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Research Update: Tongkat Ali for Aging Males, Aging Females & Young Athletes

Tongkat Ali Tongkat Ali
EuroMedica
 
Kaneka

In June of 2018 Vitamin Retailer (Natural Practitioner’s sister publication) published my article, “Tongkat Ali: Herbal Medicine for Sexual Dysfunction, Increased Testosterone and Male Fertility.” This particular article focused the effects of the herbal medicine tongkat ali on sexual health related issues in men—especially aging men. In this article, I’ll present new research on tongkat ali for aging males, aging females and young athletes. First, though, let’s review some background data about testosterone and about tongkat ali.

Testosterone Background

Testosterone (T) levels in men fall progressively with age, with some studies1 showing that men experience a gradual and progressive decline in total T levels that take place at a rate of approximately 1 percent per year beginning in their thirties. Other studies2 show an average annual decline of 1-2 percent total T levels, with an even more rapid decline in free T. Furthermore, a significant percentage of men over the age of 60 years have serum T levels that are below the lower limits of young adult men (age 20-30 years).3 For men, symptoms of this decline in testosterone may include reduced libido, fatigue and lean muscle mass, along with irritability, erectile dysfunction and depression. This can translate into interference with with intimacy in romantic relationships, as well as eroding self-confidence and quality of life. Low T in women is associated with some of these same symptoms as well as hot flashes and osteoporosis.

Tongkat Ali Background

Eurycoma longifolia Jack is an herbal medicinal plant of southeast Asian origin (Malaysia, Thailand and Indonesia), commonly known as tongkat ali (meaning Ali’s walking stick). The plant parts have been traditionally used for its antimalarial, antidiabetic, antimicrobial and antipyretic activities, but it is its aphrodisiac/testosterone promoting properties for which it has been widely used and recognized.4-7 Human clinical research on LJ100, a specific extract of tongkat ali (known in Europe as Physta) is the basis for many of the modern, science-based claims for this herb LJ100 consists of freeze-dried E. longifolia root extracts standardized to 22 percent eurypeptides and 40 percent glycosaponins. Since LJ100 and Physta are the same extract, throughout this article I will refer to it as LJ100 to prevent any confusion.

Previously Discussed Studies

In my aforementioned article, I reviewed research showing that tongkat ali extract (as LJ100) was shown to:

• Increase total T and DHEA levels in married men between the ages of 31 and 52 years,8

• Increase total T in athletes and non-athletes between the ages of 26–52 years of age),9

• Reduce cortisol and increase total T in mountain bikers,10

• Increase total T and DHEA levels and sexual health scores in men between the ages of 38 and 58 years,11

• Improve sperm morphology, and sperm motility in 75 male partners of subfertile couples,12

• Improved physical functioning, erectile function, libido, sperm mobility and semen volume in men between the ages of 30–55 years,13

• Improve total T levels and other parameters in additional studies.14-18

Now let’s take a look at the most recent research on tongkat ali extract.

Tongkat Ali in Aging Males

As previously noted, low testosterone levels cause physiological changes that compromise the quality of life in aging men. This randomized, double-blind, placebo-controlled study published in 202119 evaluated the safety and efficacy of tongkat ali in improving T levels and quality of life in 105 male subjects aged 50–70 years, with a low T level. The subjects were given either tongkat ali extract (as LJ100) 100 mg, 200 mg or placebo daily for 12 weeks. Results were that there was a significant increase in the total T levels at week 12 (P < 0.05) in the tongkat ali 100 mg group and at weeks 4 (p < 0.05), 8 (p < 0.01) and 12 (p < 0.001) in the tongkat ali 200 mg group compared to placebo. A significant within-group increase in free T occurred at weeks 4 (p < 0.01), 8 (P < 0.001) and 12 (p < 0.001) in the tongkat ali 100 mg group and at weeks 2 (P < 0.01), 4 (p < 0.01), 8 (P < 0.001) and 12 (p < 0.001) in the tongkat ali 200 mg group. The Aging Male Symptoms (AMS) score and Fatigue Severity Scale (FSS) score showed significant reductions (p < 0.001) in total scores at all time-points within- and between-group in both tongkat ali groups. DHEA levels also significantly increased (p < 0.05) within-group in both tongkat ali groups from week 2 onward. Cortisol levels significantly (p < 0.01) decreased in the tongkat ali 200 mg group, while muscle strength significantly (p < 0.001) increased in both tongkat ali groups at week 12 in the within-group comparison. No safety related clinically relevant changes were observed. In conclusion, supplementation with tongkat ali at 200 mg was able to increase the serum total testosterone, reduce fatigue and improve the quality of life in aging men within two weeks’ time—a meaningful result in a very short period of time.

