School of Medicine, Federal University of Uberlandia (UFU), Uberlandia, Minas Gerais, Brazil.
Research Director, Tier 1 Center for Research, Chattanooga, TN, United States.
J Ethnopharmacol. 2019 May 10;235:392-405. doi: 10.1016/j.jep.2019.02.033. Epub 2019 Feb 18.
ETHNO-PHARMACOLOGICAL RELEVANCE: Phytotherapeutic approaches have been widely proposed to improve male health. Despite the well-touted effects of tribulus (Tribulus terrestris L) on men's health, an optimal phytotherapy remains an elusive challenge.
We sought to critically analyze the evidence in the phytotherapic literature beyond the effects of tribulus on testosterone (T) concentration and sperm analysis to also include indications for prostate health.
A focused literature search was conducted to include studies published in Cochrane, Pubmed, and Web of Science databases between the years 2002 and 2018.
The use of tribulus and maca (Lepidium meyenii Walp, Brassicaceae) were not scientifically supported to improve serum T levels in men. Moderate evidence supports the use of long Jack (Eurycoma longifolia Jack, Simaroubaceae), mucuna (Mucuna pruriens (L.) DC., Fabaceae), ashwagandha (Withania somnifera (L.) Dunal, Solanaceae), fenugreek (Trigonella foenum-graceum L., Fabaceae), and black seeds (Nigella sativa L., Ranunculaceae) to increase total T and improve seminal parameters. Data suggests an increase in total T with the use of 5000 mg/d of powdered mucuna seed and ashwagandha root (151 and 143 ng/dL, respectively) over a 12-week period in patients with oligozoospermia. The use of mucuna was supported for patients with oligozoospermia to improve sperm parameters, with an increase of 83.3 million/mL observed after use of 5000 mg/d of powdered mucuna seed over a 12-week period. Evidence supporting the use of saw palmetto (Serenoa repens, (W.Bartram) Small, Arecaceae) to improve prostate health remains equivocal; whereas, evidence supporting the use of Pygeum africanum Hook.f., Rosaceae, Urtica dioica L., Urticaceae, beta-sitosterols, pollen extract, onion, garlic, and tomato, appears favorable and promising.
Scientific evidence supports the use of mucuna and ashwagandha as phytotherapics for improving serum T concentrations and semen parameters. Despite inconclusive evidence for use of tribulus as a T booster, it may provide advantageous effects on sperm parameters in men with idiopathic infertility. Nutraceutical strategies and some phytotherapics may also be effective to promote prostate health. Popular foodstuffs (onion, garlic, and tomato), nutraceutical agents (pollen extract and beta-sitosterols), and herbal medicines (Pygeum africanum and Urtica dioica) are rational approaches.
植物疗法已被广泛提出用于改善男性健康。尽管蒺藜（Tribulus terrestris L）对男性健康有很好的作用，但理想的植物疗法仍然是一个难以实现的挑战。
我们旨在批判性地分析植物疗法文献中的证据，不仅包括蒺藜对睾酮（T）浓度和精子分析的影响，还包括对前列腺健康的影响。
我们进行了一次重点文献检索，包括在 Cochrane、Pubmed 和 Web of Science 数据库中 2002 年至 2018 年发表的研究。
蒺藜和玛卡（Lepidium meyenii Walp，十字花科）的使用并没有科学依据可以提高男性的血清 T 水平。有中等证据支持长期使用长柄葫芦巴（Eurycoma longifolia Jack，豆科）、羽扇豆（Mucuna pruriens（L.）DC.，豆科）、南非醉茄（Withania somnifera（L.）Dunal，茄科）、胡芦巴（Trigonella foenum-graceum L.，豆科）和黑种草子（Nigella sativa L.，毛茛科）来提高总 T 水平并改善精液参数。数据表明，在少精子症患者中，使用 5000mg/d 的羽扇豆种子粉和南非醉茄根粉（分别为 151 和 143ng/dL），12 周后总 T 水平会升高。在少精子症患者中，使用羽扇豆可提高精子参数，使用 5000mg/d 的羽扇豆种子粉 12 周后，精子数量增加 8330 万/mL。关于使用锯棕榈（Serenoa repens，（W.Bartram）Small，棕榈科）改善前列腺健康的证据仍然存在争议；而关于使用非洲臀果木（Pygeum africanum Hook.f.，蔷薇科）、荨麻（Urtica dioica L.，荨麻科）、β-谷甾醇、花粉提取物、洋葱、大蒜和番茄的证据似乎有利且有希望。
科学证据支持使用羽扇豆和南非醉茄作为植物疗法来提高血清 T 浓度和精液参数。尽管蒺藜作为 T 增强剂的证据不明确，但它可能对特发性不育症男性的精子参数有有益的影响。营养保健品和一些植物疗法也可能有效促进前列腺健康。受欢迎的食品（洋葱、大蒜和番茄）、营养保健品（花粉提取物和β-谷甾醇）和草药（非洲臀果木和荨麻）是合理的方法。
