Ayurvedic herb with credible evidence for erectile dysfunction and female sexual dysfunction. The testosterone booster reputation is largely unearned for healthy men — real effects are for people with functional sexual decline, not performance enhancement.
Traditions: Ayurveda, Traditional Chinese Medicine, Unani
Multiple traditions agree on use.
Known as Gokshura ('cow's hoof'). Primary uses: male and female infertility, impotence, low libido, vitality, urinary conditions, kidney stones. Actions: Vrishya (aphrodisiac), Mutrala (diuretic), Balya (strengthening), Rasayana (rejuvenating). Pacifies Vata and Pitta; sweet taste, cooling potency. Included in Siddha Pharmacopoeia of India (2008). Gokshura granule preparations are documented in classical Sanskrit texts and validated in modern RCT for oligozoospermia.
Known as Ci Ji Li ('puncture vine fruit'). Entirely different focus from Ayurvedic use: kidney and liver tonification, eye conditions, skin pruritus, headache from liver qi stagnation. Disperses liver qi stagnation; warm, pungent, bitter nature; liver and lung meridians. Pharmacopoeia-listed in China (2005, 2015 editions), Japan (16th edition), Korea (9th edition). These indications diverge sharply from Ayurvedic/Unani sexual function uses and have not been tested in modern clinical research.
Used for sexual debility, urinary complaints, general tonic. Aphrodisiac reputation shared with Ayurveda. Geographic breadth reflects the plant's wide natural distribution as a weedy annual in tropical and subtropical zones worldwide.
Credible evidence for erectile dysfunction (meta-analysis: IIEF-5 +3.23 vs placebo) and female sexual dysfunction (multiple RCTs). The testosterone effect is real only in hypogonadal men — clinical trials consistently show no testosterone increase in healthy eugonadal men. Athletic performance evidence is negative. The mechanisms for sexual function appear to be partly androgenic and partly independent of testosterone.
IIEF-5 improved from baseline MD 4.21 (p<0.00001); vs placebo MD 3.23 on IIEF-5, MD 14.44 on IIEF-15. No significant testosterone change vs placebo — sexual function benefits appear independent of testosterone levels.
1,500 mg/day × 12 weeks for mild-moderate erectile dysfunction. IIEF improvement 2.70 vs placebo (p<0.0001). Significant improvements across all IIEF domains. No drug-related serious adverse events.
750 mg/day × 120 days. Significant improvements in sexual desire (P<0.01), arousal/lubrication (P=0.02), anorgasmia (P<0.01). Free and bioavailable testosterone increased (P<0.05).
20 mg/kg/day and 10 mg/kg/day × 4 weeks. No significant differences in testosterone, androstenedione, or LH vs placebo (all p>0.05). No androgen-increasing properties in eugonadal men.
Significant lipid profile improvements and moderate effects on inflammatory markers. No clear evidence of beneficial hormonal responses or muscle damage reduction in athletes.
Must be standardized to ≥40% furostanol saponins. Tribestan® (Sopharma, ≥45% furostanol saponins) is the best-characterized preparation. Take after meals to reduce GI adverse effects. Duration matters: 30-day trials are negative for ED; 8–12 weeks is minimum. No safety data beyond 4 months.
Taste: Mildly earthy, less challenging than ashwagandha. Most people will take capsules for clinical purposes.
Traditional Ayurvedic preparation. Mix with warm water, milk, or honey. No standardization — protodioscin content entirely unpredictable by geographic source. Sellandi 2012 used granules for oligozoospermia with positive outcomes, but the placebo group also showed 70.95% improvement, limiting interpretability. Standardized extracts are preferred for evidence-based therapeutic use.
No clinical trial data exists for tincture preparations. Dosing is based on general herbal tincture conventions only. Not recommended over standardized extract when evidence-based use is the goal.
