Tribulin

Other Names

No alternative names.

Synopsis

Tribulus Terrestris (Tribulus terrestris L.): A Comprehensive Reference

1. Identity: Botanical Name, Sources, and Preparations

1.1 Botanical and Taxonomic Identity

Tribulus terrestris L. is an annual plant of the family Zygophyllaceae, commonly known as Tribulus, hard thorns, and goat head in China. It is a crawling herbal plant that generally grows in arid climates and sandy soils. The name Tribulus comes from the Greek word tribolos, meaning "spike fruit." It is also widely known by the common names puncture vine and caltrop. In Ayurvedic tradition, it is called Gokshura or Gokhshura. In traditional Chinese medicine it is called Bai Jili.

1.2 Geographic Distribution

Tribulus terrestris is a widespread pantropic weed that grows on sandy soils in subtropical and desert climate regions around the world, including South and East Europe (Mediterranean), Asia (India, China, Vietnam), South Africa, the USA, and Mexico. Studies have revealed that its chemical composition is strictly linked with the geographic origin of the plant and hence with local climatic conditions; geographical regions significantly influence the composition of herbal drugs.

1.3 Plant Parts Used

The whole aboveground plant (herb), including whole or cut stems, leaves, flowers, and fruits, is used for medicinal purposes. According to the World Health Organization monograph, the fruits are the basic material for use. The dietary supplement ingredient Tribulus is prepared from the leaves, root, and fruit of the plant.

1.4 Common Preparations and Dosage Forms

Preparations based on the saponin fraction of T. terrestris are used for treatment of infertility and libido disorders in men and women, as well as for treatment of cardiac diseases. Food supplements containing T. terrestris extracts are on sale in the USA and Europe, with claims of a general stimulating action.

The preparation on the European market is a dry extract from Tribulus terrestris L., herba (DER 35–45:1), extraction solvent methanol 80% v/v, containing not less than 45% furostanol saponins. A medicinal product containing this extract was approved in Bulgaria in 1981.

The Tribulus terrestris fruit is the subject of the British Pharmacopoeia (2018), the Japanese Pharmacopoeia, the Korean Pharmacopoeia, the Pharmacopoeia of China, the Siddha Pharmacopoeia of India, and the Ayurvedic Pharmacopoeia of India. A WHO monograph (Fructus tribuli) exists for the fruit (2009). The fruits and roots can also be found among Natural Health Products published by Health Canada (2019). The whole plant is the subject of the Homeopathic Pharmacopoeia of India (2016).

Supplements are commercially available in the following forms:

Standardized dry extract capsules or tablets (commonly standardized for furostanol saponin or protodioscin content)
Crude powdered fruit or whole herb in capsule form
Liquid extracts and tinctures
Powder for dissolution in beverages (a traditional preparation)

2. Traditional and Historical Use

2.1 Ayurvedic Medicine (India)

Tribulus terrestris has been used for generations to energize, vitalize, and improve sexual function and physical performance in men. The fruits and roots have been used as folk medicine for thousands of years in China, India, Sudan, and Pakistan.

Tribulus terrestris, known as Gokhshura in Ayurveda, is used for various ailments. It is acknowledged for its diuretic, aphrodisiac, and nutritive properties, and is recommended for urinary issues, cough, heart disease, and digestive disorders. In India, the fruits have been used in the treatment of infertility, impotence, erectile dysfunction, and low libido in Ayurveda.

In the Ayurvedic tradition, T. terrestris is used as a diuretic (Mutrala), as an aphrodisiac (Vrsya) for men, and to help relieve hemorrhoids (Arsa).

2.2 Traditional Chinese Medicine

Tribulus terrestris, known as Bai Jili in Chinese, has been applied in traditional Chinese medicine for thousands of years. The fruits are used in traditional Chinese medicine for the treatment of different conditions. In TCM, the plant is traditionally associated with liver-related functions, headache, and dizziness, as well as being used to improve circulation and support kidney function.

2.3 Other Traditional Systems

Tribulus has a long history of use as an herbal medicine in Chinese, Unani (Arabic), and Ayurvedic (Indian) systems of medicine. It is primarily used in these systems as a diuretic and in the treatment of kidney stones, urinary tract infections, and incontinence.

This plant has been utilized for centuries in Ayurveda to address venereal disorders and sexual debility. Additionally, in Bulgaria, the plant is used as a traditional remedy for treating impotence.

The leaves and roots are used for medicinal purposes in traditional medicine in India and China, and were also in use in ancient Greece.

