Tribulus

Elham Akhtari et al. (2014) · Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences

This randomized, double-blind, placebo-controlled trial of 67 randomized women (60 analyzed) explored whether an extract of Tribulus terrestris, a low-growing plant also called puncture vine or bindii, affects sexual desire in women of childbearing age. The condition studied, hypoactive sexual desire disorder (HSDD), is a persistent lack of sexual thoughts and desire that causes personal distress, and the authors cite a prevalence of about 1 in 10 adult women in the USA and 30% in Iran. No drug is approved by the US Food and Drug Administration for it. In Iranian Traditional Medicine, texts including Avicenna's Canon of Medicine describe Tribulus as a remedy that boosts libido. The women, all married and living with a partner, were recruited at two medical centers in Tehran Province, Iran, between June 2012 and July 2013, with an average age of 36 years. After random assignment in a 1:1 ratio, one group took a syrup made from an ethanol extract of Tribulus leaves, 7.5 ml twice a day for four weeks, and the other took a look-alike sucrose syrup. Sexual function was scored with the Female Sexual Function Index (FSFI), a 19-item questionnaire covering desire, arousal, lubrication, orgasm, satisfaction and pain, completed at baseline and four weeks after treatment ended. Desire, the primary outcome, rose from 3.06 to 3.90 points in the Tribulus group but only from 2.66 to 2.86 with placebo, an adjusted difference of 0.71 points (95% CI 0.41 to 1.01, p < 0.001, meaning the gain was unlikely to be chance). Several other domains also favored Tribulus: satisfaction by 1.10 points, orgasm by 0.85, arousal by 0.75, lubrication by 0.50 and pain by 0.37 (p-values between < 0.001 and 0.041). The total FSFI score improved from 21.25 to 26.80 with Tribulus versus 20.89 to 22.41 with placebo (p = 0.040 in the results text, although the abstract gives p < 0.001). Only one participant reported a side effect, a mild (grade 1) abdominal cramp. Dropouts cited the very sweet taste and anxiety about taking an investigational drug. The authors interpret the results as supporting the traditional libido-boosting reputation of Tribulus and call for larger studies. Limitations include the small sample, only four weeks of treatment with a single follow-up, one country, and a cultural setting in which women may be reserved about reporting sexual matters. The dose is stated inconsistently between the abstract and the methods, and menopausal women were excluded, so the findings do not extend to them. The mechanism was not tested; the authors only propose a possible link to follicle-stimulating and luteinizing hormones.

Ana Luiza Cabrera Martimbianco et al. (2020) · Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia

This systematic review of five randomized controlled trials (279 women) examined whether Tribulus terrestris, a creeping herb used as a natural sexual stimulant, improves female sexual dysfunction (FSD) and what safety data exist. All participants had hypoactive sexual desire disorder (HSDD, persistently low sexual desire that causes distress) or loss of libido. Tribulus extracts contain protodioscin, a steroidal saponin (plant compound with hormone-like structure) proposed to increase luteinizing hormone, the pituitary hormone that stimulates androgen production. The review cites estimates that 30 to 50% of women experience FSD during their lifetime, and notes that the effects of Tribulus had not been established. Reviewers searched six databases and trial registries up to February 2019 for trials comparing Tribulus with placebo or another treatment. The trials took place in Brazil (four) and Iran (one) and enrolled 172 postmenopausal women (43 to 65) and 107 premenopausal women (18 to 44). Four trials gave 250 mg by mouth three times daily for 90 to 120 days; one gave a syrup twice daily for 30 days. Sexual function was measured with the Female Sexual Function Index (FSFI, scored 2 to 36) and the Sexual Quotient Female Version (SQ-F, scored 0 to 100); higher scores mean better function. Differences between trials prevented pooling results. One trial in 67 premenopausal women found a higher FSFI total score after one month on Tribulus (mean difference 4.39 points; 95% CI 2.90 to 5.88, a statistically reliable gain), driven by arousal, lubrication, orgasm and satisfaction rather than desire or pain. Two other FSFI trials at three months found no significant difference (p = 0.19 and p = 0.44). In 60 postmenopausal women, SQ-F scores rose by 16.40 points (95% CI 7.67 to 25.13) at three months. Testosterone rose in premenopausal women (mean difference 6.60; 95% CI 0.27 to 12.93) but not in postmenopausal women (2.50; 95% CI -1.79 to 6.79, a range that includes no effect). Only one trial reported adverse events: none serious, and one case of abdominal cramps. No trial measured quality of life. The authors rate the certainty of the evidence as very low, meaning future studies are likely to change the estimates. Trials were small, selection methods were unclear, and two trials lost 20% and 37.5% of participants. The authors state that current evidence does not support routine clinical use and call for more well-designed randomized trials in pre- and postmenopausal women. They note the main limitation was that only one of the contacted trial authors supplied additional data, and that this is the first systematic review of Tribulus for FSD.

