Research1 from an international consultation in collaboration with the major urology and sexual medicine associations from 60 countries showed that the prevalence of sexual dysfunction increases with age. Approximately 20 to 30 percent of adult men had at least one manifest sexual dysfunction, and the study also found that the incidence rate for erectile dysfunction (ED) was 25 to 30 cases per thousand-person years and increased with age. Likewise, an analysis2 of data from the National Health and Social Life Survey indicated that the prevalence of sexual dysfunction was 31 percent in men.
Furthermore, research3 indicates that testosterone levels in men fall progressively with age and that 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). Some studies4 show that men experience a gradual and progressive decline in total testosterone levels that take place at a rate of approximately 1 percent per year beginning in their thirties, while other studies5 show an average annual decline of 1 to 2 percent total T levels, with an even more rapid decline in free T. Ramifications of this decline in testosterone include a reduction in libido and sexual function, interfering with intimacy in romantic relationships, while also eroding self-confidence and quality of life.
One particular herbal medicine, Tongkat Ali—and specifically, an extract known as LJ100—has been shown to provide benefits to men with regard to sexual dysfunction, increased testosterone and male fertility.
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/sexual stimulant properties for which it has been widely used and recognized.6-9 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, and is discussed below. It should be noted that 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, any research citing the use of either is applicable to both.
Human Study 1
In a three-week, randomized open trial,10 30 subjects (married men whose age ranges between 31 and 52 years) received 100 mg/day of LJ100. Blood samples were collected at baseline, one week, and three weeks, and measurements were taken for total testosterone hormone, DHEA sulfate (DHEA), and sex hormone-binding globulin (SHBG) levels. In addition, the subjects filled out two questionnaires: (1) a validated sexual health inventory questionnaire (SHIQ) and (2) the partial androgen deficiency in aging men (PADAM) score questionnaires. Results showed that DHEA (a hormonal precursor to androgens like testosterone) levels gradually increased from 26 percent after one week to 47 percent after three weeks. SHBG levels decreased in 36 percent of the cases after one week, and 66 percent after three weeks. This is valuable since SHBG can bind to testosterone, making it temporarily unavailable for use by the body. In addition, the free testosterone index escalated in 39 percent of the subjects after one week to 73 percent after three weeks. Furthermore, analysis of the SHIQ questionnaire results demonstrated that 62 percent of the cases had either increased or maximum scores after consuming LJ100. Analysis of the PADAM score showed 91 percent improvement of sexual component of PADAM score, 73 percent improvement in physical component, and 82 percent improvement of psychological component of PADAM score.
Human Study 2
In a 10-day, open label clinical trial,11 testosterone was tested via saliva samples on nine individuals (26 to 52 years of age), five of whom were athletes. All volunteers received 100 mg of LJ100 twice daily, once in the morning and once in the evening. Results show that the average increase in testosterone for all subjects was 71.55 percent, with a 90.52 percent increase in athletes only, and a 47.83 percent increase in nonathletes.
Human Study 3
As the first placebo-controlled study,12 30 male subjects were recruited from a 24-hour mountain biking event were asked to provide a saliva sample before and after each lap for measurement of cortisol and testosterone. Half of the subjects consumed 100 mg of Physta and the other half consumed a placebo approximately 30 minutes prior to performing four laps (14.91 miles/lap). Compared to placebo, results showed that cortisol levels were 32.3 percent lower and testosterone levels were 16.4 percent higher with Physta, causing the researchers to conclude that Physta may help promote an overall anabolic hormonal state during intense endurance exercise.
Human Study 4
The next double-blind, placebo-controlled human clinical trial13 was conducted with 20 male volunteers (of various health conditions) from the ages of 38 to 58. They were randomly given 200, 400 or 600 mg* Physta or placebo daily for two months. Their testosterone, DHEAS, and other blood parameters were tested, and they also completed two scientifically validated questionnaires. One was sexual health inventory for men (SHIM), which measures sexual health parameters and ED, and the other was aging male symptom (AMS), which helps determine if the subjects has “andropause” (i.e. reduced testosterone levels). The results were that all three dosage levels resulted in improved SHIM scores and showed improvements in sexual desire and performance. Likewise, the AMS score showed improvement in sexual, physical, psychology and vasomotor (i.e. circulation) domains for the majority of volunteers. Testosterone and DHEAS levels showed high normal levels when compared to baseline. Diabetic volunteers showed an improved level of blood glucose, and cortisol levels suggested that the extract modulates the release of cortisol.