T. terrestris is used in various traditional medical practices — Ayurveda, Traditional Chinese Medicine, and Siddha — as a diuretic, aphrodisiac, immunomodulatory agent, anti-urolithic, antibacterial, anti-hyperlipidemic, antidiabetic, hepatoprotective, anticancer, anti-hypertensive, anthelmintic, analgesic, and anti-inflammatory drug.

3. Key Phytochemical Constituents

3.1 Overview of Chemical Classes

Many different compounds with a variety of biological properties and chemical structures have been identified from T. terrestris, including steroidal saponins, flavonoids, glycosides, phytosterols, tannins, terpenoids, amide derivatives, amino acids, and proteins. Among the different types of constituents, steroidal saponins and flavonoids are considered to be the most important metabolites with various bioactivities.

3.2 Steroidal Saponins

Spirostanol and furostanol saponins are considered the most characteristic chemicals in T. terrestris. To date, 108 kinds of steroidal saponins have been isolated, among which there are 58 kinds of spirostane saponins and 50 kinds of furostane saponins.

Furostanol and spirostanol saponins of tigogenin, neotigogenin, gitogenin, neogitogenin, hecogenin, neohecogenin, diosgenin, chlorogenin, ruscogenin, and sarsasapogenin type are frequently found in this plant. Four sulphated saponins of tigogenin and diosgenin type have also been isolated.

Furostanol glycosides, such as protodioscin and protogracillin, are mostly found; protodioscin is the most prevalent saponin. Spirostanol glycosides are found in trace amounts.

The pharmacological value of T. terrestris is largely attributed to the steroidal saponins, which possess either a furostanol or spirostanol structure, glycosylated at positions 3 and/or 26 with both linear and branched glycosidic chains.

Protodioscin is the single most studied saponin. Protodioscin is a steroidal saponin compound found in a number of plant species, most notably in the Tribulus, Trigonella, Dioscorea, and Trillium families. It is best known as the putative active component of the herbal aphrodisiac plant Tribulus terrestris.

3.3 Flavonoids and Other Constituents

A total of 82 steroidal saponins and nine flavonoids have been identified or tentatively identified from T. terrestris. Several groups of natural products in T. terrestris have been established: steroids, saponins, flavonoids, sterols, Harman alkaloids, minerals, lignan amides, and cinnamic acid amides.

The polyphenols and flavonoids contained in T. terrestris act as antioxidants because they effectively scavenge free radicals in a concentration-dependent manner.

3.4 Geographical Variability in Composition

The total components of T. terrestris from different areas reveal that although they belong to the same species, their compositions can be very different. T. terrestris from Beijing and Xinjiang share 81 common compounds, mainly including flavonoids and steroidal saponins. In contrast, T. terrestris from Rome has been found to contain some ginsenosides, which may explain different therapeutic effects of the plant from different regions.

There are a variety of methods used for extracting plant material, differences in methodologies and saponin analyses, and scientific instruments used. A lack of common standards may account for differences in the pharmacological activity and composition of T. terrestris preparations. Development of standard procedures and methods for collection of plant material and analyses are recommended.

4. Proposed Mechanisms of Action

4.1 Proposed Hormonal Effects (Hypothetical)

It is believed that T. terrestris can enhance testosterone levels by stimulating the release of gonadotropin-releasing hormone (GnRH), which in turn triggers the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The saponins of T. terrestris could exert an anabolic/androgenic influence by activating endogenous production of testosterone and luteinizing hormone (LH), which may stimulate muscle growth. It is important to note that these proposed mechanisms have primarily been investigated in animal and in vitro models, and have generally not been confirmed in controlled human trials (see Section 5).

4.2 Nitric Oxide / Corpus Cavernosum Pathway

The mechanism of T. terrestris extract on penile erection has been found to involve a reaction with the nitric oxide/nitric oxide synthase pathway and the endothelium of the corpus cavernosum (CC). In an in vivo study, the extract showed a significant concentration-dependent increase in intracavernous pressure (ICP).

Although the precise mechanism has not been fully established, protodioscin has been reported to stimulate the release of nitric oxide in corpus cavernosum tissue. Protodioscin is thought to contribute to increased androgen receptor immunoreactivity in some tissues, likely as a secondary effect of elevated levels of endogenous androgens such as testosterone and dihydrotestosterone (DHT). These findings, however, are primarily from preclinical (animal and in vitro) experiments.

4.3 Antioxidant and Anti-inflammatory Mechanisms

T. terrestris is rich in antioxidants, which help alleviate oxidative stress, enhance antioxidant defence mechanisms, and mitigate inflammation and cell death (apoptosis). T. terrestris may reduce inflammation by attenuating muscle damage and oxidative damage.

