Herbs for Men’s Health: Plants as Phytoandrogens & Herbs for Fertility
In men, testosterone concentrations are known to decline with age. Until 30 to 40 years old, levels of bioavailable testosterone in men remain constant. However, declines in serum testosterone can be up to 40 to 50 percent lower by the time a man reaches age 60.1 This observation led to terms such as “andropause,” “late-onset hypogonadism,” and “testosterone deficiency syndrome” being used to describe a set of clinical and biochemical symptoms which occur in middle-age and elderly men. Symptoms may include low libido, increased fat mass, decreased muscle mass, loss of concentration, erectile dysfunction, depression, and decreased bone mineral density.2 Low total testosterone can also result in reduced quality of life and is closely linked with other medical conditions such as obesity, metabolic syndrome, diabetes, insulin resistance, glycemic control, and hypertension.2
Androgens are a group of sex hormones that play a role in reproductive health and body development, including male fertility and sexual function. For example, testosterone is the most common androgen – though both male and female bodies make androgens. Many medicinal herbs can be used to treat and prevent male health concerns, in particular those involving the health of the prostate and fertility challenges. This is in part through promoting beneficial effects related to testosterone concentrations.3 The presence of plant steroids referred to as phytoandrogens (much like phytoestrogens) are naturally occurring compounds which appear to have androgenic effects within the body and may help in the prevention of prostate cancer and other androgen-related diseases.4 Although the research into these compounds is relatively new, there appear to be several plants with promising effects partly due to these unique phytochemicals.
Infertility affects about 48.5 million couples worldwide, with male factor infertility accounting for nearly half of all cases.5 Several studies investigating associations between infertility with modifiable lifestyle factors have provided evidence that semen quality can be impaired by psychological stress, poor nutritional status, lack of physical exercise, obesity, caffeine intake, scrotal temperature, clothing, hot water, and mobile telephones. All of these factors may impact sperm parameters and induce DNA damage by reactive oxygen species (ROS).6-8 For thousands of years across various traditional medical models, herbs have been used for the treatment of male infertility and sexual dysfunction alongside healthy diet and lifestyle changes, as well as in conjunction with current conventional infertility treatments.9
Ashwagandha (Withania somnifera)
Ashwagandha is a well-known herb from India that has been commonly used as an adaptogen to enhance overall health, vigor, endurance, and in the treatment of male infertility for more than 3,000 years. Though its mode of action has not yet been fully elucidated, Ashwagandha root – and in particular its withanolides – are reported to have several beneficial effects on male fertility. It has been widely used for the treatment of erectile dysfunction, oligozoospermia (low sperm count), and other male reproductive health problems.10-12 Various human and animal studies describe a mechanism involving direct mitigation of oxidative stress though modulation of antioxidant activity, along with the regulation of antioxidant enzymes and co-factors required for the proper functioning of antioxidant enzymes. Additionally, proposed non-oxidative mechanisms include improved endocrine homeostasis and effects upon the hypothalamic-pituitary-gonadal (HPG) axis, as well as anti-stress activities via the hypothalamic-pituitary-adrenal (HPA) axis to improve male fertility.13 Moreover, a 16-week, randomized, double-blind, placebo-controlled, crossover study in overweight men aged 40 to 70 years found that Ashwagandha intake was associated with an 18 percent greater increase in DHEA-S and 14.7 percent greater increase in testosterone when compared to the placebo.14
Tribulus (Tribulus terrestris)
Tribulus is a fruit-bearing herb used traditionally in Ayurveda for diseases related to the genitourinary and reproductive systems such as cystitis, spermatorrhea, and impotence. Also considered to be an adaptogen, aphrodisiac, and rejuvenating tonic toward the kidneys, Tribulus is commonly used as a fertility agent in both sexes, having apparent indirect estrogenic activity in females and androgenic effects in males.15 Clinical trials using a standardized extract of furanostanol saponins from Tribulus (i.e., protodioscin) support its use in male infertility cases associated with impotence and low libido.16 In one randomized control trial, male patients with partial androgen deficiency suffering from erectile dysfunction saw significant elevations in both total testosterone and subjective scoring of erectile function when Tribulus was administered over three months.17 In an animal study, Tribulus’s aphrodisiac effects were suggested to result from an increase in androgens leading to a subsequent release of nitric oxide from the nerve endings innervating the corpus cavernosum.18
Korean Ginseng (Panax ginseng)
Ginseng is considered one of the most valued medicinal plants in Traditional Chinese Medicine due to its ability to increase vitality, longevity, and the capacity to withstand stress via activity upon the HPA axis. In TCM theory, it tonifies Qi (energy) and nourishes yin fluids, being associated with uses for both mood disturbance and sexual inadequacy. Triterpene saponins called ginsenosides found within the root appear to be the major active constituents responsible for observed increases of serum testosterone concentrations, enhancement of nitric oxide release, and improvements in copulatory behavior observed in animal models.19 Several clinical trials have supported the traditional uses of Ginseng for male sexual and fertility issues, and a recent systematic review and meta-analysis suggested it play an important role as an adjunct treatment for erectile dysfunction.20,21
- George, A., & Henkel, R. (2014). Phytoandrogenic properties of E urycoma longifolia as natural alternative to testosterone replacement therapy. Andrologia, 46(7), 708-721.
