Tribulus Terrestris extract benefits and side effect, research studies by Ray Sahelian, M.D. Review of supplement dosage, frequency of use, and combining it with other aphrodisiac herbs that enhances sexuality in men and women, January 2011

Tribulus terrestris, also called "puncture vine," is a plant used around the world. It improves sexual function in humans. In Turkey, it is commonly used in folk medicine for blood pressure and cholesterol. In Europe, it has been used in folk medicine throughout history, as far back as the Greeks, for wide-ranging conditions as headache, nervous disorders, and sexual dysfunction. In China and India, this herb has been touted for use in liver, kidney, urinary, and cardiovascular remedies. But what does modern science have to say about this herb? Does it improve athletic performance, does it influence testosterone levels? Does this herb improve sexual performance, erectile function or libido?

Buy Tribulus Terrestris supplement, 400 mg per each pill
 Tribulus terrestris is a tropical vine common in sandy soils throughout India, Pakistan, Sri Lanka and other parts of the world. This herb is popular for its potent role in supporting sexual function. It can be used by both men and women. It can be combined with other aphrodisiac herbs such as avena sativa, catuaba, ginseng, horny goat weed, maca, muira puama, mucuna pruriens, tongkat ali and yohimbe as long as the dosage of each is a fraction of a capsule.

Supplement facts and amount per pill
Tribulus Terrestris extract 400 mg each pill
     (standardized to 40 % saponins)
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Sexual behavior and enhancement
Animal studies have found TT to be helpful as a sex booster. Sexual behavior and intracavernous pressure (ICP) were studied in both normal and castrated rats to further understand the role of tribulus as an aphrodisiac. ICP refers to blood flow into the corpus cavernosa of the penis. Adult rats were divided into groups of 8 each that included distilled water treated (normal and castrated), testosterone treated (normal and castrated) and tribulus treated (castrated). Compared to the castrated control, treatment of castrated rats (with either testosterone or tribulus extract) showed increase in prostate weight and ICP. There was also an improvement in sexual behavior as evidenced by an increase in mounting frequency. Aphrodisiac properties of Tribulus Terrestris extract Protodioscin in normal and castrated rats. Life Science. 2002.
   In my personal and professional experience, this herb does seem to have a positive influence on sexual enhancement. I personally have noticed improved sexual performance after a few days of use.

Effect of Tribulus terrestris on nicotinamide adenine dinucleotide phosphate-diaphorase activity and androgen receptors in rat brain.
J Ethnopharmacol. 2005.
Administration increased sexual behavior and intracavernous pressure both in normal and castrated rats and these effects were probably due to the androgen increasing property. Our findings support to the aphrodisiac claims.

Testosterone effect
I have read some websites that report it increases testosterone levels but I have not come any definitive human research that supports this in the long run. Perhaps it does raise levels of testosterone but at this point I'm not sure. And even if it does, I don't know whether it would do so consistently if tribulus is taken for prolonged periods. Animal and human studies have shown conflicting results.

I want you to know that taking tribulus terrestis for two months my total testosterone level went from 162 to 328, my Dr. said keep using it. I have no more menopause hot flashes and sweats. Thank you very much for your product.
   We would be interested in more feedback from women who use tribulus to know whether this herb has an influence on menopausal hot flashes or testosterone levels.

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Passion Rx for a man and woman
This natural herbal aphrodisiac formula provides results that are most commonly noticed within two to four days of use and the benefits continue over time. Dr. Sahelian and his research staff tested various doses and extracts of dozens of herbs from a number or raw material suppliers to determine the ideal dosage and combination for optimal aphrodisiac properties with the fewest side effects.

Passion Rx supports and enhances healthy:

For hundreds of years civilizations around the world have known about locally grown herbs that achieve wonderful results. Now, renowned physician and herbal expert Dr. Ray Sahelian, M.D., author of Natural Sex Boosters, has combined a number of exotic herbs from the Amazon jungle, India, China, Malaysia, and Africa, that support healthy desire and performance. This aphrodisiac formula provides a natural solution for those looking for an alternative to synthetic drugs.
   The potent herbal extracts in Passion Rx include ashwagandha, catuaba bark, cnidium, damiana, horny goat weed, maca, mucuna pruriens, mMuira puama, Passion flower, tongkat Ali, tribulus and yohimbe. A version is available without yohimbe bark extract.

Angina pectoris
 Tribulus terrestris has been studied in China and found to reduce the frequency of angina pectoris attacks.

Athletic performance
Does tribulus terrestris have an influence on testosterone release or enhance testosterone production? One study in rodents indicates that tribulus has an influence on androgen receptors located on brain cells in the hypothalamus. Another animal study found TT use did increase testosterone levels. However, a human study done in Australia in 2007 did not find the herb to have a major influence on muscle mass growth, nor did tribulus seem to influence blood testosterone levels in humans to any great extent. Animal and human studies have shown conflicting results in regards to its influence on testosterone levels. This herb is legal to use in all professional sports. I doubt that it offers any significant athletic performance benefits.

