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Tribulus terrestris (puncture vine)

Plant «testosterone booster» and aphrodisiac of Bulgarian folk medicine, supplement. AEMPS does not register as medicine

ATC code: A11JA-TRIBULUS

Brand names – supplements: Now Tribulus, Optimum Nutrition Tribulus, Bulk Tribulus, TribestanSupplements are not tested in clinical trials and are not registered as medications.

Updated · Methodology

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.

F

Erectile dysfunction

Not recommended

Tribulus is sold as «natural Viagra» for erectile dysfunction. Evidence base is minimal: small Bulgarian and Indian RCTs showed heterogeneous IIEF scale results; no large international RCTs. AUA 2018 lists PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) first-line for ED; tribulus is not mentioned. If tribulus was recommended for ED instead of workup (testosterone, , lipid panel, TSH) and standard therapy, consider seeking a second opinion from a urologist.

Sources

  1. AUA: Erectile Dysfunction: AUA Guideline (2018)
  2. J Ethnopharmacol: The aphrodisiac herb Tribulus terrestris does not influence the androgen production in young men (2008)

ICD-10: N52.9 · ICD-11: HA01.1

F

Low testosterone in men (supplement marketing)

Not recommended

Tribulus 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.

Sources

  1. J Ethnopharmacol: The aphrodisiac herb Tribulus terrestris does not influence the androgen production in young men (2008)
  2. Endocrine Society: Testosterone Therapy in Men with Hypogonadism: An Endocrine Society Clinical Practice Guideline (2018)

ICD-10: E29.1 · ICD-11: 5A81.1

F

Muscle mass gain (bodybuilding self-use)

Not recommended

Tribulus is sold in pre-workout formulas and «testosterone boosters» as a muscle gain product. No evidence base: no quality RCTs with lean body mass and strength endpoints. For muscle gain IOC 2018 and ISSN 2015 list creatine monohydrate (3–5 g/day), adequate protein (1.6–2.2 g/kg), progressive overload and caloric surplus; tribulus is not in the IOC-approved sports supplement list.

Sources

  1. IOC: IOC consensus statement: dietary supplements and the high-performance athlete (2018)
  2. J Ethnopharmacol: The aphrodisiac herb Tribulus terrestris does not influence the androgen production in young men (2008)
How to read tiers A–F
  • 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

Mechanism of action

Tribulus fruit and leaves contain steroidal saponins (protodioscin, protogracillin), flavonoids and alkaloids. In animal models protodioscin raises LH and testosterone in male rats; in humans no endocrine effect confirmed. Neychev 2008 (J Ethnopharmacol) RCT in 21 healthy young men: tribulus 20 mg/kg body weight × 4 weeks showed no changes in total and free testosterone, LH or FSH vs placebo. Main myth – «testosterone booster»: built on 1980s Sopharma (Bulgarian pharmaceutical company) studies whose methodology has not been reproduced.

Safety

Contraindications

  • Pregnancy and lactation
  • Children under 18
  • Hormone-sensitive breast, prostate, endometrial tumours (theoretical oestrogen- and androgen-like effect)
  • Diabetes on insulin or sulfonylurea (hypoglycaemia risk)
  • Kidney disease (nephrotoxicity cases reported)

Serious adverse effects

  • Drug-induced liver injury (DILI) – isolated published cases
  • Nephrotoxicity (published cases)
  • Hormone-sensitive tumour growth promotion

Common adverse effects

  • Nausea
  • Abdominal pain
  • Gynaecomastia in men (published cases)
  • Menstrual cycle disruption in women

Pregnancy: can you take Tribulus terrestris (puncture vine)?

No RCT data in pregnancy. AEMPS does not register. Avoid in pregnancy.

Breastfeeding: can you take Tribulus terrestris (puncture vine)?

No data on milk transfer. Lactating women should avoid.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

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Frequently asked

What is Tribulus terrestris (puncture vine) used for?

Tribulus terrestris (puncture vine) is evaluated for the following indications with varying evidence strength: Low testosterone in men (supplement marketing) (evidence tier F), Erectile dysfunction (evidence tier F), Muscle mass gain (bodybuilding self-use) (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Tribulus terrestris (puncture vine)?

Common side effects of Tribulus terrestris (puncture vine) (≥ 1 in 100): Nausea, Abdominal pain, Gynaecomastia in men (published cases), Menstrual cycle disruption in women. See the Safety section for uncommon and serious reactions.

Is Tribulus terrestris (puncture vine) safe during pregnancy?

No RCT data in pregnancy. AEMPS does not register. Avoid in pregnancy.

Is Tribulus terrestris (puncture vine) compatible with breastfeeding?

No data on milk transfer. Lactating women should avoid.

Who should not take Tribulus terrestris (puncture vine)?

Tribulus terrestris (puncture vine) is contraindicated in: Pregnancy and lactation; Children under 18; Hormone-sensitive breast, prostate, endometrial tumours (theoretical oestrogen- and androgen-like effect); Diabetes on insulin or sulfonylurea (hypoglycaemia risk); Kidney disease (nephrotoxicity cases reported). Full list in the Safety section.

Other drugs in this group

Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum), Turkey tail (Trametes versicolor, Coriolus versicolor), Urolithin A (ellagitannin metabolite, mitophagy activator), Stinging nettle root (Urtica dioica, radix), Beta-carotene, Epigallocatechin-3-gallate (EGCG, main green tea polyphenol), Myo-inositol, Quercetin