Human Study 5
An open label trial14 was conducted to investigate the effect of treatment with 200 mg/day Physta in managing idiopathic male infertility. The study measured semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility in 75 male partners of sub-fertile couples. Results showed that the average sperm motility at the first cycle of treatment was significantly increased from baseline (P = 0.037). Average sperm concentration was also increased from baseline (65.5 percent, P = 0.007) and sperm with normal morphology (94.9 percent, P = 0.007) occurred in the third cycle. Additionally, there were 11 (14.7 percent) spontaneous pregnancies during this time, six of which were achieved at completion of the first cycle of treatment and five of which were achieved at completion of two cycles of treatment.
Human Study 6
The next randomized, double-blind, placebo-controlled study15 took place over 12 weeks, and investigated the efficacy of 300 mg/day Physta versus placebo for various parameters of quality-of-life and sexual health/wellbeing in 109 men (30-55 years). The results were that, compared to placebo, the Physta group experienced significant improvements in physical functioning to week 12 (P = 0.028). The Physta group also showed higher scores in the overall erectile function domain (P < 0.001), sexual libido (14 percent by week 12), and improvements in in sperm motility at 44.4 percent, and semen volume at 18.2 percent at the end of treatment. Furthermore, overweight subjects with BMI ≥ 25 kg/m2 significantly improved in fat lost (P = 0.008).
Human Study 7
Seventy-six patients with late-onset hypogonadism (i.e. low testosterone level) were given 200 mg/day of Physta for one month in an open label trial.16 Patients were tested using AMS rating scale and serum testosterone concentrations. Results show that Physta significantly (P < 0.0001) improved the AMS score as well as the serum testosterone concentration. Before treatment, only 10.5 percent of the patients had a normal AMS score, and after treatment 71.7 percent of patients had a normal score. Likewise, before treatment, 35.5 percent of patients had normal testosterone levels, after treatment 90.8 percent of the patients had normal levels. The researchers concluded that Physta appears to be useful as a supplement in overcoming the symptoms of, and managing late-onset hypogonadism.
Human Study 8
Another randomized, placebo-controlled trial17 assessed stress hormones and mood state in 63 moderately stressed subjects (32 men and 31 women) who were supplemented with 200 mg/day Physta or placebo for four weeks. Results showed significant improvements (P < 0.05) in the Physta group for tension (−11 percent), anger (−12 percent), and confusion (−15 percent). Physta also significantly reduced the stress hormone cortisol (−16 percent, P < 0.05) and increased testosterone (+37 percent, P < 0.05). Researchers concluded that daily supplementation of Physta may be an effective approach to shielding the body from the detrimental effects of “modern” chronic stress, which may include general day-to-day stress, as well as the stress of dieting, sleep deprivation and exercise training.
Human Study 9
A five-week pilot study18 investigated the ergogenic effects of 200 mg Physta, twice daily, in 13 physically active males, and 12 physically active females (57–72 years). The results showed significant respective increases in total testosterone and free testosterone in men (P=0.0090 and P=0.005) and women (P=0.0098 and P=0.0032), was well as a significant increase in muscular force in men (P=0.0375). The increase in free testosterone in women is thought to be due to the significant decline in SHBG concentrations. The study affirms the ergogenic benefit of Physta through enhanced muscle strength.