- Morales, A., Schulman, C. C., Tostain, J., & Wu, F. C. (2006). Testosterone deficiency syndrome (TDS) needs to be named appropriately–the importance of accurate terminology.
- Smith, S. J. et al. (2021). Examining the effects of herbs on testosterone concentrations in men: A systematic review. Advances in Nutrition, 12(3), 744-765.
- Chen, J. J., & Chang, H. C. (2007). By modulating androgen receptor coactivators, daidzein may act as a phytoandrogen. The Prostate, 67(5), 457-462.
- Mascarenhas, M. N. et al. (2012). National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS medicine, 9(12), e1001356.
- Ilacqua, A. et al. (2018). Lifestyle and fertility: the influence of stress and quality of life on male fertility. Reproductive Biology and Endocrinology, 16(1), 1-11.
- Gameiro, S. et al. (2015). ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction—a guide for fertility staff. Human Reproduction, 30(11), 2476-2485.
- Cho, C. L. et al. (2017). Clinical utility of sperm DNA fragmentation testing: concise practice recommendations. Translational Andrology and Urology, 6(Suppl 4), S366.
- Crimmel, A. S. et al. (2001). Withered Yang: a review of traditional Chinese medical treatment of male infertility and erectile dysfunction. Journal of andrology, 22(2), 173-182.
- Mahdi, A. et al. (2011). Withania somnifera improves semen quality in stress-related male fertility. Evidence-Based Complementary and Alternative Medicine, 2011.
- Ambiye, V. et al. (2013). Clinical evaluation of the spermatogenic activity of the root extract of Ashwagandha (Withania somnifera) in oligospermic males: a pilot study. Evidence-Based Complementary and Alternative Medicine, 2013.
- Ahmad, M. K. et al. 2010). Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertility and sterility, 94(3), 989-996.
- Sengupta, P. et al. (2018). Role of Withania somnifera (Ashwagandha) in the management of male infertility. Reproductive biomedicine online, 36(3), 311-326.
- Lopresti, A. et al. (2019). A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males. American journal of men’s health, 13(2), 1557988319835985.
- Bone, K., Simon Mills, M. C. P. P., & Fnimh, M. A. (2012). Principles and practice of phytotherapy: modern herbal medicine. Elsevier Health Sciences, pg. 894.
- Kamenov, Z. et al. (2017). Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction—a prospective, randomized, double-blind, placebo-controlled clinical trial. Maturitas, 99, 20-26.
- Gamal El Din, S.et al. (2019). Tribulus terrestris versus placebo in the treatment of erectile dysfunction and lower urinary tract symptoms in patients with late-onset hypogonadism: a placebo-controlled study. Urologia Journal, 86(2), 74-78.
- Gauthaman, K., Ganesan, A. P., & Prasad, R. N. V. (2003). Sexual effects of puncturevine (Tribulus terrestris) extract (protodioscin): an evaluation using a rat model. The Journal of Alternative & Complementary Medicine, 9(2), 257-265.
- Wang, X., Chu, S., Qian, T., Chen, J., & Zhang, J. (2010). Ginsenoside Rg1 improves male copulatory behavior via nitric oxide/cyclic guanosine monophosphate pathway. The journal of sexual medicine, 7(2 Pt 1), 743–750.
- Borrelli, F. et al. (2018). Herbal dietary supplements for erectile dysfunction: a systematic review and meta-analysis. Drugs, 78(6), 643-673.
- Park, H. J., Choe, S., & Park, N. C. (2016). Effects of Korean red ginseng on semen parameters in male infertility patients: a randomized, placebo-controlled, double-blind clinical study. Chinese journal of integrative medicine, 22(7), 490-495.