Tongkat Ali, also known as “Malaysian ginseng”, is considered an adaptogen that helps fight stress and illness, improves physical strength, and is known as Malaysia’s three national treasures along with bird’s nest and tin.
In empirical medicine, what is the benefits of Tongkat Ali? Are there any side effects of Tongkat Ali? See text analysis for details.
What is Tongkat Ali?
Tongkat Ali (scientific name Eurycoma longifolia) is a tall, slender shrub-like tree that grows in sandy soils and can reach heights of 10 to 15 meters. It belongs to the Simaroubaceae family, a medicinal herb used in Southeast Asian countries, mainly distributed in Malaysia, Indonesia, Thailand and Myanmar.
Its roots, stems and bark are used as folk medicines to relieve various ailments, including: pain, fever, sexual insufficiency, dysentery and fatigue.
Its main active phytochemicals include: Quassinoids, Alkaloids, Triterpenes etc.
What are the proven benefits of Tongkat Ali?
1. Beneficial erectile dysfunction
Erectile dysfunction, defined as the inability to achieve or maintain an adequate level of penile erection sufficient to satisfy sexual intercourse, clinically classified as psychologically (such as relationship dissatisfaction, stress, anxiety, or depression) or organic (underlying or comorbidities), is a prevalent male sexual health problem with a prevalence of up to 31% and is expected to affect up to 322 million men by 2025.
The reported prevalence of ED is 1% to 10% (mostly psychological) in men under 40 years of age, 40% in men aged 40, and 50% to 100% (mostly organic) in men aged 70 years.
A systematic literature review and meta-analysis (2 randomized controlled trials, 139 participants) found that supplementation with Aqueous extract of Tongkat Ali root was not statistically significant for improving international markers of erectile function (IIEF-5) compared with placebo. Note 1
However, subgroup analysis found that IIEF-5 scores improved significantly to 5.2 in subjects with low baseline IIEF-15 scores, but not in subjects with higher baseline IIEF-5 scores.
*Conclusion: For erectile function improvement, supplementation with Tongkat Ali is only helpful in subjects with low IIEF-5 scores, but limited by small sample sizes and possible bias, more large long-term trials are needed for further validation.
2. Beneficial testosterone levels
Testosterone/testosterone, as the main male sex hormone, is responsible for the development of reproductive tissue and anabolic function, but total serum testosterone gradually declines with age, and the prevalence of testosterone deficiency in men aged 49 to 79 years is 2.1% to 5.7%.
The main clinical manifestations of low serum total testosterone are decreased libido, erectile dysfunction, fatigue, and low mood, and may be accompanied by changes in body composition, including increased fat mass, decreased lean mass and bone density, and loss of muscle mass and strength.
A randomized, double-blind, placebo-controlled study (12-week male aged 50-70 years, with testosterone levels <300 ng/dL) noted that Tongkat Ali standard water-soluble extract improved total testosterone levels, improved quality of life scores, and reduced symptoms of aging and fatigue. Note 2
*Conclusion: For older men with low testosterone levels, oral administration of Tongkat Ali extract may provide positive help, but limited by small sample sizes, more research is needed to further validate
3. Beneficial idiopathic male infertility
Male infertility, in which men are unable to get fertile women pregnant, accounts for 40-50% of infertility and affects about 7% of men.
Up to 90% of male infertility problems are related to sperm defects (the most common feature of idiopathic male infertility), most notably low sperm concentration (oligospermia), poor sperm motility (asthenospermia), and abnormal sperm morphology (malspermia), as well as varicocele veins, semen volume, and other dysfunction of the epididymis, prostate, and seminal vesicles.
A 3-month study of 75 men with idiopathic infertility showed that oral administration of Tongkat Ali standardized extract (200 mg per day) helped improve semen volume, sperm concentration, sperm motility and morphology, and percentage of normal sperm. Note 3
*Conclusion: Tongkat Ali can help improve semen parameters, which may be helpful for male idiopathic infertility, but limited by the small sample size, more studies are needed to further validate
4. Beneficial immune function
Human survival is closely linked to the functional immune system, which protects the host from infection and malignancy, regulates wound healing, and ultimately separates the “self” from surrounding organisms vying for space and resources.
The innate immune system provides a rapid and effective immune response, but lacks discrimination and long-term memory. The adaptive immune system works by precisely identifying antigens, memory formation, and providing adaptive proliferation of antigen-specific immune cells.
A randomized, double-blind, placebo-controlled parallel study (4 weeks in 84 middle-aged men and women with low immunity) showed that standardized aqueous extract of Tongkat Ali root improved the Scoring of Immunological Vigor and immune grade score. Note 4
In addition, the total number of T cells, CD4+ T cells, and initial T cell number in the Tongkat Ali group also improved
*Conclusion: Tongkat Ali may have a positive effect on strengthening immunity, but limited by the small sample size, more studies are still needed for further verification
Are there any side effects of Tongkat Ali?
According to available research, Tongkat Ali is dosed at 200 mg per day for 9 months or 400 mg per day for 3 months and is likely safe.
Side effects or adverse reactions that have been reported include: insomnia, restlessness, anxiety etc.
Safety precautions (6 contraindications for use)
1. Pregnant women, lactating women, and children should avoid use (due to unknown safety)
2. Please refrain from using patients with abnormal liver and kidney function (due to unknown safety)
3. Please choose a trusted manufacturer’s source when purchasing, because there are products that have been tested to contain mercury, cadmium, lead and other toxic metal residues, or add the drug Sildenafilto treat impotence. Notes 5 and 6
4. Because Tongkat Ali will increase testosterone levels, it should not be used for: heart disease, high blood pressure, male breast cancer, prostate cancer, liver or kidney disease, sleep apnea, prostatic hypertrophy, stroke, polycythemia, depression, anxiety, mood disorders… and other diseases, which can adversely affect high testosterone levels
5. Do not use in combination with the cardiovascular disease treatment drug propranolol, which may affect the efficacy of the drug
6. Tongkat Ali inhibits the metabolic activity of CYP1A2, CYP2A6 and CYP2C19 enzymes, and the inhibition of these enzymes may affect drug efficacy or cause increased side effects, common related drugs are (Note 7 ): amitriptyline, haloperidol, ondansetron, theophylline, verapamil, nicotine, chlormethiazole, coumarin, methoxyflurane, Halothane, Valproic acid, Disulfiram, Omeprazole, Lansoprazole, Pantoprazole, Diazepam, Carisoprodol, Nelfinavir etc.