Human Study 10
A 12-week, double-blind, placebo-controlled study19 examined the efficacy of Physta (200 mg/day) together with the antioxidant herb Polygonum minus (100 mg/day), compared to placebo, on sexual performance and well-being in 26 men (aged 40–65). Several validated questionnaires were used to evaluate erectile function, satisfaction with intervention, sexual intercourse performance, erectile hardness, mood, and overall quality of life. Results indicated significant improvements in scores for the erection hardness scale (EHS), SHIM and AMS compared to palcebo. This included improvements in foreplay preceding attempted intercourse and erection rating during sexual intercourse attempt (P<0.05), ability to achieve some erection, ability to achieve vaginal insertion, erection long enough for successful intercourse, and satisfaction with sexual experience (P < 0.0005). The researchers concluded that supplementation for 12 weeks with Physta and P. minus was well tolerated and more effective than placebo in enhancing sexual performance in healthy volunteers.
Human Study 11
In the midst of working to improve sexual function through the use of a nutraceutical, it is important to consider other effects that the nutraceutical may have on the body in addition to sexually related effects. In the case of LJ100, a four-week, randomized, double-blind, placebo-controlled study20 was conducted examining the effects of this herbal extract on immunity in 83 subjects in a middle-aged population. Subjects received 200 mg/day of LJ100 or a placebo. The results demonstrated that scoring of immunological vigor were significantly higher in the LJ100 group than those in placebo group (p < 0.05). The number of CD4(+) T cells (a type of immune cell) were also higher in the LJ100 group than those in P group (p < 0.05). Consequently, the “side effect” of LJ100 seems to be that it enhances comprehensive immunity in both middle-aged men and women.
While various dose ranges were used in human research on Physta/LJ100, 200 mg/day was used in seven out of the 11 studies cited, suggesting that this is a good dose to consider. Also, there appears to be more than one mechanism of action, including the biosynthesis of various androgens, the stimulation of DHEA (which initiates the conversion of androstenedione and androstenediol to testosterone), and which may also reduce SHBG to subsequently increase free testosterone levels.21 Finally, in the previously cited research, no adverse reactions were reported, and there are no reported drug interactions associated with E. longifolia Jack supplementation, aside from the recommendation that it be taken separately from the beta-blocker propranolol, since taking them together may decrease absorption of the drug in the gut.22
*This was a poster presentation from the Proceedings of the Third Asia-Pacific Forum on Andrology, published in Asian Journal of Andrology. Since the abstract lacked some data about which doses were associated with efficacy, the author was contacted and provided the information that efficacy was achieved at all three dosage levels.
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2 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999 Feb 10;281(6):537-44.
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 Matsumoto AM. Andropause: Clinical Implications of the Decline in Serum Testosterone Levels With Aging in Men. Journal of Gerontology. 2002. 57A(2):M76–M99.
5 Araujo AB, Wittert GA. Endocrinology of the Aging Male. Best Pract Res Clin Endocrinol Metab. 2011 April ; 25(2): 303–319.
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7 Handa, S.S., Rakesh, D.D., and Vasisht, K. 2006. Compendium of Medicinal and Aromatic Plants—Volume II: Asia. Trieste, Italy: ICS-UNIDO.
8 Ramawat, K.G. (ed.). 2009. Herbal Drugs: Ethnomedicine to Modern Medicine. Heidelberg, Germany: Springer-Verlag.
9 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.
10 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.
11 Unpublished. n.d. LJ100 Saliva Testosterone Test. HP Ingredients. Bandenton, PL. www.hpingredients.com/lj100_human_clinical_research.htm (accessed August 24, 2012).
12 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.
13 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.
14 Tambi, M.I. and Imran, M.K. Eurycoma longifolia Jack in managing idiopathic male infertility. Asian J Androl 2010;12:376–380.
15 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.
16 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.
17 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.
19 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.
19 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.
20 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.
21 Effendy, N.M., Mohamed, N., Muhammad, N., Mohamad, I.S., and Shuid, A.N. Eurycoma longifolia: Medicinal plant in the prevention and treatment of male osteoporosis due to androgen deficiency. Evid Based Complement Alternat Med 2012;Article ID 125761:9pp.
22 Natural Medicines Comprehensive Database. 2014. Therapeutic Research Faculty. Stockton, CA. http://naturaldatabase.therapeuticresearch.com.
Gene Bruno, MS, MHS, the dean of academics for Huntington College of Health Sciences, is a nutritionist, herbalist, writer and educator. For more than 30 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 email@example.com.