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Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review
Stephen J Smith, Adrian L Lopresti, Shaun YM Teo, and Timothy J Fairchild
ABSTRACT
Testosterone concentrations in males tend to decline with advancing age. Low testosterone, also known as androgen deficiency (AD), is associated with an increased risk of morbidity and mortality. Currently, the primary treatment for AD is testosterone replacement therapy (TRT), which may exacerbate pre-existing medical conditions. Therefore, the use of alternative options, such as herbs, spices, plants, or their extracts, has been explored as a potential treatment option for AD. The aim of this systematic review was to summarize and critically evaluate randomized controlled trials published on the efficacy of single herbal ingredients on testosterone concentrations, in addition to its fractions or binding proteins, in men (≥18 y). From the 4 databases searched, there were 13 herbs identified in 32 studies, published between 2001 and 2019. The main findings of this review indicate that 2 herbal extracts, fenugreek seed extracts, and ashwagandha root and root/leaf extracts, have positive effects on testosterone concentrations in men. Also, some evidence exists for other herbs and herbal extract, Asian red ginseng, and forskholii root extract. Overall, 9 out of 32 studies demonstrated statistically significant increases in testosterone concentrations. Moreover, 6 studies out of 32 were judged as having a low risk of bias. Current evidence is largely based on young, nonclinical populations, with 16 out of 32 studies using men <40 y of age. Conclusions are moderated by the paucity of research for many herbs, the variation in dosages and extracts used, small sample sizes, and the heterogeneity of study characteristics. Also, further research is required before definitive conclusions on efficacy and safety can be made. This systematic review was registered at PROSPERO as CRD42020173623. Adv Nutr 2020;00:1–22.
Plants and plant-based products, including herbs and spices, have been used for millennia to improve the flavor of food as well as to treat disease and improve overall health and well-being (22). For example, saffron has demonstrated antidepressant and anxiolytic effects (23), curcumin appears to offer pain relief for sufferers of arthritis (24), and cinnamon may support blood-sugar regulation in type 2 diabetics (25). The popularity of herbal products in the United States continues to rise steadily, with annual sales increasing every year for over a decade, with approximately US$8.8 billion worth of products being sold in 2018 (26). The growth in popularity of herbal products is reportedly due to several factors, including perceived efficacy associated with a long history of traditional use and apparent safety due to the perceived absence of serious side effects (27). Given the increasing body of research on herbal supplementation to support natural hormone production, it presents as a potential treatment option for AD. A recent narrative review by Clemesha et al. (28) concluded that many supplements claiming “testosterone-boosting” properties, including formulations using herbs, spices, plants, or their extracts, do not appear to be supported by scientific evidence. However, the review of Clemesha et al. (28) had several limitations such as using only a single search term, “testosterone booster,” using only Google to search for existing research and examining only the top 50 supplements. Therefore, the aim of this systematic review was to summarize and critically evaluate randomized controlled trials conducted to assess the efficacy of single herbal ingredients on testosterone concentrations, in addition to their fractions or binding proteins, in men. “Herbs, spices, plants, or their extracts” will henceforth be referred to as “herbs.”
Panax ginseng (Asian ginseng)
Trigonella foenum-graecum (fenugreek)
Withania somnifera (ashwagandha)
Tribulus terrestris (tribulus)
Lepidium meyenii (maca)
Rhodiola rosea (rhodiola)
Chlorophytum borivilianum (musali)
Garcinia cambogia (garcinia)
Coleus forskohlii (forskohlii)
Ganoderma lucidum (reishi)
Urtica dioca (stinging nettle)
Eurycoma longifolia (longjack)
Cordyceps sinensis (cordyceps)
Discussion
The main findings of this review indicate that some herbs, particularly fenugreek seed extracts and ashwagandha extracts, have positive effects on testosterone concentrations in men. Overall, 9 out of 32 studies demonstrated significant increases in testosterone concentrations. Fenugreek seed extracts (positive findings in 4 out of 6 studies) and ashwagandha root and root/leaf extracts (positive findings in 3 out of 4 studies) demonstrated the most consistent increases in testosterone concentrations. Fenugreek seed extracts also demonstrated efficacy for increasing (calculated) FT and BT concentrations. While limited to support from a single trial, a forskohlii root extract was associated with increased TT. Asian ginseng also had 1 study demonstrating its efficacy in increasing testosterone (extract details not provided), but there were 6 studies demonstrating no effect. The paucity of high-quality randomized controlled trials examining the effects of herbs on testosterone concentrations in men, along with the heterogeneous cohorts assessed in these trials, precludes definitive conclusions being made.
Conclusions
This systematic review provides some evidence that certain herbs and herbal extracts increase testosterone concentrations in men. Currently, the strongest evidence is for fenugreek seed extracts (Trigonella foenum-graecum; details of extract preparation not provided) and ashwagandha roots and leaves (Withania somnifera; water-based or ethanol: waterbased, 70:30, extracts). However, conclusions are moderated by the paucity of research for many herbs, the variation in dosages and extracts used, small sample sizes, and the heterogeneity of study characteristics. Further research is required before definitive conclusions on efficacy and safety can be made. Moreover, making specific recommendations for certain herbs should be done cautiously until further robust research is conducted.
