madman
Super Moderator
Testosterone Boosters: How Real Are Their Effects? (2022)
Adrian Andres Aguilar-Morgan, Abraham Morgentaler, and Luis Antonio Reyes-Vallejo
Abstract
In the past decade, there has been an increased interest in alternative treatments to testosterone (T) and androgen derivatives. This has led to the development of supplements known as ‘‘testosterone boosters’’ (T-boosters) or ‘‘testosterone enhancers.’’ The internet is the main source for the purchase of these products with sales reaching millions of dollars. The search for T-boosters is focused on improvement in sexual performance, muscular strength, and increased muscle mass using agents considered ‘‘natural,’’ which are thereby presumed to lack serious adverse effects. Some of these supplements have been used since antiquity. Commercially sold T-boosters nearly always comprise multiple supplements, and none of these combinations have undergone rigorous evaluations, as would be required for regulatory approval for pharmaceutical products. This makes it challenging to evaluate marketing claims. However, the limited scientific literature does exist on the primary individual agents in most T-boosters. The most commonly used agents are Tribulus Terrestris, fenugreek, zinc, maca, and ashwagandha (‘‘Indian ginseng’’). Those studies form the basis of this review. Although some studies have offered suggestive results indicating possible increases in serum T, the data are inconsistent, and studies differ widely in methods, including supplement dosage. In addition, serious adverse events have been reported. Currently, the existing literature fails to support the use of these products.
Introduction
Testosterone (T) therapy is an efficacious and safe treatment in cases of male T deficiency, and interest in the research into its approach in different fields has been recently increasing. The American Association of Clinical Endocrinologists (AACE), the American Urological Association (AUA), and the European Association of Urology recommend the use of T in patients with clear signs and symptoms of hypogonadism.1–3 T therapy has been shown to have well-documented beneficial effects on erectile function, bone marrow, muscle mass, strength, and fatty tissue, as well as on metabolism control.4–6
The past decade has seen an increase in the search for alternative treatments that may provide similar benefits as androgens on muscle mass, strength, and fatty tissue without the side effects most feared by athletes and bodybuilders, such as testicular atrophy and infertility that has led to a surge in the use of various agents that increase T, approved by the Food and Drug Administration (FDA), with narrow indications.7–9 Physicians should be aware of the information regarding the efficacy and toxicity of those substances commonly used by their patients. These products may interfere with the hypothalamic–pituitary–testicular axis affecting hormonal balance, fertility, and sexual performance.10
Although there are a number of alternative medical therapies to T therapy, including human chorionic gonadotropic, aromatase inhibitors, and selective estrogen receptor modulators,10 there is a considerable public interest for nonprescription, ‘‘natural’’ treatments, often called ‘‘testosterone boosters,’’ or ‘‘testosterone enhancers.’’ These agents are often marketed as improving sex drive and sexual performance, strength, and muscle mass. They are also claimed to be ‘‘safe’’ because they have the ‘‘advantage’’ of being composed of natural ingredients.11–16 Since there is no scientific literature that reviews the effects of T-boosters, which are usually composed of multiple agents, we here review the available data for the individual supplement components that are frequently found in T-boosters.
*Testosterone boosters
*History of T-boosters
Results
-Tribulus Terrestris
-Fenugreek
-Zinc
-Ashwagandha
-Maca
-Melatonin
Discussion
*At present, there is inadequate evidence to support the use of T-boosters to increase total, free, or bioavailable T, for the treatment of symptoms of T deficiency and male infertility, or to increase strength and muscle mass or enhance training endurance
*To date, there appear to be no studies or clinical trials with any T-booster currently available on the market. Nor are there any head-to-head clinical trials comparing T therapy and T-boosters or individual supplements. Therefore, the true effects of T-boosters are unknown. Although it remains possible that these agents may have some degree of efficacy, and that this may be demonstrated in the future with adequate studies, at this time it is impossible to recommend any of them
Conclusion
The current scientific literature fails to provide adequate data to support the use of T-boosters or their underlying components. Use of these products should be discouraged, at least until there is solid evidence demonstrating benefits and safety. Healthcare professionals should ask about supplement use when patients come seeking medical advice.
The consequences of these products on public health and the economy are unknown. This issue demands immediate attention and further study from health authorities and practitioners worldwide.
