Does ashwagandha supplementation increase serum testosterone levels in healthy adult men?

Ashwagandha and Male Testosterone Levels

Ashwagandha supplementation does increase serum testosterone levels in men, with clinical trials demonstrating increases ranging from 22-33% in stressed populations and approximately 57 ng/dL overall in men (but not in women). 1, 2

Evidence Quality and Strength

The available evidence comes exclusively from research studies, as no clinical guidelines address ashwagandha supplementation—the provided ACP guidelines 3 only address pharmaceutical testosterone replacement therapy for age-related low testosterone, not herbal supplements.

The most recent and comprehensive evidence is a 2026 systematic review and meta-analysis 1 that pooled data from 23 randomized controlled trials involving 1,706 patients. This analysis found:

• Testosterone increased by 57.43 ng/dL in men (statistically significant)
• No testosterone increase in women (5.09 ng/dL, not significant)
• Sex-specific effect confirmed with significant gender differences

Clinical Trial Evidence

Strongest Supporting Studies

The 2024 Shoden trial 2 provides the most robust single-study evidence:

• 60 subjects with high stress and elevated cortisol (>25 mcg/dL)
• Testosterone increased 22% with 60mg dose and 33% with 120mg dose of ashwagandha extract (35% withanolide glycosides)
• Placebo group showed only 4% increase
• Highly significant difference (p < 0.0001)
• Concurrent 66-67% reduction in morning cortisol levels

The 2026 sexual health trial 4 in 76 healthy men aged 30-50 demonstrated:

• 300mg twice daily for 8 weeks
• 36% increase in ejaculate volume
• 38% improvement in total sperm count
• 87% increase in total sperm motility
• Significant improvements in sexual function measures

Mechanism of Action

The testosterone-boosting effect appears to operate through multiple pathways:

1. HPA axis modulation: Ashwagandha significantly reduces cortisol (standardized mean difference = -1.18, p < 0.04) 1, which removes cortisol's suppressive effect on testosterone production
2. Direct testicular support: Preclinical evidence suggests protection of Leydig cells and steroidogenic enzyme function 5
3. Stress reduction: By lowering psychological stress, it may restore normal hypothalamic-pituitary-gonadal axis function 2

Dosing Considerations

Based on the evidence:

• Effective dose range: 60-300mg twice daily (120-600mg total daily)
• Withanolide content matters: Extracts standardized to 35% withanolide glycosides showed strongest effects 2
• Duration: Significant effects observed at 8-12 weeks
• Dose-response relationship: Higher withanolide content may produce greater effects 1

Critical Context and Limitations

Population-Specific Effects

The testosterone increase is sex-specific and context-dependent:

• Men with high stress/elevated cortisol show the largest gains 2
• Healthy men with normal baseline testosterone also benefit 4
• Women do not experience testosterone elevation 1, 6, which is clinically important for safety
• Most studies enrolled men under 40 years old 7, limiting generalizability to older populations

Evidence Gaps

1. No long-term safety data beyond 12 weeks
2. Heterogeneity in extract standardization across studies makes direct comparisons difficult
3. Small sample sizes in individual trials (typically 50-76 participants)
4. No head-to-head comparison with pharmaceutical testosterone therapy
5. Unknown effects in men with organic hypogonadism (Klinefelter syndrome, pituitary disorders, etc.)

Clinical Application Algorithm

For men seeking testosterone optimization:

1. If high stress/anxiety with suspected elevated cortisol: Ashwagandha 60-120mg twice daily (35% withanolide extract) is strongly supported 2

2. If healthy men with sexual function concerns: Ashwagandha 300mg twice daily shows clear benefit for testosterone, sperm parameters, and sexual function 4

3. If age-related low testosterone with symptoms: Consider ashwagandha as adjunctive or alternative to pharmaceutical therapy, but recognize this is extrapolated evidence—trials primarily enrolled younger men 7

4. Reassess at 8-12 weeks: Measure testosterone levels and symptom improvement; discontinue if no benefit

Safety Profile

All reviewed trials reported no adverse events with ashwagandha supplementation 2, 4. However:

• Long-term cardiovascular and prostate safety unknown (unlike pharmaceutical testosterone where concerns exist 3)
• Not FDA-approved for testosterone deficiency
• Quality and standardization vary significantly between commercial products
• Should not replace evaluation for organic causes of hypogonadism

Comparison to Pharmaceutical Testosterone

The ACP guidelines 3 note that pharmaceutical testosterone therapy provides only small improvements in sexual function with low-certainty evidence and unknown long-term safety. Ashwagandha's 22-33% testosterone increase 2 and demonstrated improvements in sexual function 4 suggest comparable or potentially superior benefit-to-risk ratio for men without organic hypogonadism, though direct comparative trials are lacking.

The critical distinction: FDA-approved testosterone is indicated only for men with hypogonadism from known organic causes 3, while ashwagandha evidence primarily comes from men with stress-related or functional testosterone concerns.