4.4 Glucose-Lowering Mechanisms (Preclinical)

The mechanism by which the antihyperglycemic effect of Tribulus terrestris appears is unknown, but recent studies suggest that this action could be related to the ability of T. terrestris to inhibit α-glucosidase and α-amylase. These proposed enzyme-inhibiting mechanisms remain subject to ongoing investigation and have not been fully validated in humans.

5. Scientific Evidence by Area of Use

5.1 Male Sexual Function and Testosterone

This is the most extensively studied clinical application of T. terrestris. After a comprehensive literature search (n = 162), 52 studies were selected for full-text reading and 10 studies were eligible for a 2025 systematic review, comprising 9 clinical trials and 1 quasi-experimental study. The Jadad score revealed low methodological quality for 50% of the studies.

The studies in this systematic review involved 15 to 172 participants (total = 483) aged between 16 and 70 years with different health conditions: healthy men (n = 5), oligozoospermia (n = 1), erectile dysfunction (n = 1), erectile dysfunction associated with hypogonadism (n = 2), and unexplained infertility (n = 1).

Erectile dysfunction outcomes: TT supplementation at doses of 400 to 750 mg/day for 1 to 3 months improved erectile dysfunction in 3 of the 5 studies that assessed this parameter.

Testosterone outcomes: Eight out of ten studies did not report significant changes in androgen profile following TT supplementation, but the subjects in the neutral studies did not have low androgen levels at baseline. Only 2 studies showed significant intra-group increases in total testosterone levels, which had low clinical magnitude (60–70 ng/dL) and involved subjects with hypogonadism.

Overall conclusion (2025 systematic review): TT supplementation has a low level of evidence regarding its effectiveness in improving erectile function in men with erectile dysfunction, and no robust evidence was found for increasing testosterone levels.

One specific large RCT: In a Phase IV, prospective, randomized, double-blind, placebo-controlled clinical trial in parallel groups, 180 males aged between 18 and 65 years with mild or moderate ED with or without hypoactive sexual desire disorder were enrolled; 90 were randomized to TT (Tribestan) and 90 to placebo. Patients with ED and hypertension, diabetes mellitus, and metabolic syndrome were included. 86 patients in each group completed the study; the IIEF score improved significantly in the TT group compared with the placebo group.

Another RCT (30 men, 800 mg, 30 days): Among 30 healthy men with erectile dysfunction treated with Tribulus terrestris (800 mg) or placebo daily for 30 days, there were no differences in changes in sexual function or testosterone.

Evidence strength summary: Overall evidence for improving erectile function is low quality; evidence for testosterone elevation in healthy, eugonadal men is not supported by the current weight of clinical trials.

5.2 Female Sexual Dysfunction

A randomized, double-blind, placebo-controlled trial assessed the safety and efficacy of Tribulus terrestris in women with hypoactive sexual desire disorder during their fertile years. Sixty-seven women were randomly assigned to TT extract (7.5 mg/day) or placebo for 4 weeks. Desire, arousal, lubrication, orgasm, satisfaction, and pain were measured at baseline and after 4 weeks using the Female Sexual Function Index (FSFI).

At the end of the fourth week, patients in the TT group had experienced significant improvement in their total FSFI (p < 0.001), desire (p < 0.001), arousal (p = 0.037), lubrication (p < 0.001), satisfaction (p < 0.001), and pain (p = 0.041) domains of FSFI. The frequency of side effects was similar between the two groups.

A second clinical assessment, conducted at a Brazilian hospital, included female patients of reproductive age with sexual dysfunction who were treated with 250 mg Tribulus terrestris extract (1 tablet three times daily for 90 days). There was a statistically significant improvement in total FSFI scores (p < 0.0001) post-treatment, with improvement among 106 (88.33%) of subjects. There was a statistically significant (p < 0.0001) increase in the level of DHEA, while the levels of both serum testosterone (p = 0.284) and free testosterone decreased (p < 0.0001).

Evidence strength summary: Preliminary positive signals exist in small clinical trials for female sexual dysfunction, but the evidence base is limited in size and duration. The absence of testosterone elevation despite improved sexual function is notable.

5.3 Athletic Performance and Body Composition

TT is a plant used in traditional Chinese medicine, Ayurvedic medicine, and sports nutrition to improve health and performance. However, no conclusive evidence exists about the potential beneficial effects of TT on sport and health biomarkers in physically active adults.

