Effects of a Proprietary Freeze-Dried Water Extract of Eurycoma longifolia (Physta) and Polygonum minus on Sexual Performance and Well-Being in Men: A Randomized, Double-Blind, Placebo-Controlled Study
Background. Physta is a proprietary product containing a freeze-dried water extract of Eurycoma longifolia (tongkat ali), which is traditionally used as an energy enhancer and aphrodisiac. We aim to evaluate a 300？mg combination of Physta and Polygonum minus, an antioxidant, with regard to sexual performance and well-being in men. Methods. Men that aged 40–65 years were screened for this 12-week randomized, double-blind, placebo-controlled, parallel-group study. Outcome measures included validated questionnaires that aimed to evaluate erectile function, satisfaction with intervention, sexual intercourse performance, erectile hardness, mood, and overall quality of life. Results. 12 subjects in the active group and 14 in the placebo group completed the study. Significant improvements were noted in scores for the Sexual Intercourse Attempt diary, Erection Hardness Scale, Sexual Health Inventory of Men, and Aging Male Symptom scale ( for all). Three adverse events were reported in the active group and four in the placebo group, none of which were attributed to study product. Laboratory evaluations, including liver and kidney function testing, showed no clinically significant abnormality. Conclusion. Supplementation for twelve weeks with Polygonum minus and the proprietary Eurycoma longifolia extract, Physta, was well tolerated and more effective than placebo in enhancing sexual performance in healthy volunteers. 1. Introduction Erectile dysfunction (ED) occurs as a result of a lack of blood flow to the penis, impairing the ability to achieve or maintain an erection suitable for sexual intercourse [1]. This condition affects approximately 30 million men in the United States and approximately 52% of men aged 40–70 years worldwide [1]. While the incidence of erectile dysfunction increases with age, men at all ages are at risk. Risk factors for ED include heart disease, hypertension, hyperlipidemia, diabetes, prostate disease, depression, stress, anxiety, smoking, and prescription/recreational drug use. Testosterone is a steroid hormone that plays a key role in development and maintenance of the male reproductive system. As men age, the endogenous production of testosterone by the Leydig cells tends to decrease at a rate of 1.6% per year [2]. Decreased levels of testosterone, including levels that are still within the normal range, have been linked to erectile dysfunction, particularly in older men [2–4]. The most popular prescription medications aimed at treating ED today are classified as cGMP-specific phosphodiesterase type 5 (PDE5) inhibitors, which act by
References
[1]
B. M. Berookhim and N. Bar-Chama, “Medical implications of erectile dysfunction,” Medical Clinics of North America, vol. 95, no. 1, pp. 213–221, 2011.
[2]
A. Tsujimura, “The relationship between testosterone deficiency and men's health,” The World Journal of Men's Health, vol. 31, pp. 126–135, 2013.
[3]
J. E. Lackner, E. Rücklinger, G. Schatzl, G. Lunglmayr, and C. W. Kratzik, “Are there symptom-specific testosterone thresholds in aging men?” BJU International, vol. 108, no. 8, pp. 1310–1315, 2011.
[4]
S. Arver and M. Lehtihet, “Current guidelines for the diagnosis of testosterone deficiency,” Frontiers of Hormone Research, vol. 37, pp. 5–20, 2009.
[5]
J. C. Cappelleri, S. E. Althof, R. L. Siegel, A. Shpilsky, S. S. Bell, and S. Duttagupta, “Development and validation of the Self-Esteem and Relationship (SEAR) questionnaire in erectile dysfunction,” International Journal of Impotence Research, vol. 16, no. 1, pp. 30–38, 2004.
[6]
J. C. Cappelleri, R. L. Siegel, D. B. Glasser, I. H. Osterloh, and R. C. Rosen, “Relationship between patient self-assessment of erectile dysfunction and the sexual health inventory for men,” Clinical Therapeutics, vol. 23, no. 10, pp. 1707–1719, 2001.
[7]
J. P. Mulhall, I. Goldstein, A. G. Bushmakin, J. C. Cappelleri, and K. Hvidsten, “Validation of the erection hardness score,” Journal of Sexual Medicine, vol. 4, no. 6, pp. 1626–1634, 2007.
[8]
M. Kamatenesi-Mugisha and H. Oryem-Origa, “Traditional herbal remedies used in the management of sexual impotence and erectile dysfunction in western Uganda,” African Health Sciences, vol. 5, no. 1, pp. 40–49, 2005.
[9]
N. Malviya, S. Jain, V. B. Gupta, and S. Vyas, “Recent studies on aphrodisiac herbs for the management of male sexual dysfunction—a review,” Acta Poloniae Pharmaceutica, vol. 68, no. 1, pp. 3–8, 2011.
