In men, testosterone levels decline around the age of 30 and by age 80 may be down to just 20% of the levels found in men in their 20s. Problems go beyond the obvious, like loss of libido, inability to perform sexually and low sperm counts. Men with low testosterone tend to have less stamina, reduced muscle mass and reduced libido. They can also have cognitive problems as well as depression and anxiety.

Low testosterone can lead to more serious health problems. It is linked to obesity (and increased abdominal fat), Alzheimer’s disease18, diabetes (33% of type 2 diabetics have low testosterone—J Clin Endocrinol Metab 2004 Nov;89(11):5462‐8.), and heart disease (J Sex Med 2018 Sep;15(9):1260‐1271; and Circulation 2007 Nov 20;116(21):2427‐34). The thing you really notice in men with low testosterone levels is a lack of initiative—they fit the stay‐at‐home, couch‐potato stereotype. They may say things like, “I used to like to work on the car (go on a hike, go dancing, work around the yard, etc.), but I really don’t feel like doing that anymore.”

Medical treatment for low testosterone is give the hormone as an injection or in a gel form. Testosterone therapy may make sleep apnea worse. It may increase the number of red blood cells, which can increase the risk of clotting. Men on long-term using forms of testosterone therapy long term appear to have a higher risk of cardiovascular problems, like heart attacks, strokes, and deaths from heart disease. There is also concern that testosterone treatment can stimulate the growth of prostate cancer cells.

Testosterone therapy for men can be dangerous to women and children if they come in contact with the drug by touching the patient’s skin. This usually occurs when men use testosterone gel and the application site is exposed. Anyone who comes in contact with the application site is at risk of developing side effects.

Women can experience acne or hair growth, and if they are pregnant, the unborn baby may be harmed. In 2009, the FDA issued a warning about adverse effects in children exposed to testosterone gels through contact with application sites. Symptoms included abnormally large genitalia (penis and clitoris), advanced bone age, early puberty, and aggressive behavior. Young boys may even develop enlarged breasts. A doctor should be contacted right away if these symptoms occur.

There are substances that can enhance testosterone production, improve sperm counts, increase energy and well-being, and help men with erectile dysfunction. These substances do not create the same problems as drug therapy.

Eurycoma longifolia (Indonesian tongkat ali): This is found in southeast Asia. Malaysian men claim that tea made from this plant improves their sexual abilities and virility. As a result, this plant is in such high demand that it is now considered a “protected” species. Studies have been conducted across the globe to explore the promising role of Eurycoma logifolia in managing various male sexual disorders, which include erectile dysfunction, male infertility, low libido, and downregulated testosterone levels. In a review of studies (Chin J Nat Med 2017 Jan;15(1):71-80), the authors stated, “In summary, there is convincing evidence for the prominence of Eurycoma longifolia in improving the male sexual health.” They also noted that seven of the studies, “revealed remarkable association between the use of Eurycoma longifolia and the efficacy in the treatment of male sexual disorders”.

A review of research articles appearing in Complement Ther Med [2015 Oct;23(5):693-8], found that Eurycoma longifolia may benefit men with erectile dysfunction.  One study in Int J Prev Med 2019 Jul 5;10:118, found that Eurycoma longifolia improved peak power output when combined with resistance training.

Ginseng reduces obesity and improves fat metabolism, even in the absence of testosterone. It also improves erectile dysfunction (Br J Clin Pharmacol 2008 Oct;66(4):444‐50 and J Ethnopharmacol 2018 Jan 10;210:80‐87).

Epimedium, (also known as “horny goat weed”) has been shown to increase blood flow to the penis in an animal study (J Sex Med. 2010 Apr;7(4 Pt 1):1518‐28). In another study (World J Mens Health 2017 Dec;35(3):170‐177), it improved sperm production as part of an herbal formula.

Lepidium Meyenii (Maca) has been shown to improve sperm mobility and quality (Maturitas 2016 Oct;92:64‐69 and Asian J Androl 2001 Dec;3(4):301‐3). In a double-blind, placebo-controlled study (Andrologia 2002 Dec;34(6):367‐72), it was shown to improve libido.

Tribulus terrestis, in a double-blind, placebo-controlled study (Urologia 2019 May;86(2):74‐78.), the authors stated, “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.” Another study (Andrologia 2017 Jun;49(5)), looked at 65 men with abnormal semen evaluation. They were given 250 mg of Tribulus terrestris dried extract per day. The subjects experienced a decrease in the percentage of body fat and increase in lean mass were significant, as well as increase in dihydrotestosterone levels.

In general, herbal therapies are safer than drug therapies. However, to be on the safe side, they should not be used during pregnancy or lactation, or by males or females with a history of cancer. Further, it should not be used by males with an increased PSA, or by athletes subject to testing for steroids. Talk to your doctor about these issues before taking any of these herbs.