Ashwaganda, sexual health, and testosterone Original paper

    In this 8-week randomized controlled trial, ashwagandha was found to increase sexual health and serum testosterone levels in men, compared to placebo.

    This Study Summary was published on November 7, 2022.

    Background

    Stress, anxiety, and depression tend to be inversely associated with sexual health[1][2] and androgens (male sex hormones).[3] Ashwagandha root is an adaptogen (a substance that enables an organism to handle stress in a more resourceful manner) that has traditionally been used for its anxiolytic and aphrodisiac properties.[4] While few studies suggest that ashwagandha can provide benefits for reproductive health, more research is warranted due to its antioxidant, anxiolytic, and testosterone-boosting potential.[5]

    The study

    This 8-week randomized controlled trial included 50 adult men (average age of 35) with no health conditions who took either 600 mg of ashwagandha root extract (KSM-66 Ashwagandha® standardized to more than 5% total withanolides, the primary bioactive compound) or a placebo.

    The primary outcomes of interest was the score on the self-reported Derogatis Interview For Sexual Functioning-Male (DISF-M) questionnaire that evaluates sexual cognition/fantasy, arousal, behavior, desire, and orgasm. The secondary outcomes were changes in serum testosterone and prolactin levels and the short-form survey–36 quality of life questionnaire score.

    The results

    The ashwagandha intervention increased sexual function (total DISF-M scores and each domain) and may have increased serum testosterone by 15% percent (see the note below), compared to placebo.

    Ashwagandha’s effect on sexual function

    Note

    Although the study reports a significant between-group difference in testosterone levels (i.e., testosterone increased more in the ashwagandha group than the control group), one of their figures actually suggests the opposite, which is why we softened our language about this particular finding. This is particularly important because the existing research regarding testosterone benefits from ashwagandha is shaky.

    The authors received a financial grant to recruit study volunteers and received the ashwagandha root extract and placebo from the nutraceutical company that produces the supplement.

    The pharmacologic activity of ashwagandha remains for less than two years and the absorption of its bioactives may be enhanced with the addition of piperine.[15][16]

    The big picture

    The placebo effect appears to be rather common in sexual health studies and should not be ignored. A 2020 meta-analysis of 63 randomized controlled trials reported that a placebo treatment resulted in a small to moderate improvement in erectile dysfunction, and it was not significantly different from the intervention treatment (a phosphodiesterase 5 inhibitor).[17] A 2018 meta-analysis of 8 randomized controlled trials reported that most of the treatment effect for female sexual dysfunction is accounted for by the placebo effect.[18] This supports the notion of psychological and interpersonal factors that play a large role in sexual health and/or dysfunction.[19] This also suggests that the overall understanding of sexual health is limited and, potentially most importantly, that interventions need to be carefully designed to control for these factors to ensure the detection of a true effect.

    In humans, relatively strong evidence supports the use of ashwagandha for anxiolytic and stress-relieving effects,[20][21][22] as well as improved sleep duration and quality,[23] but high quality evidence for sexual health improvements is still needed.

    The intimate link between mental and sexual health combined with the established mental health benefits of ashwagandha make it difficult to determine the direct effect of ashwagandha on sexual health. Some studies have reported improvements in semen quality, sex hormone, and lipid peroxidation attributed to ashwagandha’s antioxidant, anti-inflammatory, and antiapoptotic (i.e., against programmed cell death) properties in men with fertility issues.[24][5] However, these properties are also suggested as underlying mechanisms for purported exercise benefits (e.g., strength/power, cardiorespiratory fitness) of ashwagandha, along with improved blood markers and recovery (e.g., better sleep, reductions in stress).[25][26]

    Another less researched aspect of ashwagandha that could indirectly influence sexual health is its potential influence over the hypothalamic-pituitary-adrenal axis, which plays a central role in stress response. For example, ashwagandha may reduce performance anxiety.[27] Ashwagandha has been shown to reduce cortisol (a stress hormone) levels[28][29] and appears to increase levels of gaba-aminobutyric acid (GABA; an inhibitory neurotransmitter) and gonadotropin-releasing hormone, a hormone that is critical to sexual development and a healthy reproductive system.[30][31]

    In previous studies, increases in testosterone have been observed following 12[32] and 8[33] weeks of daily supplementation with ashwagandha, but testosterone levels were not found to be significantly different from the placebo group. The change in the 8-week treatment group was significantly greater than the placebo group, but this may have been because their preintervention levels were lower and/or the intervention was combined with a resistance training regimen. Resistance exercise is known to increase testosterone, and the increases can vary depending on rest between sets, exercise intensity, and muscle volume.[34][35] Still, it has been suggested that withanolides, which are steroidal lactone triterpenoids that are considered to be the primary bioactive compounds of ashwagandha, have a structural semblance with testosterone, and thus are hypothesized to exert similar effects, even though their similar outward appearance does not necessarily indicate a similar function.[36] The study under review appears to be the best evidence for ashwagandha's testosterone-boosting potential.

    Overall, ashwagandha appears to have a positive influence on sexual health, but the underlying mechanism is far from understood. It likely has an indirect effect on sexual health via its anxiolytic, stress-reducing, antioxidant, and anti-inflammatory effects, and it may increase testosterone, but more high quality studies are needed to confirm this effect.

    This Study Summary was published on November 7, 2022.

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