[10]
H. H. Aung, L. Dey, V. Rand, and C.-S. Yuan, “Alternative therapies for male and female sexual dysfunction,” American Journal of Chinese Medicine, vol. 32, no. 2, pp. 161–173, 2004.
[11]
S. Hussein, R. Ibrahim, and L. P. Kiong, “A summary of reported chemical constituents and medicinal uses of Eurycoma longifolia,” Journal of Tropical Medicinal Plants, vol. 8, no. 1, pp. 103–110, 2007.
[12]
M. A. Hassali, T. M. Khan, A. A. Shafie, and M. Nazir, “Public knowledge about herbal beverages in Penang, Malaysia,” Australasian Medical Journal, vol. 1, pp. 1–12, 2009.
[13]
S. R. Doustjalali, M. Marzalina, and M. A. Nor Datiakma, “A gel-based proteomic kit to screen the quality of water-soluble root extracts of Eurycoma longifolia,” Journal of Tropical Forest Science, vol. 17, no. 3, pp. 479–480, 2005.
[14]
M. I. Tambi and A. Kadir, “Eurycoma longifolia Jack: a potent adaptogen in the form of water soluble extract (LJ100) in maintaining men's health,” The Aging Male, 2007.
[15]
P. Zanoli, M. Zavatti, C. Montanari, and M. Baraldi, “Influence of Eurycoma longifolia on the copulatory activity of sexually sluggish and impotent male rats,” Journal of Ethnopharmacology, vol. 126, no. 2, pp. 308–313, 2009.
[16]
C. H. Li, J. W. Liao, P. L. Liao, et al., “Evaluation of acute 13-week subchronic toxicity and genotoxicity of the powdered root of Tongkat Ali (Eurycoma longifolia Jack),” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 102987, 11 pages, 2013.
[17]
N. D. Roslan, J. M. Yusop, S. N. Baharum et al., “Flavonoid biosynthesis genes putatively identified in the aromatic plant polygonum minus via expressed sequences tag (EST) analysis,” International Journal of Molecular Sciences, vol. 13, no. 3, pp. 2692–2706, 2012.
[18]
S. W. Qader, M. A. Abdulla, L. S. Chua, and S. Hamdan, “Potential bioactive property of Polygonum minus Huds (kesum) review,” Scientific Research and Essays, vol. 7, pp. 90–93, 2012.
[19]
S. E. Althof, E. W. Corty, S. B. Levine et al., “EDITS: development of questionnaires for evaluating satisfaction with treatments for erectile dysfunction,” Urology, vol. 53, no. 4, pp. 793–799, 1999.
[20]
L. A. J. Heinemann, T. Zimmermann, A. Vermeulen, C. Thiel, and W. Hummel, “A new 'aging males' symptoms' rating scale,” Aging Male, vol. 2, no. 2, pp. 105–114, 1999.
[21]
R. C. Rosen, A. Riley, G. Wagner, I. H. Osterloh, J. Kirkpatrick, and A. Mishra, “The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction,” Urology, vol. 49, no. 6, pp. 822–830, 1997.
[22]
A. T. Beck, N. Epstein, G. Brown, and R. A. Steer, “An inventory for measuring clinical anxiety: psychometric properties,” Journal of Consulting and Clinical Psychology, vol. 56, no. 6, pp. 893–897, 1988.
[23]
A. T. Beck, R. A. Steer, R. Ball, and W. F. Ranieri, “Comparison of Beck depression inventories -IA and -II in psychiatric outpatients,” Journal of Personality Assessment, vol. 67, no. 3, pp. 588–597, 1996.
[24]
Random.org, “True random number service,” 2006, http://www.random.org/.
[25]
S. B. Ismail, W. M. Z. Wan Mohammad, A. George, N. H. Nik Hussain, Z. M. Musthapa Kamal, and E. Liske, “Randomized clinical trial on the use of PHYSTA freeze-dried water extract of Eurycoma longifolia for the improvement of quality of life and sexual well-being in men,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 429268, 10 pages, 2012.
[26]
M. I. Tambi, M. K. Imran, and R. R. Henkel, “Standardised water-soluble extract of Eurycoma longifolia, Tongkat Ali, as testosterone booster for managing men with late-onset hypogonadism?” Andrologia, vol. 44, supplement 1, pp. 226–230, 2012.
[27]
R. Bhat and A. A. Karim, “Tongkat Ali (Eurycoma longifolia Jack): a review on its ethnobotany and pharmacological importance,” Fitoterapia, vol. 81, no. 7, pp. 669–679, 2010.