The effect of five weeks of Tribulus terrestris supplementation on muscle strength and body composition during preseason training in elite rugby league players.
J Strength Cond Res. 2007. School of Exercise Science and Sport Management, Southern Cross University Lismore, New South Wales, Australia.
Twenty-two Australian elite male rugby league players were match-paired and randomly assigned in a double-blind manner to either a TT or placebo group. All subjects performed structured heavy resistance training as part of the club's preseason preparations. A tribulus terrestris extract (450 mg each day)) or placebo capsule was consumed once daily for 5 weeks. After 5 weeks of training, strength and fat free mass increased significantly without any difference between those who took placebo or those taking tribulus terrestris extract. No between-group differences were noted in the urinary testosterone / epitestosterone ratio.

The hormonal effects of Tribulus terrestris and its role in the management of male erectile dysfunction - an evaluation using primates, rabbit and rat.
Phytomedicine. 2008. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore.
Tribulus terrestris extract was administered intravenously in primates for acute study. Rabbits and normal rats were treated with orally for 8 weeks. In addition, castrated rats were treated either with testosterone cypionate or tribulus terrestris orally (5mg/kg daily for 8 weeks). Blood samples were analyzed for testosterone, dihydrotestosterone (DHT) and dehydroepiandrosterone sulphate levels. In primates, the increases in testosterone, DHT and DHEAS were statistically significant. In rabbits, both testosterone and DHT were increased compared to control, however, only the increases in DHT were statistically significant. In castrated rats increases in testosterone levels by 51% and 25% were observed with testosterone and tribulus terrestris extract respectively that were statistically significant. The herb increases some of the sex hormones, possibly due to the presence of protodioscin in the extract.

Weight lifting or training
I have been told that tribulus terrestris is good to use when weightlifting and that the testosterone in it is helpful for building muscle. Is it effective for body building purposes for a man.
   There are no studies to prove this herb is effective for weightlifting or bodybuilding.

Blood pressure effect
 Antihypertensive and vasodilator effects of methanolic and aqueous extracts of Tribulus terrestris in rats.
J Ethnopharmacol. 2006. Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Kuwait University, Safat, Kuwait.
It was concluded that methanolic and aqueous extracts of Tribulus terrestris possess significant antihypertensive activity in spontaneously hypertensive rats. The antihypertensive effects appeared to result from a direct arterial smooth muscle relaxation possibly involving nitric oxide release and membrane hyperpolarization.

Study of antihypertensive mechanism of Tribulus terestris in 2K1C hypertensive rats: role of tissue ACE activity.
Life Sci. 2003.
The present study investigated the antihypertensive mechanism of tribulus in 2K1C hypertensive rats by measurement of circulatory and local ACE activity in aorta, heart, kidney and lung. Our results indicated that there is a negative correlation between consumption of tribulus terrestris and angiotensin-converting enzyme activity in serum and different tissues in 2K1C rats.

Cancer influence

Breast cancer
The inhibitory effect of saponins from Tribulus terrestris on Bcap-37 breast cancer cell line in vitro
Zhong Yao Cai. 2003.
Saponins from tribulus terrestris had potent inhibitory effect on Bcap-37 cell line in a concentration-dependent manner.

Kidney cancer
Experimental study of saponins from Tribulus terrestris on renal carcinoma cell line
Zhongguo Zhong Yao Za Zhi. 2005.
Saponins can significantly inhibit the growth of renal carcinoma cell in vitro, partially, by apoptosis.

Prostate surgery, cancer
I am six years post prostatectomy with a 0.01 PSA level. Is there a risk in taking tribulus? The research seems unclear.
   I am not aware of any research specifically on its role after prostate removal and prostate cancer, but I do not suspect the occasional use will have much of an influence.

Cholesterol and lipids
Effect of saponin from Tribulus terrestris on hyperlipidemia
Zhong Yao Cai. 2003.
The preventive and therapeutic effects of saponin on diet-induced hyperlipidemia in mice have been studied. It showed that in preventive experiment the tribulus terrestris saponin could significantly lower the levels of serum total cholesterol and triglyceride. 

Energy and fatigue fighter
Tribulus has some energy boosting abilities, as do ginseng, cordyceps, maca, and tongkat ali. MultiVit Rx multivitamin formula is a great option for energy enhancement. As with most herbs, I recommend taking breaks from use.

