A low libido, increased visceral fat, fatigue, brain fog, erectile dysfunction or osteoporosis and simply a lack of motivation to get things done are symptoms of ageing among males. The main contributor to this phenomenon is testosterone deficiency syndrome (TDS) and up to 80% of men will experience some kind of ageing males’ symptoms.
This significant decline in testosterone levels is further closely linked with medical conditions such as obesity, metabolic syndrome, diabetes or hypertension.
The conventional way of treating TDS is the testosterone replacement therapy (TRT), for which preparations are on the market pose side effects where its link to prostate cancer is debated.
Eurycoma longifolia (Tongkat Ali; TA) is natural alternative to TRT and has been shown to restore serum testosterone levels, thus significantly leading to healthy aging.
The benefits of TA has been clinically evidenced in several pre-clinical and 10 clinical studies in the area of modulating healthy testosterone levels, improving physical and mental wellbeing, muscle size and strength, erectile function, mood, immunity and reducing fat, fatigue, stress and increasing fertility.
SUMMARY OF PRESENTATION
Testosterone deficiency syndrome (TDS) is characterised by symptoms of low libido, increased fat mass, decreased muscle mass, loss of concentration, erectile dysfunction(ED), depression, and decreased bone mineral density and serum testosterone levels. From 40 years of age, serum testosterone concentrations in men decline reaching levels of 40–50% lower at the age of 60. TDS can result in reduced quality of life and adversely affect the bodily functions as it is closely linked with other medical conditions such as obesity, metabolic syndrome, diabetes, insulin resistance, glycaemic control, hypertension, rheumatoid arthritis and osteoporosis.
Testosterone Replacement Therapy, Treatment for TDS
Testosterone deficiency syndrome is treated with testosterone replacement therapy (TRT). Testosterone treatment has several benefits such as improving sexual desire and function, increase bone mineral density, improve mood, energy and quality of life, change body composition and improve muscle mass and strength, improve cognitive function and improving metabolic syndrome and type-2 diabetes and cardiovascular disease. However, TRT has been associated with adverse side effects and its link to prostate cancer cannot be disqualified.
Alternative to TRT: Effect of TA on Testosterone Levels
Early pre-clinical research of Eurycoma longifolia (El), Tongkat Ali (TA) with traditional history of use, demonstrated increased testosterone levels and increase in the production of sperm in animal models and as an aphrodisiac property. In a study that investigated 75 men with idiopathic infertility, TA (Physta®) supplementation of 200 mg/day improved testosterone levels and semen profiles by increasing higher semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility (Tambi & Imran, 2010) (Fig. 1). Tongkat Ali supplementation was also investigated in a pilot study in senior amateur cyclists (13 male and 12 female), aged between 57 and 72 years. A dose of 400 mg per day of Tongkat Ali (Physta®) increased muscle strength and testosterone levels significantly (Fig. 2).
Effect of TA on Sexual Health
In a 12 weeks trial by Ismail et al. (2012), sexual libido scores for subjects on TA (Physta®), significantly increased between week 6 and 12 as compared to placebo (P < 0.001). Significant improvements in sexual satisfaction were recorded (P = 0.001). Selected items in the sexual libido domain, “Over the last 4 weeks, how is your interest towards sexual relationship?”,significantly increased by 14.4% from baseline and Values of item “Over the last 4 weeks, as compared to the previous 4 weeks, the frequency of your sexual relationship is increased?”, significantly increased by 17.1%. The overall erectile function score increased significantly from baseline to week 12 as compared to placebo (P < 0.001), indicating an improvement on erectile functioning in subjects using TA. In another study, the TA (Physta®) was administered to mildly erectile dysfunctional men in a randomised, placebo controlled trial of 26 subjects (Udani et al., 2011), where significant improvements in several parameters were observed at the end of trial; Erection Hardness Scale (P = 0.012), Sexual Health Inventory for Males (P = 0.03) and Ageing Male Symptom Score (P = 0.047) (Fig. 3).
Erection Hardness Scale
Effect of TA on Muscle Strength
Hamzah & Yusof (2003) tested 14 healthy male adults on either 100 mg of TA (Physta®) or placebo and study participants performed an intensive strength training programme for 8 weeks. At the end of the study muscle strength increased by 6.78% in the TA group, and the subjects had more lean muscle mass as compared to only 2.77% increase in muscle strength with no change in the muscle mass, in the placebo group. While the percentage of body fat reduced in both groups, the effect was more pronounced in the TA group. Muscle size as determined by the mean arm circumference, in the TA group increased significantly by 1.8 cm. Yet there was no significant change in the placebo group.
Effect of TA on metabolic disorder/antihyperglycaemic/body fat
Husen et al. (2004) reported a significant antihyperglycaemic effect of TA in a rat model where diabetes was induced by streptozotocin. In this study, extracts of TA revealed a significant antihyperglycaemic effect.
Effect of TA on Quality of Life
In a randomised, double-blind, placebo-controlled clinical trial on the supplementation of 109 men with TA extract was performed (Ismail et al., 2012). This study showed significant improvements in all relevant parameters tested (Quality of Life as observed with the SF-36 Quality of Life questionnaire, Sexual Well-Being as investigated by means of the International Index of Erectile Function, Sexual Health Questionnaire. There was a significant improvement
of overall scores of Physical Functioning domain from baseline to week 12 (P = 0.006) as compared to placebo. (Fig.4). Furthermore, TA treatment significantly reduced fat mass in overweight subjects (≥BMI 25) (Fig.5).
Dark grey column: TA
Light grey column: placebo
Effect of TA on Stress
A randomised placebo-controlled study including 32 men and 32 women was conducted by Talbott et al. (2013) in moderately stressed subjects. Significant improvements were found in the TA (Physta®) group for Tension (−11%), Anger (−12%), and Confusion (−15%). Stress hormone profile (salivary cortisol and testosterone) was significantly improved by TA supplementation, with reduced cortisol exposure (−16%) and increased testosterone status (+37%).
Safe and effective alternative to TRT with toxiclogical studies upto OECD 2 gene reproductive toxicity studies with NOAEL>1000 mg/kg.