Supplementation with tribulus does not enhance body composition or exercise performance in resistance-trained males, according to one controlled study. Another study in top athletes receiving 450 mg of commercial extracts in capsules (minimum 60% saponins) for five weeks resulted in no effect on physical parameters.

A randomized, single-blind, placebo-controlled study in CrossFit athletes administered 770 mg of TT supplementation or placebo daily for 6 weeks to 30 healthy CrossFit-trained males.

In a 2022 PRISMA systematic review, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior. More studies are needed to confirm the benefits of TT due to the limited number of studies available in the current literature.

Lipid profile in athletes: Overall, participants supplemented with TT in the reviewed studies displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response.

Evidence strength summary: The evidence consistently does not support TT as an ergogenic aid for muscle strength, body composition, or athletic performance. Some lipid improvements in athletes have been reported, but the evidence base is small.

5.4 Blood Glucose and Metabolic Health

Considering the folkloric use of TT in diabetes and proven anti-hyperglycemic and anti-hyperlipidemic effects in animal studies, one randomized trial evaluated the efficacy of a hydroalcoholic extract of T. terrestris on serum glucose and lipid profile of women with diabetes mellitus. Ninety-eight diabetic women were randomly allocated to receive TT (1,000 mg/day) or placebo for three months. Patients were evaluated for fasting blood glucose, 2-hour postprandial glucose, glycosylated hemoglobin, and lipid profile.

T. terrestris showed a significant blood glucose-lowering effect in diabetic women compared to placebo (p < 0.05). Total cholesterol and LDL of the TT group were significantly reduced compared with placebo, while no significant effect was observed on triglyceride or HDL levels. This study showed a preliminary, promising hypoglycemic effect of TT in diabetic women.

Evidence strength summary: Preliminary human evidence (one RCT) suggests glucose- and LDL-lowering effects in diabetic women. This finding requires replication in larger, longer, and more diverse trials before any conclusions can be drawn.

5.5 Urinary Tract and Kidney Stone (Anti-urolithic) Effects

An aqueous extract of Tribulus terrestris was observed to exert a diuretic effect and increase urinary sodium and chloride concentrations. Puncture vine from the Zygophyllaceae family possesses various pharmacological properties, which include antiurolithic, diuretic, anti-inflammatory, and immunomodulatory in vitro and in vivo effects. These effects are, however, largely demonstrated in preclinical (animal) models. Clinical trials in humans specifically targeting urolithiasis are lacking.

5.6 Preclinical Evidence in Other Areas

There are data suggesting that Tribulus terrestris saponins act as antidiabetic agents and protect against nonalcoholic fatty liver disease (NAFLD) in animal models. T. terrestris exerted a protective effect against testicular damage induced by cadmium in rats, an effect mediated by its antioxidant action, while also stimulating testosterone production from Leydig cells. These are animal and in vitro findings only, and cannot be directly extrapolated to human clinical outcomes.

6. Body Systems and Health Areas of Association

Reproductive/Sexual System (Male): Investigated for erectile dysfunction, hypogonadism, infertility, and oligozoospermia in clinical trials. Evidence is low quality and mixed.
Reproductive/Sexual System (Female): Studied for hypoactive sexual desire disorder and general sexual dysfunction. Preliminary positive clinical signals exist.
Endocrine/Hormonal: Proposed LH-mediated testosterone elevation, investigated in multiple clinical trials; evidence does not support meaningful testosterone increase in healthy males.
Musculoskeletal/Athletic Performance: Marketed and studied as an ergogenic aid; clinical evidence consistently does not support improvements in muscle strength, body composition, or exercise performance.
Cardiovascular/Metabolic: Improvements in lipid profiles (total cholesterol, LDL) and blood glucose observed in some human trials, particularly in diabetic women.
Urological: Historically used as a diuretic and anti-urolithic agent; diuretic effects shown in preclinical models; clinical validation is limited.
Hepatic: Proposed hepatoprotective effects in animal models; potential hepatotoxicity identified in case reports in humans (see Safety section).
Immunological/Anti-inflammatory: Anti-inflammatory activity demonstrated in vitro and in zebrafish models via NF-κB/MAPK inhibition; not confirmed in human clinical trials.

