Is tongkatali safe to use for medical purposes, such as treating low libido or erectile dysfunction?

Tongkat Ali (Eurycoma longifolia) for Low Libido and Erectile Dysfunction

Herbal therapies like Tongkat Ali are not recommended for the treatment of erectile dysfunction due to insufficient data on safety and efficacy from randomized controlled trials with independent data monitoring. 1

Evidence on Tongkat Ali

• Tongkat Ali (Eurycoma longifolia) is a herbal supplement commonly marketed for improving male libido, sexual prowess, and fertility 2, 3
• Some research suggests it may restore serum testosterone levels and improve sexual health in men with low testosterone 2, 4
• Laboratory studies indicate it may enhance testosterone production by inhibiting aromatase conversion of testosterone to estrogen 5
• Animal studies show dose-dependent increases in sexual performance, though less effective than testosterone replacement 6

Safety and Efficacy Concerns

• The American Urological Association (AUA) explicitly recommends against using herbal therapies for erectile dysfunction due to lack of documented safety and efficacy 1
• The lack of regulation for herbal therapies has permitted inconsistencies in:
  • Raw materials used
  • Manufacturing procedures
  • Identification of potentially active agents
  • Product potency and quality both within and between brands 1
• Some herbal products have been found to be contaminated with therapeutic levels of PDE5 inhibitors 1
• Most websites containing information about Tongkat Ali supplements have low quality ratings despite having low risk scores 3

Recommended First-Line Approaches for Sexual Dysfunction

For Low Libido in Men:

• First address modifiable factors:
  • Lifestyle modifications including weight loss and regular physical activity 7
  • Evaluation for drugs and substances that interfere with testosterone production/action 7
  • Check for comorbid metabolic diseases (obesity, metabolic syndrome, diabetes) 7

For Erectile Dysfunction:

• PDE5 inhibitors are the first-line treatment for erectile dysfunction 1
• For patients with low testosterone levels:
  • Testosterone replacement therapy is indicated for men with symptomatic hypogonadism 7
  • Combination of PDE5 inhibitors and testosterone therapy may be considered for more severe forms 7

Clinical Approach to Patients Interested in Tongkat Ali

• Inform patients about the lack of regulation and standardization of herbal products 1
• Discuss the potential risks of using unregulated supplements, including possible contamination 1
• Redirect patients toward evidence-based treatments with proven safety and efficacy profiles 1, 7
• Consider checking testosterone levels in men with low libido to determine if hypogonadism is present 7

Conclusion

While some preliminary research suggests potential benefits of Tongkat Ali for testosterone levels and sexual function, the current evidence is insufficient to recommend its use for medical purposes. Patients should be guided toward established treatments with proven safety and efficacy profiles for erectile dysfunction and low libido.