Is Tongat Ali safe and effective for treating male fertility or sexual health issues?

Tongkat Ali for Male Fertility and Sexual Health: Evidence-Based Assessment

Based on current evidence, Tongkat Ali (Eurycoma longifolia) cannot be recommended for treating male infertility or sexual health issues due to insufficient high-quality clinical evidence supporting its safety and efficacy. 1

Current Evidence on Tongkat Ali

Efficacy Considerations

• The WHO guidelines on male infertility strongly recommend against herbal therapies for treating abnormal semen parameters and male infertility based on very low quality evidence 1
• Studies evaluating herbal supplements like Tongkat Ali constitute only a small part of available literature, with heterogeneous methodologies making robust conclusions impossible 1
• Limited research shows:
  • Some animal studies suggest Tongkat Ali may increase testosterone levels and improve spermatogenesis by inhibiting aromatase and phosphodiesterase 2
  • Small human studies indicate potential benefits for late-onset hypogonadism symptoms 3, 4
  • Rat studies show increased sperm parameters and testosterone levels 5

Safety Concerns

• Adverse effects were reported in 16.6% of herbal therapy studies for male infertility 1
• No standardized dosing or quality control exists across commercially available products
• Online information about Tongkat Ali supplements is generally of low quality, potentially misleading consumers 6
• No long-term safety data exists for Tongkat Ali use in humans

Alternative Evidence-Based Approaches

For men concerned about fertility:

1. Avoid factors known to impair fertility:

   • Discontinue anabolic steroids, which suppress spermatogenesis 1
   • Consider reducing smoking, which may negatively affect sperm parameters 1
   • Adopt a diet lower in fats and higher in fruits and vegetables 1

2. For men with hypogonadism who desire fertility:

   • Discontinue exogenous testosterone therapy if currently using it 7
   • Consider evidence-based treatments like clomiphene citrate or human chorionic gonadotropin (hCG) 7
   • Monitor testosterone levels and semen parameters during treatment 7

3. Sperm preservation options:

   • Sperm cryopreservation is an established technique for fertility preservation 1
   • Consider this option before treatments that may affect fertility 1

Clinical Decision Algorithm

1. Evaluate baseline fertility status:

   • Obtain semen analysis to assess sperm parameters
   • Measure hormonal levels (FSH, LH, testosterone)
   • Identify any modifiable risk factors

2. Address modifiable factors first:

   • Discontinue harmful substances (anabolic steroids, excessive alcohol)
   • Optimize lifestyle factors (diet, exercise, stress management)
   • Treat any underlying conditions

3. For persistent issues:

   • Consider evidence-based medical therapies (clomiphene citrate, hCG)
   • Refer to reproductive specialist if needed
   • Discuss assisted reproductive technologies when appropriate

Important Caveats

• The methodological quality of most studies on herbal therapies for male infertility is poor 1
• Techniques to measure outcomes are not standardized between trials 1
• There is often a lack of clear pre-selection of appropriate subgroups for testing 1
• Men with abnormal semen parameters should be informed of associated health risks 1
• Advanced paternal age (≥40) carries increased risks of adverse health outcomes for offspring 1

Until large, well-designed randomized controlled trials with appropriate endpoints (live birth rates, clinical pregnancy rates) are conducted, Tongkat Ali should not be recommended as a treatment for male infertility or sexual health issues.