José de Oliveira Vilar Neto et al. (2025) · Nutrients

This systematic review of 10 clinical studies (483 men in total) examined whether Tribulus terrestris supplements improve erectile dysfunction (ED, difficulty achieving or keeping an erection) and testosterone levels. Tribulus is a plant used for centuries in India and China as a sexual stimulant. Its steroidal saponins (plant compounds with hormone-like structure) are proposed to raise testosterone and to boost nitric oxide, a molecule that relaxes blood vessels and supports erections, though the authors note the mechanism is not fully understood. The review asked whether the evidence supports either claim, and it looked at men with and without low testosterone. Researchers searched 13 databases for studies in which men took Tribulus on its own, without other supplements or drugs. Ten studies qualified: nine clinical trials and one study without a control group, conducted in Egypt, Bulgaria, Brazil, Australia, India, China and Spain. Participants were aged 16 to 70: healthy men, men with ED (some also with low testosterone), and men with low sperm counts or unexplained infertility. Doses ran from 400 mg to 12 g per day for 4 weeks to 3 months. Study quality was graded with the Jadad scale, a 5-point checklist of randomization, blinding and dropouts. Three of the five studies that measured erectile function found improvement, and all three enrolled men with ED. One trial using 500 mg daily for 3 months raised International Index of Erectile Function (IIEF-5) scores against placebo, with significance already at 4 weeks (p = 0.0119) and stronger by the end (p < 0.0001). Eight of ten studies found no significant testosterone change, and those men did not have low testosterone at the start. Two studies in men with low testosterone found rises of about 58 to 71 ng/dL (27 to 33%), a small increase in clinical terms (roughly from 215 to 273 and 213 to 284 ng/dL), and both scored poorly for methodological quality (Jadad 2 and 0). None of the studies reported side effects, and lipid and liver tests showed no impairment. The authors conclude that evidence for improved erectile function at 400 to 750 mg per day is of low level and that no solid evidence shows Tribulus raises testosterone. Half of the studies had a high risk of bias, samples were small, saponin content varied between products, and no meta-analysis was possible. The authors state that Tribulus is not a substitute for first-line treatment of severe ED and call for well-controlled randomized trials to define dose and duration, including trials in men with low testosterone.

Ramin Ansari et al. (2024) · Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences

This randomized, double-blind, placebo-controlled trial with 51 adults explored whether Mofatet powder — a six-herb formulation from Traditional Persian Medicine (TPM) — could shrink existing calcium kidney stones, not just prevent new ones. TPM is a centuries-old medical system, described in texts by Rhazes and Avicenna, that combines specific plant combinations for named conditions; Mofatet powder is one such combination, traditionally taken as a boiled decoction of six seeds and fruits in equal parts. Kidney stones affect up to 15% of people worldwide, and most current drugs only stop new stones from forming rather than dissolving the ones already there. Researchers recruited 51 adults (mean age about 50) with confirmed calcium stones at least 5mm across, in Shiraz, Iran. Twenty-six received capsules of a freeze-dried extract of the six-herb blend (cucumber seed, pumpkin seed, celery seed, fennel seed, anise seed, and tribulus fruit) twice daily for 5 weeks; 25 received a matching placebo. Stone size was tracked by ultrasound imaging, alongside urine and blood chemistry. The herbal group's stones shrank by 60.73% on average, compared to just 2.52% in the placebo group (a highly significant difference, p<0.001), and two people's stones disappeared entirely versus none on placebo. Urinary magnesium — a mineral that normally helps stop stone-forming crystals from growing — rose by nearly 58% in the herbal group, while urinary calcium (a stone-forming risk factor) dropped. Urine also became less concentrated (lower specific gravity), which reduces the conditions that let crystals form in the first place. Importantly, kidney and liver function tests (BUN, creatinine, AST, ALT) showed no meaningful changes in either group, and no significant side effects were reported over the five weeks — though the herbal group did show a rise in blood calcium that the researchers did not fully explain. These findings suggest this traditional formulation could be a safe, complementary option for people managing calcium kidney stones, likely by making urine less prone to crystal formation rather than by dissolving stones directly. The trial was conducted at a single center with a modest number of participants over a short 5-week window, so the results need confirming in larger, longer studies before this becomes a routine recommendation.