Published in 2021, another six-month, randomized, double-blinded, placebo controlled clinical trial20 analyzed the effects of a concurrent training (CT) associated with tongkat ali (TA) supplementation on the muscle strength, cardiorespiratory fitness, and symptomatology score in aging men (47.6 ± 5.2 years) with androgen deficiency. Participants were randomized into four groups, control (C; n = 12); TA (n = 11); CT (n = 11); and CT + TA (n = 11). The TA groups received 200 mg/day of TA (as LJ100). Results were that the isokinetic peak torque of the knee extensors increased in the CT (14 percent) and CT + TA (17 percent) groups (p = 0.040; p = 0.006, respectively), while isokinetic peak torque of knee flexion increased in the CT + TA group only (p < 0.05). For all participants, testosterone levels were correlated with isokinetic peak torque of knee extension (p = 0.001) and flexion (p = 0.028). Subjects of the CT (27.3 percent) and CT + TA (36.1 percent) groups decreased the symptomatology of androgen deficiency (p = 0.005). This study demonstrated the benefits of CT and TA consumption as a non-pharmacological treatment for androgen deficiency.

Also published in 2021, a third six-month, randomized, double-blind, placebo-controlled four-arm clinical trial21 was conducted for the purpose of ascertaining the effect of concurrent training and supplementation with TA on erectile function and testosterone levels in men with androgen deficiency, and assessing the association of erectile function with levels of total testosterone. Forty-five male participants (47.38 ± 5.03 years) were randomized into four groups (G1: control + placebo; G2: control + TA; G3: concurrent training + placebo; G4: concurrent training + TA). Twenty-two received a 200 mg supplement of TA (as LJ100) and 23 underwent the intervention with concurrent training, three times a week for 60 min at progressive intensity. Results were that erectile function demonstrated improvements in both interventions; however, the most significant results were obtained by men allocated to concurrent training + TA. In conclusion, the combination of TA and concurrent training improved erectile function and increased total testosterone levels in men with androgen deficiency.

TA in Young Healthy Adults

Previous TA research focused primarily on older populations. This double-blind, placebo-controlled, matched-paired study published in 202122 aimed to assess the impact of TA on the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal axes in 32 healthy young males (24.4 ± 4.7 years) to determine if this might promote functional testosterone prowess. Subjects received 600 mg/day TA extract (as LJ100) or placebo for two weeks. Blood analysis showed significant differences in levels of testosterone (p = .005), free testosterone (p = .012) and estradiol (p = .008) levels in the TA group, while the placebo group did not reach statistical significance. The lack of changes in luteinising hormone and follicle-stimulating hormone levels suggests that a lesser role played by TA in activating the hypothalamic-pituitary-gonadal axis in the young adults. The raised testosterone level may be due to a greater rate of hormone production via the hypothalamic-pituitary-adrenal axis. The supplementation of TA for two weeks demonstrates steroidogenic effects on young men were dose related. Consequently, the raised testosterone following TA supplementations could benefit muscle and strength gain in young adults.

