Low testosterone in men (supplement marketing)
A middle-aged-man complaint of low libido, morning fatigue and lost muscle mass, popularly blamed on «low testosterone». Real hypogonadism requires two morning total testosterone measurements below 12 nmol/L plus symptoms and confirmed cause (Endocrine Society 2018, ISSAM 2022). Supplements – boron, zinc, tribulus, ashwagandha, tongkat ali – are marketed as testosterone boosters, yet large meta-analyses and systematic reviews show no clinically meaningful testosterone rise in men without confirmed hypogonadism.
ICD-10 E29.17 drugs
Also known as: Low T, Andropause, Testosterone boosters
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DBoronNot recommended · Trace element with no established human biological role, supplementBoron is widely marketed as a «natural testosterone booster». The pitch traces to a small Naghii 2011 study (8 men, one week of 10 mg/day boron) with a 28 % rise in free testosterone. Larger RCTs have failed to reproduce the effect: the Pizzorno 2015 review and NIH ODS 2022 fact sheet note that data in men with normal testosterone are insufficient and inconsistent. Endocrine Society 2018 and ISSAM 2022 do not include boron in hypogonadism guidelines. In men with confirmed symptomatic hypogonadism (testosterone below 12 nmol/L on two morning samples plus symptoms) testosterone replacement is discussed with urology. If boron was bought to raise testosterone, consider seeking a second opinion and start with measuring the level.
- DCordyceps (Cordyceps sinensis, Cordyceps militaris)Not recommended · Medicinal mushroom of Tibetan and Chinese medicine, supplement. AEMPS does not register as medicineCordyceps is a fungus (Cordyceps sinensis, Cordyceps militaris) marketed as a supplement to raise testosterone in men. There is no evidence base for this use: studies have not shown a convincing benefit for testosterone levels in people. Low testosterone calls for a workup with a doctor (endocrinologist, urologist-andrologist) and treatment chosen for the cause, so this supplement should not replace therapy with proven benefit, since that can mean missing the care you need.
- DPanax ginseng (Korean/Chinese ginseng)Not recommended · Plant adaptogen, supplement. In EU – traditional herbal medicinal product (EMA HMPC); OTC tincture in RussiaGinseng (Panax ginseng) is a plant extract sold as a supplement to raise testosterone, libido and energy in men. For low testosterone in men, ginseng has not shown convincing benefit, and there is no solid evidence base for this use. When low testosterone is confirmed, what helps is finding the cause with a doctor (a urologist or endocrinologist) and, where indicated, testosterone replacement therapy. Do not take ginseng in place of treatment with proven benefit, since that risks missing the care you actually need.
- DTongkat ali (Eurycoma longifolia)Not recommended · Botanical supplement, Eurycoma longifolia root, traditional Malaysian and Indonesian medicine; sold on iHerb and Amazon as a «natural testosterone booster», adaptogen and aphrodisiac. NOTE: in 2016-2019 the FDA recalled tongkat ali products for lead contamination and adulteration with synthetic PDE-5 inhibitorsTongkat ali is an over-the-counter supplement actively marketed as a «natural testosterone booster». The Tambi RCT (Andrologia 2012) in 76 men with late-onset hypogonadism used the standardised water-soluble Physta extract 200 mg/day for one month: total testosterone rose from 5.7 to 8.7 nmol/L (normal >12) and Ageing Males' Symptoms scores improved. The study was sponsored by the manufacturer of Physta and lacked placebo control. Leisegang's systematic review (Andrologia 2022) pooled 11 RCTs: half showed a modest testosterone rise, half did not; evidence quality is limited by small samples (20–100 people), short duration (4–12 weeks) and sponsorship. EFSA in 2021 did not approve the novel-food application. The Endocrine Society Guideline 2018 recommends, in confirmed hypogonadism (total testosterone <12 nmol/L on two morning measurements with symptoms), testosterone replacement therapy by gel, injection or subcutaneous implant with monitoring of PSA, haematocrit and lipids; supplements do not substitute. IMPORTANT: in 2016–2019 the FDA recalled tongkat ali products for lead contamination and adulteration with sildenafil or tadalafil. If tongkat ali is being considered, discuss with an endocrinologist, choose certified manufacturers (USP, NSF, GMP) and get tested – if testosterone is low, replacement therapy is more effective than a supplement.
- FD-aspartic acid (DAA)Not recommended · D-enantiomer of aspartic acid, sport and biohacking supplement. AEMPS does not register as medicineD-aspartic acid is a popular «natural testosterone booster» in biohacking and sport segments, sold on the Topo 2009 paper about +42% testosterone over 12 days. Modern RCTs refute the result: Melville 2017 (PLoS One) in 22 trained men showed no change in total or free testosterone with DAA 6 g/day over 12 weeks vs placebo. Willoughby 2013 in 20 men at 3 g/day for 28 days also showed no change. Moreover, Melville 2015 found that 6 g/day lowered total testosterone, so the supplement does the opposite of what it promises. Endocrine Society 2018 in confirmed hypogonadism recommends testosterone replacement therapy; DAA is in no international guideline. If DAA was recommended for «low testosterone» without proper workup, consider seeking a second opinion from an endocrinologist.
- FMucuna pruriens (velvet bean)Not recommended · Plant source of L-DOPA. Used in Ayurveda for Parkinson disease; in the West – biohacking supplementMucuna in the biohacking segment is sold as a «natural testosterone booster» promising male fertility and sexual function. No evidence base: small Indian studies with small samples and weak methodology. Endocrine Society 2018 in confirmed hypogonadism recommends testosterone replacement therapy via injections, gel or implants; mucuna is not mentioned. If mucuna was recommended for «low testosterone» without proper workup (total + free testosterone morning, LH, FSH, prolactin, SHBG, ferritin), consider seeking a second opinion from an endocrinologist.
- FTribulus terrestris (puncture vine)Not recommended · Plant «testosterone booster» and aphrodisiac of Bulgarian folk medicine, supplement. AEMPS does not register as medicineTribulus terrestris is the top-selling «natural testosterone booster» in sport and biohacking segments, promising testosterone, muscle mass and libido increase. Systematic reviews and RCTs refute the effect: Neychev 2008 (J Ethnopharmacol) in 21 healthy young men showed no changes in total and free testosterone, LH or FSH with tribulus vs placebo. Pokrywka 2014 systematic review confirmed no hormonal effect. Endocrine Society 2018 in confirmed hypogonadism (total testosterone <300 ng/dL on two morning samples + symptoms) recommends testosterone replacement therapy under endocrinology supervision. If tribulus was recommended for «low testosterone» without proper workup, consider seeking a second opinion from an endocrinologist.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit