Dismenorrea

Acetyl-L-Carnitine (ALCAR) has been investigated specifically in aging men for andropause-related symptoms. A landmark 2004 RCT in 120 aging men compared ALCAR and propionyl-L-carnitine with testosterone undecanoate; carnitine supplementation significantly improved erectile function, sexual desire, and depression scores comparable to testosterone therapy. ALCAR also supports mitochondrial function in Leydig cells, which declines with age.

A 16-week randomized, double-blind, placebo-controlled crossover RCT in overweight men aged 40–70 found ashwagandha (21 mg of 35% withanolide glycosides daily for 8 weeks) increased testosterone by ~14.7% and DHEA-S by ~18% versus placebo. The adaptogenic herb reduces cortisol, a key suppressor of testosterone synthesis in stressed and aging men. It has been used in Ayurveda for over 3,000 years to support male vitality and reproductive health.

Epimedium is traditionally used in TCM as a tonic for male sexual dysfunction and aging. Icariin has been shown to exhibit testosterone-mimetic properties in animal models, improve age-related testicular dysfunction, and restore Sertoli cell function. Studies show it may restore low testosterone and improve sexual vitality in aging males, though dedicated human RCTs for andropause endpoints are absent.

Boron is a trace mineral with documented 'androgen amplifier effects'; a meta-analysis found boron supplementation significantly increased free testosterone in men after as little as one week of supplementation. It also reduces sex hormone-binding globulin (SHBG), which rises with age and limits testosterone bioavailability—a central concern in andropause. Boron additionally supports vitamin D metabolism, further augmenting testosterone-supporting pathways in aging men.

Bulbine natalensis is a South African plant traditionally used as a male aphrodisiac. Preclinical animal studies (rat models) demonstrate significant increases in serum testosterone and LH, along with improvements in reproductive tissue weight and sperm quality. It is considered a rapidly emerging ingredient in andropause and testosterone support formulations, though human clinical trial data remain limited.

Chrysin is a natural flavone found in honey and passionflower that inhibits the aromatase enzyme, reducing testosterone-to-estrogen conversion. Elevated aromatase activity with aging (particularly in adipose tissue) is a direct contributor to the low testosterone/high estrogen ratio seen in andropause. While in vitro aromatase inhibition is well-documented, human bioavailability studies have raised questions about oral effectiveness.

Cordyceps (Cordyceps sinensis/militaris) has been used in Traditional Chinese Medicine for centuries as a male tonic for fatigue, sexual function, and kidney yang energy. Preclinical data show cordycepin ameliorates age-related testicular dysfunction in rat models, improving testosterone levels and spermatogenic function. Clinical studies report improvements in fatigue, libido, and sexual function in aging men, consistent with andropause symptom relief.

D-Aspartic Acid (D-Asp) is an endogenous amino acid in neuroendocrine tissues involved in the synthesis and release of LH and testosterone. A systematic review (Roshanzamir & Safavi, IJRB, 2017) found animal studies consistently demonstrate testosterone elevation, though human trials yield inconsistent results—some RCTs in infertile men and aging males show meaningful testosterone increases. It represents one of the most mechanistically characterized amino acid-based testosterone support compounds.

DHEA levels decline in aging men alongside testosterone, contributing to the hormonal changes of andropause. DHEA serves as a peripheral testosterone precursor and its supplementation has been investigated for improving body composition, mood, energy, and sexual function in aging men. Evidence for meaningful clinical benefit in healthy older men remains limited and inconsistent.

Diindolylmethane (DIM) is a bioactive compound derived from cruciferous vegetables that modulates estrogen metabolism, shifting it toward the less potent 2-hydroxy pathway. In aging men, rising estrogen levels due to increased aromatase activity compete with declining testosterone—DIM's aromatase-modulating effect helps restore the testosterone-to-estrogen ratio. It is listed among the most prevalent individual components in testosterone booster supplements targeting andropause.

Eurycoma longifolia (Tongkat Ali) is the botanical source of Tongkat Ali, with a 2022 systematic review and meta-analysis of five RCTs demonstrating a significant increase in total testosterone (SMD=1.352, p=0.001) in hypogonadal and healthy men. A 6-month double-blind RCT specifically in men with androgen deficiency of aging males (ADAM) confirmed improved erectile function and testosterone elevation. It is among the most evidence-supported natural interventions for andropause.

Eurycomanone is the primary quassinoid and bioactive marker compound of Eurycoma longifolia (Tongkat Ali), proposed as a principal contributor to its testosterone-elevating mechanism. It inhibits SHBG binding of testosterone, thereby increasing free testosterone bioavailability in aging men where SHBG levels are elevated. Eurycomanone's presence is used to standardize Tongkat Ali extracts in clinical studies.

Eurypeptides are bioactive peptide fractions from Eurycoma longifolia (Tongkat Ali) root that directly enhance testosterone biosynthesis in Leydig cells by stimulating CYP450c17 and 17β-HSD enzyme activities. They are cited in RCT publications as a key mechanism by which Tongkat Ali extracts increase testosterone in men with androgen deficiency of aging males (ADAM).

