Herbs and Nutrients That May Assist

Tribulus
Tribulus terrestris, fruit dry
Damiana
 Turnera diffusa, leaf dry
Horny goat weed
 Epimedium sagittatum, herb top dry
Nelumbium/Lotus seed
 Nelumbo nucifera, seed dry
Zinc
 Zinc amino acid chelate

Clinical Applications

• Male sexual health
• Low libido
• Impotence
• Male subfertility
  • Idiopathic
  • Low sperm count
  • Poor sperm motility

Clinical Overview

Tribulus Reproductive Support is a formulation combining the best of Ayurvedic, traditional Chinese, Central American and Western herbal medicine, along with modern nutritional medicine, to provide optimal support for male sexual health and function. This combination of herbs and zinc may be beneficial for increasing testosterone levels, improving sexual performance and improving fertility due to low sperm counts.

Background Information

Tribulus terrestris (puncture vine) fruit is used in traditional Chinese and Ayurvedic medicine as a tonic which increases virility, fertility and sperm production, and rejuvenates the reproductive system. It is used in impotence and is an aphrodisiac. It is also used to enhance reproductive function in the female, to rejuvenate the uterus, and increase fertility and lactation. ^[1] The leaf is used in Western herbal medicine for the same applications. ^[2]

Turnera diffusa (damiana) leaf is used in both traditional Western and Mexican medicine for sexual inadequacy, sexual anxiety, impotence, and as an aphrodisiac and invigorator. ^[3]

Epimedium sagittatum (horny goat weed) herb is used traditionally for impotence, as an aphrodisiac and to enhance sperm production. ^[4]

Nelumbo nucifera (lotus, also known as Nelumbium speciosum) seed has its history of use in Ayurvedic medicine where it is used as an aphrodisiac and reproductive tonic for men. It is also used in the female for promotion and fertility. ^[5]

Studies in primates have found that administration of Tribulus terrestris increases testosterone, dihydrotestosterone (DHT), and dihydroepiandosterone sulphate (DHEAS); and in rabbits and castrated rats there were significant increases in DHT and testosterone, respectively. It was suggestive that the increase in sex hormones was possibly due to the presence of protodioscin (a furostanol saponin) in the extract. ^[6]

Tribulus has been found to increase sexual activity in rats, increasing such parameters as mounting frequency and intromission frequency, and increasing the strength of erection. ^[7]

Although, in healthy young men (aged 20-36), tribulus at a daily dose of 20 mg/kg of dry extract daily ^[*] for 4 weeks was not associated with any changes in testosterone, androstenedione and luteinising hormone levels, ^[8] animal studies indicate that other mechanisms could be involved in stimulation of libido. The findings in animal studies of increased nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) positive neurons and increased androgen receptor activity (upregulation of receptor expression) in the sexual dimorphic areas[†] of the hypothalamus indicate an overall increased androgen activity with tribulus herb extract. This may be either from the stimulation of androgen production, or from direct activity from steroidal components of tribulus such as protodioscin. ^[9] These changes in the areas of the brain associated with sexual behaviour correlate with the aphrodisiac property of tribulus.

Supporting its traditional use, a study has found that damiana improved the copulatory performance of sexually sluggish rats; increasing the percentage of rats achieving ejaculation and significantly reducing mount, intromission and ejaculation latencies, post-ejaculatory interval and intercopulatory interval. ^[10]

Zinc has many roles in male fertility. Low seminal zinc levels have been correlated with decreased fertility. Zinc is a cofactor for more than 80 metalloenzymes involved in DNA transcription and protein synthesis and as DNA transcription is a major part of germ cell development, zinc is likely to be important for reproduction. Zinc concentrations are very high in the male genital organs compared with other tissues and body fluids. Zinc has a role in testicular development, sperm maturation and release, and testosterone synthesis and has antioxidant properties that counteract reactive oxygen species (ROS). Studies in animals have shown increased oxidative damage of proteins, lipids and DNA in zinc deficiency, and zinc salts have been shown to protect against oxidative damage and depletion of glutathione. Glutathione has several important functions related to fertility: amongst its roles, glutathione balances the levels of ROS produced by spermatozoa, influences DNA compaction and the stability and motility of spermatozoa, and spermatozoal glutathione is also important immediately following fertilisation. ^[11]

