifolia. AMS-S: sexual aspects of the AMS Scale. f 2 : effect size (Cohen). p-value□: for the difference between the group; p-value* for the difference between times; and p value# for group versus time interaction. Uppercase letters on the lines represent the difference between groups, while lowercase letters on the columns represent the difference between times. Different letters in lines represent the significant statistical differences between groups and different letters in columns represent significant statistical differences between times. Statistically significant values (p ≤ 0.05) are highlighted. Results presented as mean ± standard deviation

 

[madman]

Table 2 Multiple linear regression analysis correlating total testosterone with the domains of sexual health in a model adjusted by the groups. (n = 38). C: correlation / LR: linear regression

 

[madman]

Table 3

2-way RM-ANOVA for comparison of total testosterone of the four groups in the four moments of the study. (n = 38). BL - baseline; 1 month - after one month of intervention; 4 months - after four months of intervention; 6 months - after six months of intervention. G1: control + placebo; G2: control + Eurycoma longifolia; G3: concurrent training + placebo; G4: concurrent training + Eurycoma longifolia. f 2 : effect size (Cohen). p-value□: for the difference between the group; p-value* for the difference between times; and p value# for group versus time interaction. Lowercase letters on the lines represent the difference between time, while uppercase letters on the columns represent the difference between groups. Different letters in lines represent the significant statistical difference between times and different letters in columns represent significant statistical differences between groups. Statistically significant values (p ≤ 0.05) are highlighted. Results presented as mean ± standard deviation.

 

[madman]

Fig. 2. Mechanism of action of Eurycoma longifolia. The increase in testosterone by the consumption of EL is related to several mechanisms. At the hypothalamus-pituitary axis, the EL generates a greater stimulus of LH release by the pituitary, and thereby greater production and secretion of testosterone by Leydig cells. In the testosterone synthesis process, the eurypeptides act enhancing the action of CYP450c17 and e17 enzymes, and by that generating a greater production of dehydroepiandrosterone and testosterone. Besides, quassinoids denominated eurycomanome act by inhibiting aromatase and diminishing the conversion of testosterone to estradiol or estrone [14,28,36,37]. GnRH: Gonadotropin-Releasing Hormone FSH: Follicle-stimulating hormone LH: Luteinizing hormone T: testosterone. Figure created by the author.