What are the effects of tongkat ali on testosterone levels?

Effects of Tongkat Ali on Testosterone Levels

Tongkat Ali (Eurycoma longifolia) may modestly increase testosterone levels in men with hypogonadism, but lacks sufficient high-quality evidence to recommend as a primary treatment for testosterone deficiency compared to conventional testosterone replacement therapy.

Mechanism and Evidence for Testosterone Effects

Tongkat Ali (TA) has been studied as a potential natural alternative to testosterone replacement therapy with some promising but limited results:

• In a study of men with late-onset hypogonadism, a standardized water-soluble extract of Tongkat Ali (200 mg daily for 1 month) significantly improved serum testosterone concentration, with 90.8% of patients showing normal testosterone levels after treatment compared to only 35.5% before treatment 1

• Another study found that 400 mg daily TA extract for 5 weeks significantly increased total and free testosterone concentrations in both elderly men and women, along with improved muscle strength 2

• TA appears to work by stimulating the release of free testosterone and may have additional benefits in reducing cortisol levels (stress hormone), with one study showing a 37% increase in testosterone status and 16% reduction in cortisol exposure 3

Comparison to Conventional Testosterone Therapy

While Tongkat Ali shows some promise, conventional testosterone replacement therapy (TRT) remains the standard treatment for hypogonadism with more robust evidence:

• The American College of Physicians and other guideline societies recommend TRT as the medical treatment for men with low testosterone levels, with target total testosterone levels of 450-600 ng/dL 4

• TRT has demonstrated improvements in sexual function, energy levels, muscle mass, bone mineral density, and overall well-being with moderate-strength evidence 4

• Unlike Tongkat Ali, conventional TRT has standardized dosing protocols and established monitoring parameters for safety 4

Safety Considerations

When considering any testosterone-enhancing treatment, several safety concerns must be monitored:

• Testosterone therapy requires monitoring of hematocrit (discontinue if exceeds 54%), PSA (consider biopsy if >4.0 ng/mL or increases >1.0 ng/mL/year), and other parameters 5, 4

• Testosterone therapy is contraindicated in patients with active prostate or breast cancer, hematocrit >50%, severe untreated sleep apnea, uncontrolled heart failure, and recent cardiovascular events 4

• Oral forms of testosterone (17-alpha-alkylated androgens) can lead to hepatotoxicity and should be avoided 5

• Testosterone therapy may exacerbate sleep apnea, particularly in men with other risk factors 5

Clinical Application

For patients considering Tongkat Ali for testosterone enhancement:

1. First confirm whether true testosterone deficiency exists through proper laboratory testing

   • Morning total testosterone levels
   • Evaluation of LH, FSH, thyroid function, and other hormones as appropriate 4

2. For diagnosed hypogonadism:

   • Conventional TRT remains the first-line treatment with stronger evidence
   • Tongkat Ali might be considered as a complementary approach or for patients with contraindications to TRT

3. For those who choose Tongkat Ali:

   • Standardized extracts (200-400 mg daily) appear most effective
   • Monitor testosterone levels and symptoms
   • Be aware that effects are likely more modest than conventional TRT

Limitations of Current Evidence

The evidence for Tongkat Ali has significant limitations:

• Most studies are small and of short duration
• Standardization of extracts varies between products
• Long-term safety data is lacking
• Effects appear less potent than conventional testosterone therapy

While Tongkat Ali shows promise as a natural approach to increasing testosterone levels, patients with clinically significant hypogonadism should be evaluated for conventional testosterone replacement therapy under proper medical supervision.