Mechanism of action, how does it work?
 Tribulus terrestris may work by relaxing smooth muscles and increasing blood flow into the corpus cavernosa. The relaxant effect observed is probably due to the increase in the release of nitric oxide from the endothelium and nerve endings. Since the herb relaxes smooth muscles, this may account for its benefits in abdominal colic. The role of  this herb on testosterone production or release needs to be evaluated further before any statements can be made with confidence. Most people notice the benefits on the third or fourth day of use.

What's in the herb and the plant?
The fruits of tribulus contain a number of different substances including saponins (protodioscin, furostanol), glycosides, flavonoids, alkaloids, resins, tannins, sugars, sterols, and essential oil. Recently, two new saponins have been isolated: Terrestrinins A and B, .
   A frequently mentioned substance in tribulus terrestris is protodioscin, which some claim is one of the active substances within this plant. When different samples of tribulus were analyzed, significant differences in the composition of saponins were observed depending on the origin and plant part used. One analysis of products showed considerable variations of 0.17 to 6.5 % in protodioscin content.

 Availability of supplements
Tribulus is most often found in combination with other sex-enhancing herbs in various libido products. This herb is also sold by itself often in a dosage ranging from 250 to 750 mg. It is found in a variety of extract potencies. Some examples of tribulus extracts include 20 percent saponins, 40 percent saponins, 45 percent saponins, 60 percent saponins, 20 percent protodioscin, 40 percent protodioscin.

Tribulus side effects, caution, safety, risk, danger
No significant tribulus side effects have yet been reported in the medical literature regarding its use by humans as part of a clinical trial, but there have been case studies of individuals abusing this herb and having certain complications. Little is known about the long-term use of TT consumption in humans. As with most herbs, it is best to take breaks from use in order to minimize potential long term adverse effects. When sheep consume tribulus terrestris as 80% of their diet, liver damage and other changes occur. In my personal experience, and feedback from patients, I have noticed and heard the following tribulus terrestris side effects: more energy, feeling warmer, slightly faster heart beat, restlessness. These adverse event are dose dependent. I personally do not notice the tribulus side effects on dosages less than 300 mg, but these adverse effects are more common above 500 mg.

Tribulus terrestris-induced severe nephrotoxicity in a young healthy male.
Nephrol Dial Transplant. 2010. Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
We report a case of hepatotoxicity, nephrotoxicity and neurotoxicity in an Iranian male patient who used the plant's extract to prevent kidney stone formation. He presented with seizure and very high serum aminotransferases and creatinine after consuming herbal water for 2 days. Discontinuation of the herbal remedy resulted in improvement in symptoms and normalization of his liver enzymes.

Withdrawal
I have not seen any evidence of significant withdrawal symptoms after discontinuation.

Research studies
Hypoglycemic effect of saponin from Tribulus terrestris
Zhong Yao Cai. 2002.
The level of serum glucose could be significantly reduced by saponin from Tribulus terrestris, which was the rate of 26% and 40% in normal mice and diabetic mice in respectively. The level of serum triglyceride could be reduced 23%. The tribulus saponin could also decrease the content of serum cholesterol. Serum SOD activity of the mice was increased by the saponin. Saponins from Tribulus terrestris reduce the level of serum glucose.

The effects of Tribulus terrestris on body composition and exercise performance in resistance-trained males.
Int J Sport Nutr Exerc Metab. 2000
The purpose of this study was to determine the effects of the herbal preparation Tribulus terrestris (tribulus) on body composition and exercise performance in resistance-trained males. Fifteen subjects were randomly assigned to a placebo or tribulus (3.21 mg per kg body weight daily) group. Body weight, body composition, maximal strength, dietary intake, and mood states were determined before and after an 8-week exercise (periodized resistance training) and supplementation period. There were no changes in body weight, percentage fat, total body water, dietary intake, or mood states in either group. Muscle endurance increased for the bench and leg press exercises in the placebo group, while the tribulus terrestris group experienced an increase in leg press strength only . Supplementation with tribulus does not enhance body composition or exercise performance in resistance-trained males.

Sexual behavior and intracavernous pressure (ICP) were studied in both normal and castrated rats to further understand the role of tribulus containing protodioscin as an aphrodisiac. Adult Sprague-Dawley rats were divided into five groups of 8 each that included distilled water treated (normal and castrated), testosterone treated (normal and castrated, 10 mg/kg body weight, subcutaneously, bi-weekly) and tribulus treated (castrated, 5 mg/kg body weight, orally once daily). Decreases in body weight, prostate weight and ICP were observed among the castrated groups of rats compared to the intact group. There was an overall reduction in the sexual behaviour parameters in the castrated groups of rats as reflected by decrease in mount and intromission frequencies (MF and IF) and increase in mount, intromission, ejaculation latencies (ML, IL, EL) as well as post-ejaculatory interval (PEI). Compared to the castrated control, treatment of castrated rats (with either testosterone or tribulus extract) showed increase in prostate weight and ICP that were statistically significant. There was also a mild to moderate improvement of the sexual behaviour parameters as evidenced by increase in MF and IF; decrease in ML, IL and PEI. It is concluded that tribulus extract appears to possess aphrodisiac activity.