Stephen J Smith, Adrian L Lopresti, Shaun YM Teo, and Timothy J Fairchild
ABSTRACT
Testosterone concentrations in males tend to decline with advancing age. Low testosterone, also known as androgen deficiency (AD), is associated with an increased risk of morbidity and mortality. Currently, the primary treatment for AD is testosterone replacement therapy (TRT), which may exacerbate pre-existing medical conditions. Therefore, the use of alternative options, such as herbs, spices, plants, or their extracts, has been explored as a potential treatment option for AD. The aim of this systematic review was to summarize and critically evaluate randomized controlled trials published on the efficacy of single herbal ingredients on testosterone concentrations, in addition to its fractions or binding proteins, in men (≥18 y). From the 4 databases searched, there were 13 herbs identified in 32 studies, published between 2001 and 2019. The main findings of this review indicate that 2 herbal extracts, fenugreek seed extracts, and ashwagandha root and root/leaf extracts, have positive effects on testosterone concentrations in men. Also, some evidence exists for other herbs and herbal extract, Asian red ginseng, and forskholii root extract. Overall, 9 out of 32 studies demonstrated statistically significant increases in testosterone concentrations. Moreover, 6 studies out of 32 were judged as having a low risk of bias. Current evidence is largely based on young, nonclinical populations, with 16 out of 32 studies using men <40 y of age. Conclusions are moderated by the paucity of research for many herbs, the variation in dosages and extracts used, small sample sizes, and the heterogeneity of study characteristics. Also, further research is required before definitive conclusions on efficacy and safety can be made. This systematic review was registered at PROSPERO as CRD42020173623. Adv Nutr 2020;00:1–22.
Plants and plant-based products, including herbs and spices, have been used for millennia to improve the flavor of food as well as to treat disease and improve overall health and well-being (22). For example, saffron has demonstrated antidepressant and anxiolytic effects (23), curcumin appears to offer pain relief for sufferers of arthritis (24), and cinnamon may support blood-sugar regulation in type 2 diabetics (25). The popularity of herbal products in the United States continues to rise steadily, with annual sales increasing every year for over a decade, with approximately US$8.8 billion worth of products being sold in 2018 (26). The growth in popularity of herbal products is reportedly due to several factors, including perceived efficacy associated with a long history of traditional use and apparent safety due to the perceived absence of serious side effects (27). Given the increasing body of research on herbal supplementation to support natural hormone production, it presents as a potential treatment option for AD. A recent narrative review by Clemesha et al. (28) concluded that many supplements claiming “testosterone-boosting” properties, including formulations using herbs, spices, plants, or their extracts, do not appear to be supported by scientific evidence. However, the review of Clemesha et al. (28) had several limitations such as using only a single search term, “testosterone booster,” using only Google to search for existing research and examining only the top 50 supplements. Therefore, the aim of this systematic review was to summarize and critically evaluate randomized controlled trials conducted to assess the efficacy of single herbal ingredients on testosterone concentrations, in addition to their fractions or binding proteins, in men. “Herbs, spices, plants, or their extracts” will henceforth be referred to as “herbs.”
Panax ginseng (Asian ginseng)
Trigonella foenum-graecum (fenugreek)
Withania somnifera (ashwagandha)
Tribulus terrestris (tribulus)
Lepidium meyenii (maca)
Rhodiola rosea (rhodiola)
Chlorophytum borivilianum (musali)
Garcinia cambogia (garcinia)
Coleus forskohlii (forskohlii)
Ganoderma lucidum (reishi)
Urtica dioca (stinging nettle)
Eurycoma longifolia (longjack)
Cordyceps sinensis (cordyceps)
Discussion
The main findings of this review indicate that some herbs, particularly fenugreek seed extracts and ashwagandha extracts, have positive effects on testosterone concentrations in men. Overall, 9 out of 32 studies demonstrated significant increases in testosterone concentrations. Fenugreek seed extracts (positive findings in 4 out of 6 studies) and ashwagandha root and root/leaf extracts (positive findings in 3 out of 4 studies) demonstrated the most consistent increases in testosterone concentrations. Fenugreek seed extracts also demonstrated efficacy for increasing (calculated) FT and BT concentrations. While limited to support from a single trial, a forskohlii root extract was associated with increased TT. Asian ginseng also had 1 study demonstrating its efficacy in increasing testosterone (extract details not provided), but there were 6 studies demonstrating no effect. The paucity of high-quality randomized controlled trials examining the effects of herbs on testosterone concentrations in men, along with the heterogeneous cohorts assessed in these trials, precludes definitive conclusions being made.
Conclusions
This systematic review provides some evidence that certain herbs and herbal extracts increase testosterone concentrations in men. Currently, the strongest evidence is for fenugreek seed extracts (Trigonella foenum-graecum; details of extract preparation not provided) and ashwagandha roots and leaves (Withania somnifera; water-based or ethanol: waterbased, 70:30, extracts). However, conclusions are moderated by the paucity of research for many herbs, the variation in dosages and extracts used, small sample sizes, and the heterogeneity of study characteristics. Further research is required before definitive conclusions on efficacy and safety can be made. Moreover, making specific recommendations for certain herbs should be done cautiously until further robust research is conducted.
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