[28]
M. I. Tambi, M. K. Imran, and R. R. Henkel, “Standardised water-soluble extract of Eurycoma longifolia, Tongkat Ali, as testosterone booster for managing men with late-onset hypogonadism?” Andrologia, vol. 44, supplement 1, pp. 226–230, 2012.
[29]
S. Hamzah and A. Yusof, “The ergogenic effect of Eurycoma longifolia Jack: a pilot study (joint conference of BASEM and BASES),” British Journal of Sports Medicine, vol. 37, no. 5, pp. 464–470, 2003.
[30]
M. I. Bin Mohd Tambi and M. K. Imran, “Eurycoma longifolia Jack in managing idiopathic male infertility,” Asian Journal of Andrology, vol. 12, no. 3, pp. 376–380, 2010.
[31]
H. H. Ang and K. L. Lee, “Effect of Eurycoma longifolia Jack on orientation activities in middle-aged male rats,” Fundamental and Clinical Pharmacology, vol. 16, no. 6, pp. 479–483, 2002.
[32]
H. H. Ang, K. L. Lee, and M. Kiyoshi, “Sexual arousal in sexually sluggish old male rats after oral administration of Eurycoma longifolia Jack,” Journal of Basic and Clinical Physiology and Pharmacology, vol. 15, no. 3-4, pp. 303–309, 2004.
[33]
H. H. Ang and T. H. Ngai, “Aphrodisiac evaluation in non-copulator male rats afterchronic administration of Eurycoma longifolia Jack,” Fundamental and Clinical Pharmacology, vol. 15, no. 4, pp. 265–268, 2001.
[34]
H. H. Ang, T. H. Ngai, and T. H. Tan, “Effects of Eurycoma longifolia Jack on sexual qualities in middle aged male rats,” Phytomedicine, vol. 10, no. 6-7, pp. 590–593, 2003.
[35]
H. H. Ang and M. K. Sim, “Eurycoma longifolia increases sexual motivation in sexually naive male rats,” Archives of Pharmacal Research, vol. 21, no. 6, pp. 779–781, 1998.
[36]
M. M. Noor, M. H. S. Mohd Nor, and L. C. Hassan, “The effect of Eurycoma longifolia Jack (Tongkat Ali) on sexual behaviour and sperm quality in rats,” Malaysian Journal of Pharmaceutical Sciences, vol. 2, no. 1, pp. 53–60, 2004.
[37]
H. H. Ang and M. K. Sim, “Aphrodisiac effects of Eurycoma longifolia root in non-copulator male rats,” Fitoterapia, vol. 69, no. 5, pp. 445–447, 1998.
[38]
K.-L. Chan, B.-S. Low, C.-H. Teh, and P. K. Das, “The effect of Eurycoma longifolia on sperm quality of male rats,” Natural Product Communications, vol. 4, no. 10, pp. 1331–1336, 2009.
[39]
M. S. Exton, T. H. Krüger, N. Bursch et al., “Endocrine response to masturbation-induced orgasm in healthy men following a 3-week sexual abstinence,” World Journal of Urology, vol. 19, no. 5, pp. 377–382, 2001.
[40]
M. Jiang, “Periodic changes in serum testosterone levels after ejaculation in men,” Acta Physiologica Sinica, vol. 54, no. 6, pp. 535–538, 2002.
[41]
Y. K. Choudhary, P. Bommu, Y. K. Ming, and N. B. Zulkawi, “Acute, sub-acute, and subchronic 90-days toxicity of Eurycoma longifolia aqueous extract (Physta) in wistar rats,” International Journal of Pharmacy and Pharmaceutical Sciences, vol. 4, pp. 232–238, 2012.
[42]
E. S. Pescatori, V. Silingardi, G. M. Galeazzi, M. Rigatelli, A. Ranzi, and W. Artibani, “Audiovisual sexual stimulation by virtual glasses is effective in inducing complete cavernosal smooth muscle relaxation: a pharmacocavernosometric study,” International Journal of Impotence Research, vol. 12, no. 2, pp. 83–90, 2000.
[43]
T. Suetomi, F. Endo, H. Takeshima, and H. Akaza, “Evaluation of the effectiveness of sildenafil using questionnaire methods versus audio-visual sexual stimulation,” International Journal of Urology, vol. 12, no. 4, pp. 369–373, 2005.
[44]
D. G. Hatzichristou, I. S. De Tejada, S. Kupferman et al., “In vivo assessment of trabecular smooth muscle tone, its application in pharmaco-cavernosometry and analysis of intracavernous pressure determinants,” Journal of Urology, vol. 153, no. 4, pp. 1126–1135, 1995.
