When considering treatment options for male performance support, as practitioners, we automatically think of traditional male tonics such as Tribulus terrestris (tribulus) and Turnera diffusa (damiana). Other herbs we should be considering for supporting male physiology include Panax ginseng (Korean ginseng) and Withania somnifera (withania). This article explores the traditional use of male tonic herbs and provides modern clinical relevance.
Traditionally, extracts of the arial part and fruit of tribulus were used as a diuretic, male tonic and as an aphrodisiac. Today, tribulus is widely promoted in the sporting industry as a natural way to enhance circulating androgen concentrations in athletes and bodybuilders. A recent systematic review was undertaken to determine modern indications for the use of tribulus as a male performance supportive adjunct. Tribulus provided promising mediation of testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone (DHEA) levels in animal studies. Further research is required elucidate the mechanism of action of tribulus in humans.
In folk medicine, damiana was considered an aphrodisiac with both sedative and anxiolytic qualities. A recent study aimed to determine whether damiana could restore copulation in sexually-inhibited animal subjects. Dosing of 20-80mg/kg of damiana in combination with 2mg/kg Pausinystalia yohimbe (yohimbine) significantly increased the percentage of males achieving two ejaculatory series.[4,5] In addition, a control of damiana alone was shown to reduce the post-ejaculatory interval.
Follow-up animal studies compared damiana (10-40mg/kg) to sildenafil citrate (Viagra) (10mg/kg) with or without a non-specific nitrous oxide (NO) inhibitor. Both were demonstrated to facilitate expression of male sexual behaviour associated with NO release by shortening mainly ejaculation latency, supporting its use. The flavonoids found in damiana may have contributed to reducing anxiety associated with sexual contact.
Organic, physiological, endocrine and psychological factors are involved in the ability to attain and maintain an erection. Herbal medicines such as Panax ginseng (Korean ginseng) and Withania somnifera (withania) provide potential in supporting male physiology because of the unique multiple actions that adaptogens provide.
A literal translation of the word ginseng is ‘man essence’, because of its associated affinity with the male body. In traditional Chinese medicine (TCM), ginseng is highly regarded as the most potent qi tonic used to benefit those with low vitality, poor immunity, metabolic dysfunction but also to enhance physical performance and sexual function.
Korean ginseng has been clinically demonstrated to alleviate erectile dysfunction by improving the ability to achieve and maintain erections in male patients. A collection of constituents found in ginseng known as ginsenosides are able to facilitate penile erection by directly inducing vasodilation of the penile corpus cavernosum, via mediation of NO release from endothelial cells and perivascular nerves.
In a double-blind, placebo-controlled study of men diagnosed with erectile dysfunction, 900mg of Korean ginseng was administered three times daily for eight weeks. The positive results of this study included: higher rates of penile tip rigidity, improved penetration rates and overall improvement in erection maintenance versus placebo group.
Additional ginseng may provide benefit men with poor sperm parameters. Animals treated with ginseng (1g/kg/day orally for 56 days) exhibited significant increase in sperm count and motility due to activation of cAMP-responsive modulation in the testes.
Withania is often referred to as Indian ginseng because it is used in much the same way as Korean ginseng. However, it is considered less stimulating. In Ayurvedic medicine, withania is referred to as a ‘’rasyana’ and used to promote physical and mental health, improve vitality and promote longevity. Traditional and modern uses of withania includes as an adaptogen, diuretic, sedative, antioxidant, anti-inflammatory and an aphrodisiac.
Recent research has proposed that withania has the ability to inhibit lipid peroxidation from occurring as well as indirectly mimicking gamma amino-butyric acid (GABA) endocrine stress-induced risk factors associated with male infertility.
A double-blind placebo-controlled study was undertaken in oligospermic males. The withania group received 225mg of the proprietary KSM-66® extract three times daily. Those receiving withania had a number of statistically significant outcomes after 12 weeks including increase in sperm concentration, seminal volume, motility and raised free testosterone versus baseline measurements. This evidence promotes the use of KSM-66® for the treatment of oligospermic males for preconceptional and male performance support.
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