TA in Aging (Menopausal) Females

In 2020, a randomized, double-blind, placebo-controlled, 24-week study was published23 with 119 healthy women aged 41-55 years, experiencing peri-menopausal or menopausal symptoms. The study was conducted to determine effectiveness of a combination of Labisia pumila (a traditional herbal medicine of Malaysia and Indonesia) and TA extract (as LJ100) or placebo in changing in the frequency and severity of hot flashes. Secondary endpoints were also assessed, including concentrations of serum hormones and lipid profile. Results were that, at week 12, significant (p < 0.01) improvements in hot flash symptoms were observed in the combination Labisia pumila and TA group and placebo group. Even though there was no significant difference between groups, there was a higher percentage of improvement in the combination group: 65 percent compared to 60 percent in placebo. Luteinizing hormone and follicle-stimulating hormone levels were significantly reduced (P < 0.05) at weeks 12 and 24, respectively, compared to baseline in the combination group, with no significant changes observed in the placebo group. There were also meaningful increases in total T and free T in the combination group at week 12 but not the placebo group. There were significant (P < 0.05) reductions in serum low-density lipid and triglycerides levels at week 12 in the combination group, but no changes seen in placebo group. At the end of week 24, changes in hematology and clinical chemistry parameters remained within normal clinical ranges in both groups. In conclusion, the combination of L. pumila and TA may support reduction in hot flushes and improvements in hormone and lipid profile in healthy peri-menopausal and menopausal women.

Conclusions

TA is an herbal medicine with a body of research demonstrating efficacy for sexual dysfunction, increasing testosterone and improving male fertility. New research published between 2020 and 2021 further demonstrated that TA was able to increase total testosterone, reduce fatigue and improve the quality of life in aging men within two weeks’ time, raise testosterone, which could benefit muscle and strength gain in young adults, and reduce hot flushes and improve hormone and lipid profiles in healthy peri-menopausal and menopausal women.

References:

1 Matsumoto AM. Andropause: Clinical Implications of the Decline in Serum Testosterone Levels With Aging in Men. Journal of Gerontology. 2002. 57A(2):M76–M99.

2 Araujo AB, Wittert GA. Endocrinology of the Aging Male. Best Pract Res Clin Endocrinol Metab. 2011 April ; 25(2): 303–319. 3 Wang C, Nieschlag E, Swerdloff R, Behre HM. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol. 2008;159:507–514.

4 Bhat, R. and Karim, A.A. Tongkat Ali (Eurycoma longifolia Jack): A review on its ethnobotany and pharmacological importance. Fitoterapia 2010;81:669–679.

5 Handa, S.S., Rakesh, D.D., and Vasisht, K. 2006. Compendium of Medicinal and Aromatic Plants—Volume II: Asia. Trieste, Italy: ICS-UNIDO.

6 Ramawat, K.G. (ed.). 2009. Herbal Drugs: Ethnomedicine to Modern Medicine. Heidelberg, Germany: Springer-Verlag.

7 Singh, R., Singh, S., Jeyabalan, G., and Ali, A. An overview on traditional medicinal plants as aphrodisiac agent. J Pharmacogn Phytochem 2012;1:43–56.

8 Tambi, M.I.M. and Saad, J.M. Water-soluble extract of Eurycoma longifolia Jack soluble extract as a potential natural energizer for healthy aging men. Unpublished. Specialist Reproductive Research Center, National Population & Family Development Board, Ministry of Women & Family Development, Malaysia. 2000:9pp.

9 Unpublished. n.d. LJ100 Saliva Testosterone Test. HP Ingredients. Bandenton, PL. www.hpingredients.com/lj100_human_clinical_research.htm (accessed August 24, 2012).

10 Talbott, S., Talbott, J., Negrete, J., Jones, M., Nichols, M., and Roza, J. Poster 32: Effect of Eurycoma longifolia extract on anabolic balance during endurance exercise. JISSN 2006;3:S32.

11 Tambi, M.I. Nutrients and botanicals for optimizing men’s health. Examining the evidence for Eurycoma longifolia longjack, the Malaysian Ginseng in men’s health. Asian J Androl 2009;11:37–38.