A 2024 randomized double-blind trial in 95 men aged 40–80 found fenugreek extract at 1800 mg/day significantly increased the free testosterone index by 12.2% and raised salivary testosterone by 37.2% versus placebo at 12 weeks. Rao et al. demonstrated fenugreek seed extract (600 mg/day for 12 weeks) alleviated andropause symptoms and improved blood testosterone in men aged 43–75 with age-related androgen deficiency. Its active compounds (furostanolic saponins including protodioscin) are proposed to inhibit aromatase and 5-alpha-reductase.

A 2025 randomized, double-blind, placebo-controlled trial (116 men with andropause symptoms) found ginseng berry extract (700 mg/day for 8 weeks) significantly improved Aging Male Symptoms (AMS) scores, ADAM questionnaire improvement rates, IIEF scores, and total testosterone versus placebo. Panax ginseng has extensive traditional use in East Asian medicine for male vitality and is among the most studied botanicals for andropause.

Ginsenosides are the primary bioactive saponins of Panax ginseng responsible for its androgenic and adaptogenic effects. They stimulate nitric oxide synthesis in erectile tissue, modulate HPG axis signaling, and contribute to ginseng's documented improvements in andropause symptoms including sexual function, energy, and testosterone levels in aging men.

Icariin is the principal flavonoid of Epimedium (horny goat weed), traditionally used in Chinese medicine for erectile dysfunction and kidney yang deficiency—a category encompassing andropause. Preclinical studies show icariin significantly increases testosterone levels via mRNA regulation of StAR and PBR in steroidogenic pathways, and improves erectile function in aged male rats. It also inhibits PDE5, the same target as pharmaceutical erectile dysfunction drugs.

Indole-3-Carbinol (I3C) is a glucosinolate hydrolysis product from cruciferous vegetables and the dietary precursor to DIM (diindolylmethane). I3C modulates estrogen metabolism and aromatase activity, reducing the testosterone-competing estrogen burden in aging men. It is listed among the most prevalent individual components in testosterone booster/andropause supplement formulations.

L-arginine is the biological precursor to nitric oxide (NO), which mediates penile smooth muscle relaxation and erection—a process critically impaired in andropause-associated erectile dysfunction. A double-blind, randomized, placebo-controlled study (Chen et al., BJU International, 1999) demonstrated significant improvement in erectile function in men with organic erectile dysfunction receiving high-dose L-arginine. It is listed among the most studied natural compounds for andropause-related sexual dysfunction.

Maca (Lepidium meyenii), native to the Peruvian Andes, has been used as an aphrodisiac and endurance enhancer for thousands of years. Multiple clinical trials demonstrate improvements in libido, sexual desire, and sexual dysfunction in middle-aged men, even without significant changes in testosterone levels. Its active compounds—macamides and macaenes—are thought to act via central mechanisms on sexual desire rather than direct hormonal action.

Pregnenolone is the primary steroid precursor synthesized from cholesterol, serving as the upstream precursor to all steroid hormones including DHEA, testosterone, estrogen, and cortisol. Its levels decline with age in parallel with andropause. Clinical practitioners in andropause management use pregnenolone supplementation to support hormone biosynthesis capacity, and some evidence suggests it can naturally boost testosterone by modulating cortisol and supporting steroidogenic pathways.

Protodioscin is the primary steroidal saponin in Tribulus terrestris responsible for its androgenic properties, documented to interact with androgen receptors and potentially enhance testosterone and DHEA production. It is found in multiple andropause-targeted plants (Tribulus, Dioscorea, Fenugreek) and is the active compound behind the libido, testosterone, and LH-stimulating effects attributed to these species.

Rhodiola rosea is an adaptogenic root with documented effects on cortisol reduction, fatigue, and mood—addressing the stress-mediated hormonal suppression component of andropause. Clinical studies show Rhodiola reduces fatigue and cortisol-driven physical/psychological symptoms in aging men. By lowering chronic cortisol burden, it supports HPG axis function and testosterone maintenance. It is traditionally used in Scandinavian, Russian, and Tibetan medicine for male vitality.

A 2022 systematic review and meta-analysis of five RCTs (Leisegang et al., Medicina) found Eurycoma longifolia significantly increased total testosterone in both healthy and hypogonadal men (SMD = 1.352, 95% CI 0.565–2.138, p=0.001). A specific 6-month double-blind RCT in men with androgen deficiency of aging males (ADAM) showed Tongkat Ali improved erectile function and increased testosterone in ~50% of participants. It has also been traditionally used in Southeast Asia as a male tonic and aphrodisiac.

Tribulus terrestris contains steroidal saponins (protodioscin) that interact with androgen receptors and are proposed to stimulate LH secretion, supporting testosterone synthesis. A prospective, randomized, double-blind, placebo-controlled trial (Kamenov et al., Maturitas, 2017) found improvements in sexual function in men with erectile dysfunction and reduced libido. While its testosterone-elevating effects in humans remain inconsistent across trials, its libido and sexual function benefits in aging men are more consistently documented.