Adrian Andres Aguilar-Morgan, Abraham Morgentaler, and Luis Antonio Reyes-Vallejo
Abstract
In the past decade, there has been an increased interest in alternative treatments to testosterone (T) and androgen derivatives. This has led to the development of supplements known as ‘‘testosterone boosters’’ (T-boosters) or ‘‘testosterone enhancers.’’ The internet is the main source for the purchase of these products with sales reaching millions of dollars. The search for T-boosters is focused on improvement in sexual performance, muscular strength, and increased muscle mass using agents considered ‘‘natural,’’ which are thereby presumed to lack serious adverse effects. Some of these supplements have been used since antiquity. Commercially sold T-boosters nearly always comprise multiple supplements, and none of these combinations have undergone rigorous evaluations, as would be required for regulatory approval for pharmaceutical products. This makes it challenging to evaluate marketing claims. However, the limited scientific literature does exist on the primary individual agents in most T-boosters. The most commonly used agents are Tribulus Terrestris, fenugreek, zinc, maca, and ashwagandha (‘‘Indian ginseng’’). Those studies form the basis of this review. Although some studies have offered suggestive results indicating possible increases in serum T, the data are inconsistent, and studies differ widely in methods, including supplement dosage. In addition, serious adverse events have been reported. Currently, the existing literature fails to support the use of these products.
Introduction
Testosterone (T) therapy is an efficacious and safe treatment in cases of male T deficiency, and interest in the research into its approach in different fields has been recently increasing. The American Association of Clinical Endocrinologists (AACE), the American Urological Association (AUA), and the European Association of Urology recommend the use of T in patients with clear signs and symptoms of hypogonadism.1–3 T therapy has been shown to have well-documented beneficial effects on erectile function, bone marrow, muscle mass, strength, and fatty tissue, as well as on metabolism control.4–6
The past decade has seen an increase in the search for alternative treatments that may provide similar benefits as androgens on muscle mass, strength, and fatty tissue without the side effects most feared by athletes and bodybuilders, such as testicular atrophy and infertility that has led to a surge in the use of various agents that increase T, approved by the Food and Drug Administration (FDA), with narrow indications.7–9 Physicians should be aware of the information regarding the efficacy and toxicity of those substances commonly used by their patients. These products may interfere with the hypothalamic–pituitary–testicular axis affecting hormonal balance, fertility, and sexual performance.10
Although there are a number of alternative medical therapies to T therapy, including human chorionic gonadotropic, aromatase inhibitors, and selective estrogen receptor modulators,10 there is a considerable public interest for nonprescription, ‘‘natural’’ treatments, often called ‘‘testosterone boosters,’’ or ‘‘testosterone enhancers.’’ These agents are often marketed as improving sex drive and sexual performance, strength, and muscle mass. They are also claimed to be ‘‘safe’’ because they have the ‘‘advantage’’ of being composed of natural ingredients.11–16 Since there is no scientific literature that reviews the effects of T-boosters, which are usually composed of multiple agents, we here review the available data for the individual supplement components that are frequently found in T-boosters.
*Testosterone boosters
*History of T-boosters
Results
-Tribulus Terrestris
-Fenugreek
-Zinc
-Ashwagandha
-Maca
-Melatonin
Discussion
*At present, there is inadequate evidence to support the use of T-boosters to increase total, free, or bioavailable T, for the treatment of symptoms of T deficiency and male infertility, or to increase strength and muscle mass or enhance training endurance
*To date, there appear to be no studies or clinical trials with any T-booster currently available on the market. Nor are there any head-to-head clinical trials comparing T therapy and T-boosters or individual supplements. Therefore, the true effects of T-boosters are unknown. Although it remains possible that these agents may have some degree of efficacy, and that this may be demonstrated in the future with adequate studies, at this time it is impossible to recommend any of them
Conclusion
The current scientific literature fails to provide adequate data to support the use of T-boosters or their underlying components. Use of these products should be discouraged, at least until there is solid evidence demonstrating benefits and safety. Healthcare professionals should ask about supplement use when patients come seeking medical advice.
The consequences of these products on public health and the economy are unknown. This issue demands immediate attention and further study from health authorities and practitioners worldwide.