Supplement emails
 Q. With regard to the ingredients in Passion Rx, doesn't raising testosterone levels in males, specifically tribulus terrestris, increase prostate cancer risk?
   A. Very few studies have been done to determine the long term influence of tribulus terrestris supplement use in terms of testosterone production or release. We do not recommend daily use of Passion Rx. This product is taken mostly 2 days on, 2 or more days off. And, the amount of tribulus extract in Passion Rx is small. We are not concerned about this association.

How many different types of tribulus extracts are available?
   The ones I have seen are the following: Tribulus terrestris powder, 10% extract, 20% extract, and 40% extract. There are other tribulus extracts but the above are the most commonly used.

Any reason to be concerned in using it having ( BPH ) benigh prostate enlargement?
   We have not seen any research regarding a connection between tribulus terrestris and prostate enlargement, but as with most supplements, we advise taking breaks from use and this minimize any potential problems.

I am a 63 yr old male. I am lifting weights to maintain body strength. I was advised to take two Tribulus Terrestris capsules before and two after my work out. I work out every other day. I have high blood pressure controlled by medication. Was the advice I was given correct.
    We don't think this herb is a good option for those considering weight lifting or body building. Creatine and protein supplements are more appropriate.

What can you tell me (or direct me to) about tribulus terrestris and osteoporosis in men or women by virtue of testosterone increases?
    In order to know how whether this plant is effective for osteoporosis, at least a one year study has to be done in women. No such study has been done, therefore it is not possible to say whether TT is an appropriate herb for the treatment of osteoporosis. Other options have been studied much better. Furthermore, even if the plant extract stimulates testosterone release, are the effects consistent over time? Will there be side effects with long term daily use? What is the appropriate dose for adequate testosterone release without other negative consequences? All these questions have not been determined.

Are there hazardous side effects of using Tribulus terrestris and Viagra simultaneously? Can the minimum dose of 25 mg of sildenafil citrate can be taken along? What is the duration of a dosage?
    It is always a good idea, before mixing herbs and pharmaceutical drugs, to first learn how each one work by itself. In the case of tribulus terrestris one can learn the effects by taking in the morning at one capsule a day for at least 4 or 5 days. When combining medications and herbs the dosage of each should be reduced. Each person has a different dosage at which the benefits and side effects will be noticed. Tribulus and other herbs take a few days to start working so there is no point in taking the supplement the same day as a Viagra pill. One can take the herbal pill two or three days in a row before planned sexual activity and then take Viagra, Cialis or Levitra on the day of sexual activity. The effects of tribulus can last a day or two after the last dose.

More details about the plant
Puncturevine is a prostrate annual herb that grows from a simple taproot. It produces numerous stems, up to several feet long, that are much branched and arise from the crown to produce a dense mat. The fruit is a woody burr with sharp, rigid spines (strong enough to puncture bicycle tires or penetrate shoe soles). Tribulus is Latin for "three-pointed, a caltrop," the shape of which is suggested by the three-pronged fruit, and referring to the caltrop, a military weapon, an iron ball with projecting spikes. It is a serious weed in pastures, roadsides, waste places, vacant lots and cultivated fields. The spines of the tribulus fruit can cause damage to the feet of animals and are a nuisance to children. If growing in orchards or vineyards, it is a problem to the fruit pickers. If grazing animals happen to eat a bur, it may cause injury to the mouth, stomach, and intestines. The foliage is toxic to livestock, especially sheep, when consumed in large quantities.
   This plant is found throughout the United States, except along the northern tier from Montana to New England. It is also found in Asia, South Africa, the Mediterranean region, South America, and Australia. Tribulus terrestris was introduced into the United States with livestock imported from the Mediterranean region. It has become widespread since then. The fruits or berries are the parts most often used in traditional medicine. The composition of different substances within tribulus is likely to vary depending on which part of the world it grows.

History
 In China it is used in a number of conditions affecting the liver and kidney as well as the cardiovascular and immune systems. The role of tribulus terrestris in eastern European folk medicine for muscle strength and sexual potency led to two decades of formal (though secret) government-sponsored studies. The development of a formula for tribulus terrestris, along with the rise of a market economy in eastern Europe, has rapidly expanded its use over the last decade. Tribulus terrestris herb is now sold as a standardized pharmaceutical preparation for muscle strength and sexual potency throughout Europe, the Middle East, and Asia.

Forms Available
Tribulus Fruit extract 20% saponins, 40%
Also available are 20% Protodioscin and 40% Protodioscin
Various misspellings include terrestis, tribulous, terrestrus, terristrus, tribulas
This page was last updated in 2011.