Tribulus terrestris versus placebo in the treatment of erectile dysfunction and lower urinary tract symptoms in patients with late-onset hypogonadism: A placebo-controlled study

Abstract

Aging is associated with a series of morphological and functional modifications that leads to reduced physiological efficiency and atrophy of various organs and systems. Tribulus terrestris induces its effect in fertility and sexual functions through the steroidal saponins, particularly the dominant saponins protodioscin. We aimed in this study to evaluate the efficacy and safety profiles of Tribulus terrestris in aging males with partial androgen deficiency who suffered from erectile dysfunction and lower urinary tract symptoms. A total of 70 randomized aging patients with erectile dysfunction and lower urinary tract symptoms were recruited from June 2017 to March 2018 from our andrology outpatient clinic. Thirty-five patients (group A) received Tribulus terrestris three times daily for 3 months and the other 35 patients (group B) received placebo. The mean of aspartate transaminase was elevated in group A after 3 months of receiving Tribulus terrestris (26.5 (before), 27.8 (after), respectively, p = 0.03). Moreover, there were significant elevations in the means of both total testosterone together with the score of the validated Arabic index of erectile function (5-item version of the International Index of Erectile Function) (2.2, 10.7 (before), 2.7, 16.1 (after), p < 0.001, p < 0.001, respectively). Finally, the mean of the total prostate-specific antigen was elevated in this group (1.4 (before), 1.7 (before), p = 0.007, respectively). Interestingly, there were no worsening of the lower urinary tract symptoms in group A as there was no change in the mean score of the international prostate symptom score, which was used to assess these symptoms before and after treatment (mean 14.4 (before), 14.6 (after), p = 0.67, respectively). In sum, this study replicates the findings of previous reports about the robust effect of this herbal medicine in elevating the testosterone level and improving the sexual function of patients who suffered from erectile dysfunction with partial androgen deficiency.

<p>Gross saponin of <em>Tribulus terrestris</em> improves erectile dysfunction in type 2 diabetic rats by repairing the endothelial function of the penile corpus cavernosum</p>

“…At the same time, ICP and ICP/MAP records of the rats in this study also showed that the erectile function of the mixed treatment group significantly improved compared with the T2DMED group, the GSTT-only group, or the sildenafil-only group. This confirms previous studies on GSTT in basic and clinical trials to improve erectile function 25–28. We further found that GSTT can improve the expression of eNOS in rat endothelial cells, directly increasing the concentration of NO, and ultimately improving the level of cGMP in each group.…”

Alternative medicine and herbal remedies in the treatment of erectile dysfunction: A systematic review

“…Tribulus terrestris was investigated as a single herb in two of the included studies, both using standardised extractions for saponins and reporting a positive effect on the IIEF and various domains [ 37 , 38 ]. Furthermore, with Tribulus terrestris as the major constituent, the combination formulae Tradamix TX1000, VXP, and NRL/MW/201,901 were also shown to increase IIEF and all domains [ 29 , 39 , 40 ].…”

Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review

“…Four studies (39,48,54,61) examined the effects of Tribulus terrestris on testosterone concentrations. Two studies used patented extracts, Trib Gold, manufactured by Nerhadou International, standardized to contain up to 45% steroidal saponins (extract source not provided) (39), and Tribestan, manufactured by Sopharma, delivering a minimum of 675 mg furostanol saponins (from overground parts of the herb) (48). Santos et al (61) and Neychev and Mitev (54) both used a dry extract of tribulus.…”

“…Santos et al (61) and Neychev and Mitev (54) both used a dry extract of tribulus. Three studies were randomized controlled trials (39,48,54) and 1 study was a randomized, double-blind, placebo-controlled trial (61). A total of 301 participants were recruited for the studies involving Tribulus terrestris, with ages ranging from 18 to 65 y and sample sizes ranging from 21 to 180 participants.…”