MP treatment in infertile men has been clinically shown to raise serum testosterone and LH while lowering FSH and prolactin—the same hormonal parameters affected in andropause. The dopaminergic mechanism restores hypothalamic-pituitary-gonadal (HPG) axis function. Traditional Ayurvedic medicine specifically documents MP as a rejuvenator for male aging.

Vitamin D receptors (VDR) are expressed in Leydig and Sertoli cells of the testes, suggesting a direct role in testosterone production. Observational studies consistently show positive correlation between 25(OH)D levels and testosterone in aging men. Intervention trials suggest that vitamin D supplementation improves testosterone and sexual hormones primarily in vitamin D-deficient men (hypovitaminosis D), which is common in aging male populations.

Vitamin D3 (cholecalciferol) is the biologically preferred form of vitamin D, with receptors expressed in Leydig cells of the testes. A placebo-controlled RCT (Pilz et al.) demonstrated that D3 supplementation significantly increased total and free testosterone in men versus placebo over one year. Its relevance to andropause is highest in men with established vitamin D deficiency, a common finding in aging male populations.

Yohimbe bark contains yohimbine, an alpha-2 adrenergic receptor antagonist documented in peer-reviewed clinical trials to improve erectile dysfunction—one of the defining symptoms of andropause. Multiple controlled trials and meta-analyses support its efficacy for organic and psychogenic erectile dysfunction. It is one of the few plant-derived compounds with a well-characterized pharmacological mechanism for andropause-related sexual dysfunction.

Yohimbine is the primary alkaloid from Yohimbe bark and a well-characterized alpha-2 adrenergic receptor antagonist with documented efficacy for erectile dysfunction—the hallmark symptom of andropause—in multiple randomized controlled trials. A meta-analysis of seven double-blind RCTs confirmed yohimbine is significantly superior to placebo for erectile dysfunction. It is among the few plant-derived compounds with a clearly defined pharmacological mechanism for andropause-related sexual dysfunction.

Zinc is an essential mineral for male reproductive physiology and testosterone synthesis; zinc deficiency is directly associated with reduced testosterone levels. A clinical review (Bandeira Filho et al., Clinical Therapeutics, 2020) confirmed that medicinal zinc doses (50 mg elemental zinc/day) can increase total testosterone and improve sperm count in hypogonadal men. The mineral inhibits aromatase, reducing testosterone-to-estrogen conversion, a mechanism particularly relevant in aging men.

Beta-sitosterol's 5α-reductase inhibitory activity and BPH-symptomatic relief are relevant to male hormonal aging, as both prostatic enlargement and DHT-related processes accelerate with declining testosterone during andropause. Phytosterol-rich plant extracts have a traditional history of use in male vitality and aging. No human RCT specifically targeting andropause symptom endpoints with beta-sitosterol has been published.

Damiana (Turnera diffusa) is a Central American shrub used traditionally for centuries as a male aphrodisiac and tonic. It contains the flavone apigenin, which has documented aromatase-inhibiting properties, and acts as a functional testosterone mimetic by enhancing nitric oxide pathways in erectile tissue. Traditional use across Mesoamerican cultures specifically for male sexual dysfunction and reduced libido aligns with andropause symptom management.

Fadogia agrestis is used in traditional African medicine (particularly Nigeria and West Africa) as an aphrodisiac and male sexual tonic for conditions aligning with andropause symptoms. Animal studies in rodents suggest possible testosterone elevation following extract administration. However, no peer-reviewed human RCTs exist as of 2024, and some animal data raise toxicity concerns at higher doses.

Horny goat weed (Epimedium spp.) has been used in Traditional Chinese Medicine for over 2,000 years for conditions aligning with andropause: kidney yang deficiency presenting as erectile dysfunction, reduced libido, and fatigue. Its active compound icariin inhibits PDE5 and supports testosterone biosynthesis. Traditional use is extensively documented; clinical human evidence remains primarily preclinical/animal but is mechanistically well-characterized.

Muira Puama (Ptychopetalum olacoides), a Brazilian Amazonian plant, has been used traditionally as an aphrodisiac and male sexual tonic for centuries. Studies suggest it promotes blood flow to erectile tissue and may mimic testosterone function by increasing sexual desire and function via nitric oxide pathways and cavernous smooth muscle relaxation. Men experiencing andropause frequently use Muira Puama for libido and erectile support.

Saw palmetto (Serenoa repens) is used traditionally and in modern phytomedicine for andropause-related symptoms, particularly those involving benign prostatic hyperplasia (BPH) which commonly co-presents with andropause. It inhibits 5-alpha-reductase, reducing conversion of testosterone to DHT—relevant to andropause-associated prostate enlargement and potentially to maintaining testosterone levels. Multiple clinical trials support its use for urinary symptoms of BPH in aging men.

Tribulus is used in traditional medicine and marketed for andropause-related symptoms such as declining libido, fatigue, and erectile dysfunction in aging men. One clinical trial specifically included men with late-onset hypogonadism. Evidence for reversing hormonal aging per se is absent, but sexual function improvements are documented.