12 Tambi, M.I. and Imran, M.K. Eurycoma longifolia Jack in managing idiopathic male infertility. Asian J Androl 2010;12:376–380.

13 Ismail, S.B., Mohammad, W.M.Z.W., George, A., Hussain, N.H.N., Kamal, Z.M.M., and Liske, E. Randomized clinical trial on the use of PHYSTA freeze-dried water extract of Eurycoma longifolia for the improvement of quality of life and sexual well-being in men. Evid Based Complement Alternat Med 2012;Article ID 429268:10pp.

14 Tambi MI, Imran MK, Henkel RR. Standardised water-soluble extract of Eurycoma longifolia, Tongkat ali, as testosterone booster for managing men with late-onset hypogonadism? Andrologia. 2012 May;44 Suppl 1:226-30.

15 Talbott, S.M., Talbott, J.A., George, A., and Pugh, M. Effect of Tongkat Ali on stress hormones and psychological mood state in moderately stressed subjects. JISSN 2013;10:28.

16 Henkel, R.R., Wang, R., Bassett, S.H., Chen T., Liu, N., Zhu, Y., and Tambi, M.I. Tongkat ali as a potential herbal supplement for physically active male and female seniors—A pilot study. Phytother Res 2014;28:544–550.

17 Udani, J.K., George, A.A., Musthapa, M., Pakdaman, M.N., and Abas, A. Effects of a proprietary freeze-dried water extract of Eurycoma longifolia (Physta) and Polygonum minus on sexual performance and wellbeing in men: A randomized, double-blind, placebo-controlled study. Evid Based Complement Alternat Med 2014; Article ID 179529:10pp.

18 George A, Suzuki N, Abas AB, Mohri K, Utsuyama M, Hirokawa K, Takara T. Immunomodulation in Middle-Aged Humans Via the Ingestion of Physta Standardized Root Water Extract of Eurycoma longifolia Jack–A Randomized, Double-Blind, Placebo-Controlled, Parallel Study. Phytother Res. 2016 Apr;30(4):627-35.

19 Chinnappan SM, George A, Pandey P, et al. Effect of Eurycoma longifolia standardised aqueous root extract–Physta on testosterone levels and quality of life in ageing male subjects: a randomised, double-blind, placebo-controlled multicentre study. Food Nutr Res. 2021; 65: 10.29219/fnr.v65.5647.

20 Leitão AE, de Carvalho Souza Vieira M, Gomes DA, et al. Exercise associated or not to the intake of Eurycoma longifolia improves strength and cardiorespiratory fitness in men with androgen deficiency. Complement Ther Clin Pract. 2021 Feb;42:101301.

21 Leitão AE, de Carvalho Souza Vieira M, Pelegrini A, et al. A 6-month, double-blind, placebo-controlled, randomized trial to evaluate the effect of Eurycoma longifolia (Tongkat Ali) and concurrent training on erectile function and testosterone levels in androgen deficiency of aging males (ADAM). Maturitas. 2021 Mar;145:78-85.

22 Chan KQ, Stewart C, Chester N, et al. The effect of Eurycoma Longifolia on the regulation of reproductive hormones in young males. Andrologia. 2021 May;53(4):e14001.

23 Chinnappan SM, George A, Evans M, Anthony J. Efficacy of Labisia pumila and Eurycoma longifolia standardised extracts on hot flushes, quality of life, hormone and lipid profile of peri-menopausal and menopausal women: a randomised, placebo-controlled study. Food Nutr Res. 2020 Sep 3;64.

Gene Bruno, MS, MHS, the provost for Huntington University of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 40 years he has educated and trained natural product retailers and health care professionals, has researched and formulated natural products for dozens of dietary supplement companies, and has written articles on nutrition, herbal medicine, nutraceuticals and integrative health issues for trade, consumer magazines and peer-reviewed publications. He can be reached at gene.bruno@hchs.edu.