Efficacy of Tongkat Ali (Eurycoma longifolia) on erectile function improvement: Systematic review and meta-analysis of randomized controlled trials

Abstract

Randomized controlled trials investigating Tongkat Ali compared to placebo were included. Outcome of interest was the improvement of erectile dysfunction. The difference of changes from baseline of the outcome between Tongkat Ali and placebo was pooled using weighted mean difference (WMD).Methodological quality of included studies was assessed using Jadad's quality scale and Cochrane's risk of bias. Results:Of the 342 articles identified, 2 studies involving a total of 139 participants were analyzed. No significant between group difference was found in the mean WMD of the change in the 5-item version of the International Index of Erectile Function (IIEF-5) at week-12 (0.91; 95% CI: -1.50 to 3.33 with I 2 = 89.5%, P-value = 0.002) with statistical heterogeneity. Based on the subgroup analysis, significant improved IIEF-5 score of 2.15 (95% CI 1.03 to 3.27) was found in subjects with lower baseline IIEF-5 score, but this was not seen among those with higher baseline IIEF-5 score.Conclusion: Based on current evidence, the herbal extract of Tongkat Ali may have clinical effect on erectile function. However, more efficacy trials are warranted to further support current evidence.

Modulation of some markers of erectile dysfunction and malonaldehyde levels in isolated rat penile tissue with unripe and ripe plantain peels: identification of the constituents of the plants using HPLC

“…The result revealed that PDE-5 activity was inhibited by the extracts concentration dependently. This finding is in line with previous reports that medicinal plant extracts can inhibit PDE-5 activity, especially plants rich in flavonoids (Dell'Agli et al 2008;Shin et al 2015;Kotirum et al 2015;Pavan et al 2015). The PDE-5 inhibitory potentials of the studied peels could be linked to their rich flavonoid.…”

Phenolic analysis and erectogenic function of African Walnut ( Tetracarpidium conophorum ) seeds: The impact of the seed shell on biological activity

“…Hence, the use of plant‐base food/materials is greatly encouraged to combat ED (Gupta et al, ; Adefegha, Oboh, et al, ). This finding agreed with the studies of Kotirum, Ismail, and Chaiyakunapruk () and Adefegha, Oyeleye, Dada, et al () that plant food, especially those that are rich in phenolic compound, could inhibit PDE‐5 activity, and can be employed in the management of ED. Hence, the inhibition of PDE‐5 activity by the extracts could be linked to their richness in polyphenols most especially the flavonoid.…”

“…Hence, this give an insight into its folkloric potential in the management/treatment for ED. Thus, this study agreed with several reports where phenolic compounds have been reported to possess PDE-5, arginase, ACE, and AChE inhibitory properties as well as antioxidant potentials (Adefegha, Oyeleye, Dada, et al, 2018;Akomolafe et al, 2016;Kotirum et al, 2015).…”

“…Although, the use of synthetic inhibitors such as sildenafil, has been proven to be effective, however, reports have shown that they also elicit some complications (Herrmann, Chang, Klugherz, & Mahoney, 2000;Saxena, Prakash, Porwal, Sissodia, & Sharma, 2012). Hence, the use of plant-base food/materials is greatly encouraged to combat ED (Gupta et al, 2005;Adefegha, Oboh, et al, 2016 with the studies of Kotirum, Ismail, and Chaiyakunapruk (2015) and Adefegha, Oyeleye, Dada, et al (2018) that plant food, especially those that are rich in phenolic compound, could inhibit PDE-5 activity, and can be employed in the management of ED. Hence, the inhibition of PDE-5 activity by the extracts could be linked to their richness in polyphenols most especially the flavonoid.…”

Plants in the management of male infertility

“…There are also several animal studies to support the aphrodisiac and testosterone‐enhancing properties of E. longifolia root extract (Ang & Ngai, ; Ang & Sim, , ). Furthermore, clinical trials have provided additional data on the potential of E. longifolia to improve serum testosterone level and in the treatment of erectile dysfunction, and appeared to be useful in the management of diseases related to androgen deficiency (George & Henkel, ; Jayusman, Mohamed, Alias, Mohamed, & Shuid, ; Kotirum, Ismail, & Chaiyakunapruk, ; Tambi, Imran, & Henkel, ). To understand the androgen secretion‐promoting ability of E. longifolia root extract, it was reported that the eurycomanone constituent acts at the level of Leydig cells by inhibiting aromatase‐mediated conversion of testosterone to oestrogen (Low, Choi, Abdul Wahab, Das, & Chan, ).…”