Tribulus has been marketed as a testosterone booster for athletes since the 1990s. That framing is almost entirely wrong. What the evidence actually shows is a different — and more interesting — story: credible effects on sexual dysfunction in people who already have it, with almost no effect on testosterone or athletic performance in healthy people.
Where the evidence is real:
Erectile dysfunction: A 2025 meta-analysis of 8 RCTs found IIEF-5 scores improved by an average of 3.23 points vs placebo and 4.21 points from baseline. The best-powered trial (Kamenov 2017, n=172) used 1,500 mg/day Tribestan® for 12 weeks and found IIEF improvement of 2.70 vs placebo (p<0.0001). Notably, testosterone did not increase vs placebo — the mechanism appears to operate through peripheral pathways rather than androgen production.
Female sexual dysfunction (HSDD): De Souza 2016 (n=36 postmenopausal women, 750 mg/day × 120 days) found significant improvements in sexual desire (P<0.01), arousal and lubrication (P=0.02), and anorgasmia (P<0.01), with increases in free and bioavailable testosterone (P<0.05). Vale 2018 (n=40 premenopausal women with diminished libido) showed significant improvements across all FSFI domains (p<.001). A 2020 systematic review of 5 RCTs (279 participants) confirmed the pattern, though evidence certainty is limited by heterogeneity across trials.
Sperm quality: Sanagoo 2019 (systematic review, 7 studies) found 6 of 7 trials showed improvements in sperm concentration, motility, or morphology. Salgado 2017 (n=65 men with abnormal semen evaluation, Androsten® protodioscin-standardized extract) found significant improvements in sperm concentration, motility, and liquefaction time, alongside significant DHT increases.
Where the evidence is weak or absent:
Testosterone in healthy men: Neychev 2005 (n=21, doses up to 20 mg/kg/day × 4 weeks) found no significant changes in testosterone, androstenedione, or LH vs placebo (all p>0.05). Vilar Neto 2025 (10 trials, 483 participants) found only 2 of 10 studies showed meaningful testosterone increases — and only in hypogonadal subjects, not healthy men.
Athletic performance: A 2022 systematic review of 7 studies (Fernández-Lázaro) found no clear evidence of beneficial hormonal responses or muscle damage reduction in athletes. One 6-week CrossFit trial (n=30) found testosterone maintenance vs a 21.85% decline in controls (p<0.05) — which suggests attenuation of exercise-induced testosterone decline rather than an anabolic effect. Bench press improved more in the TT group (+19.22% vs +8.52%), though no other lifts differed.
The critical nuance: In the erectile dysfunction meta-analysis, testosterone did not increase vs placebo — yet IIEF scores did. The sexual function benefits operate at least partly independently of testosterone levels. This matters for understanding what you’re actually taking it for.
Ayurveda (millennia of use):
Traditional Chinese Medicine:
A meaningful divergence: Ayurvedic and Unani uses for sexual function and fertility are largely supported by modern clinical evidence. TCM’s different indications — eye conditions, skin, headache from liver qi — haven’t been tested. These traditions weren’t using the same plant for the same thing.
What’s absent: No EMA traditional-use monograph was established (no traditional European use documented). No WHO monograph exists. This plant arrived in Western supplement markets via Soviet athletic research in the 1980s — not through traditional Western herbalism. The claims attached to it in Western marketing reflect that origins story more than the actual traditional record.
Nearly all clinical evidence uses standardized dry extracts of the fruit. The preparation matters more here than in most herbal medicine. Protodioscin — the primary active compound — varies by 1 to 1,530 mg per 100g dry weight across geographic sources. That’s not natural variation you can average out; it means unstandardized products may contain negligible active compounds.