Two uncontrolled studies have shown that oral zinc may improve fertility in subfertile males. The first study consisted of 37 patients aged 20-40 years with idiopathic infertility of more than five years duration. Participants had azoospermia of <15 million/mL; or between 15 million/mL and 25 million/mL with motility <30%. In the group of 22 patients with a plasma testosterone less than 4.8 ng/mL (normal range 2.3-10 ng/mL), but not in those with higher testosterones, administration of zinc sulphate 120 mg twice (96 mg elemental zinc daily) for 40-50 days resulted in significant rises in total plasma testosterone, DHT and sperm count. During the total of 100 days treatment, nine wives became pregnant, compared to none in the group with initially higher testosterone levels. ^[12]

In a second study, of fourteen males aged 24-45 years, idiopathic oligospermia (sperm count < 40 million/mL), and unsuccessful conception after at least 2 years, zinc sulphate 220 mg (88 mg elemental zinc) for 4 months significantly improved sperm count and numbers of progressively motile and normal spermatozoa. The wives of 3 of these patients conceived. ^[13]

Although the doses of elemental zinc in these studies are higher than in Tribulus Reproductive Support, it should be mentioned that mineral amino acid chelates are generally better absorbed than sulphate or salt formulations, ^[14],[15] as they do not have to compete for mineral transporters with other mineral such as iron or magnesium, and are less susceptible to reductions in solubility resulting from elevated pH, or from complexes with food ingredients such as calcium and phytates. To what degree this impacts upon results is not known, as there is no published definitive comparison of the bioavailability of different zinc formulation and controlled human clinical studies with zinc of any form in male subfertility are lacking. Further study is required to determine optimal daily zinc dosing.

Pregnancy

• Caution. Safety has not been conclusively established during pregnancy. Practitioner discretion is advised when prescribing for use in pregnancy due to the following cautions:
  • Horny goat weed has exhibited androgenic and oestrogenic activity, which might be harmful to a developing foetus.

Breastfeeding

Limited/unavailable research. A review did not identify any concerns for use during breastfeeding; however, safety has not been conclusively established.

Contraindications

• Individuals with known allergies or hypersensitivities to Tribulus terrestris, Epimedium sagittatum, Nelumbo nucifera, Turnera diffusa, and zinc amino acid chelate should avoid use. Discontinue immediately if you experience symptoms such as rash, itching, swelling, dizziness, or difficulty breathing, and seek medical attention.

Cautions – Moderate Level

• Antibiotics: Separate the dose of zinc contain supplements to 3 hours after taking antibiotics
• Anticoagulant / antiplatelet drugs: Theoretically, tribulus, horny goat weed and nelumbium (lotus seed) might increase the risk of bleeding.
• Antidiabetic drugs: Theoretically, taking damiana and nelumbium (lotus seed), with antidiabetic drugs might increase the risk of hypoglycaemia.
• Antihypertensive drugs: Theoretically, tribulus and horny goat weed might increase the risk of hypotension.
• Bictegravir, emtricitabine, and tenofovir alafenamide (used to treat human immunodeficiency virus (HIV): Theoretically, zinc might interfere with the absorption and efficacy of these medications.
  • Take medications at least 2 hours before or 6 hours after zinc containing supplements. 
• Integrase inhibitors (antiretroviral drugs that block the action of HIV enzyme integrase) - avoid with zinc containing supplements.
• Lithium: Theoretically, tribulus might increase the levels and clinical effects of lithium.
• Oestrogens: Theoretically, concomitant use of horny goat weed with estrogens might increase their therapeutic and adverse effects.
• Pentobarbital: Theoretically, taking lotus concomitantly with pentobarbital might increase sedation.

Footnotes

[*] unknown dry herb equivalent

[†] Areas that differ morphologically between the sexes