| Preparation | Standardization | Evidence Base | Best For |
|---|---|---|---|
| Tribestan® (Sopharma) | ≥45% furostanol saponins | Best: n=172 RCT, meta-analysis | Erectile dysfunction |
| Standardized 40% saponin extract | 40% furostanol saponins | RCTs: n=36, n=40, n=30 | HSDD, athletic use |
| Androsten® (protodioscin specified) | Protodioscin specified | n=65 fertility RCT | Male infertility |
| Gokshura granules (Ayurvedic) | None | n=60 Ayurvedic RCT | Traditional fertility use only |
| Tincture (1:5) | None | No clinical data | Not recommended |
Erectile dysfunction:
Female HSDD / diminished libido:
Male infertility / sperm quality:
Late-onset hypogonadism (confirmed low testosterone only):
Before starting (1-week baseline):
During trial: Track the same measures at week 4, week 8, and endpoint. The effect profile in trials shows improvements across multiple FSFI/IIEF domains — note whether changes are to desire, function, satisfaction, or all three. Compare to baseline, not to abstract expectations.
RED FLAGS — Stop immediately:
What they may experience: improved frequency and quality of sexual response, increased desire, better arousal — effects seen across multiple RCTs, multiple populations.
This is the most consequential practical consideration for tribulus.
The protodioscin content varies from 1 to 1,530 mg per 100g dry weight depending on geographic origin. That’s not a rounding error — it means a product from one region may contain 1,530 times more active compound than one from another. Unstandardized products are essentially unknown quantities.
What to look for:
What to avoid:
Tribulus is not the testosterone booster it was sold as in the 1990s. For healthy men with normal testosterone, testosterone doesn’t move. For athletes, performance doesn’t clearly improve.
What it is: a credible option for sexual dysfunction that already exists — erectile dysfunction, diminished libido in women, poor sperm quality. The evidence here is real: a meta-analysis, several reasonably powered RCTs, consistent improvements across multiple FSFI domains in women. The mechanism appears to operate partly through androgen metabolism (free testosterone, DHT) and partly through pathways that don’t show up in total testosterone measurements at all.
If you have one of these conditions: Choose a standardized extract (≥40% furostanol saponins), commit to 8–12 weeks minimum, take with food, track systematically. Duration matters more here than with most herbs — the negative trials are short; the positive ones run longer.
If you’re healthy and looking for enhancement: The evidence doesn’t support it. The testosterone effect doesn’t exist for you.
Before you start: Check your medication list against CYP3A4 substrates. The statin interaction is documented, confirmed, and serious. Don’t stack this with atorvastatin.
Duration: Minimum 8–12 weeks for erectile dysfunction. 4 months (120 days) for female sexual dysfunction. 60–90 days for male infertility (one full spermatogenesis cycle ~74 days). The only negative ED trial ran for just 30 days — duration appears to matter more here than in most herbal protocols.
What to notice:
Start at the indicated dose — clinical trials use full doses from the start, and there is no dose-titration evidence for tribulus. Take with or after food to minimize nausea. Only use preparations standardized to furostanol saponin content. The most important variable is duration: the 12-week Kamenov trial was positive; the 30-day Santos trial was not. If you're using this for testosterone support, confirm your testosterone is actually low first — there is no evidence it moves testosterone in men with normal levels.
Generally considered: caution
Contraindications:
Pregnancy/Nursing: Contraindicated in pregnancy (androgenic mechanism, no safety data). Avoid during lactation (no data available).
Well tolerated at standard doses in controlled trials up to 12 weeks — adverse event rates similar to placebo in major RCTs (Suharyani 2025 meta-analysis). The most serious drug interaction is CYP3A4 inhibition: TT is a confirmed moderate inhibitor, and the rhabdomyolysis case with atorvastatin (Huff 2024) in a 71-year-old is documented, confirmed harm. Check your full medication list before starting. Modest AST elevation documented in 3-month trial (26.5 → 27.8, p=0.03) — all values remained within normal range, but monitor liver enzymes in prolonged use or if you have any hepatic risk. Priapism (sustained erection >4 hours) is documented as a rare adverse event — emergency room, immediately. Avoid unstandardized water extracts; the multi-organ toxicity case involved a traditional water preparation, not a standardized pharmaceutical extract. No controlled safety data beyond 4 months.