7. Dosage Forms and Dosages Reported in Clinical Studies

The following dosages are those reported in specific published studies and should not be interpreted as recommended therapeutic doses:

Doses of 400 to 750 mg/day for 1 to 3 months were used in clinical trials assessing erectile dysfunction and testosterone.
7.5 mg/day of TT extract for 4 weeks was used in a randomized placebo-controlled trial of women with hypoactive sexual desire disorder.
250 mg T. terrestris extract (1 tablet three times daily for 90 days) was used in a clinical assessment of female sexual dysfunction.
1,000 mg/day for three months was used in a randomized trial of diabetic women assessing blood glucose and lipid effects.
770 mg/day for 6 weeks was administered to CrossFit athletes in a placebo-controlled study.
Daily doses of 750 to 1,500 mg of Tribulus terrestris extract (unspecified whether fruit or root) have commonly been used in meta-analyses and systematic reviews, and a dosage of 750 mg per day is more common.
Sleep disturbances, exhaustion, fatigue, and elevated heart rate have been reported after consuming more than 1,000 mg per day.

The standardized preparation on the European market is a dry extract (DER 35–45:1), extracted with methanol 80% v/v, containing not less than 45% furostanol saponins. Significant variation in saponin content between commercial products has been documented, making dose comparisons across studies difficult.

8. Safety, Toxicity, and Drug Interactions

8.1 Short-Term Adverse Effects

Short-term studies (up to 3 months) have reported few adverse effects, such as stomach cramps and nausea. Sleep disturbances, exhaustion, fatigue, and elevated heart rate have been reported after consuming more than 1,000 mg per day.

No TT-induced toxicity was reported in a 2022 systematic review of physically active adults.

8.2 Hepatotoxicity and Nephrotoxicity (Case Reports)

A few cases of severe liver and renal (kidney) damage have been reported after individuals consumed supplements containing Tribulus.

Although Tribulus has been linked to severe jaundice and death in grazing animals, there are only a few case reports of hepatotoxicity in humans. One published case describes a 46-year-old man who took tribulus supplements daily for 2 months. He developed severe jaundice prompting hospital admission. His total bilirubin peaked at 48 mg/dL, with concomitant renal dysfunction (creatinine of 7.1). His liver biopsy showed features consistent with drug-induced liver injury.

Another reported case describes a 30-year-old man who developed nausea and poor appetite after taking tribulus tablets as part of his muscle-building program. His total bilirubin peaked at 39 mg/dL, with a creatinine of 3.1 mg/dL. His liver biopsy showed bland cholestasis. After 6 weeks of stopping tribulus, his bilirubin downtrended to 4.4 mg/dL with a creatinine of 1.2 mg/dL. This case shows a clear temporal correlation between ingestion of tribulus supplements and development of liver and renal injury.

A 28-year-old man reported a severe case of nephrotoxicity after consuming Tribulus juice. Another case of toxicity from TT supplements involved a 30-year-old man who was diagnosed with acute tubular necrosis.

8.3 Animal Toxicity

The Tribulus terrestris plant is known to be toxic to grazing animals and can cause distinctive liver injury known as "geeldikkop" or hepatogenous photosensitivity. Histology of the liver from sheep dying after feeding upon the leaves of Tribulus terrestris demonstrates crystals. The plant is known to be toxic to rats and sheep after ingesting large amounts, with effects including damage to the heart, liver, and kidneys.

8.4 Human Safety Evidence and Regulatory Assessments

Tribulus is an herbal product prepared from the leaves, fruit, and roots of Tribulus terrestris; extracts have been used as an aphrodisiac, general tonic, and mood stimulant in traditional medicine. The native plant causes serious liver injury in grazing animals, but tribulus extracts have not been linked convincingly to instances of clinically apparent liver injury when given in typical doses in humans.

Research evaluating the safety of Tribulus in humans is limited. More research is needed to determine the safety of Tribulus as a dietary supplement ingredient, especially long-term and in varying doses.

8.5 Doping Considerations

Given the testosterone-boosting action claimed for TT extracts, research has been performed to evaluate whether the consumption of TT extracts could influence doping tests of athletes regarding the urinary testosterone/epitestosterone (T/E) ratio limit of 4:1 set by the World Anti-Doping Agency. Athletes subject to anti-doping controls should be aware of this theoretical concern, even though clinical evidence does not confirm meaningful testosterone increases.

8.6 Gynecomastia (Case Report)

A case report mentioned in the Canadian Natural Health Products monograph references a publication by Jameel et al. on gynecomastia and the plant product Tribulus, described as "Gynaecomastia and the plant product 'Tribulus'." This appears to be an isolated case report and should be interpreted cautiously.

9. Evidence Quality and Limitations Across the Literature

Tribulus terrestris is a popular herbal supplement marketed to enhance fitness performance, despite inconclusive evidence regarding its efficacy and safety.

Recurring methodological limitations across the body of research on TT include:

Small sample sizes (many trials below 100 participants)
Low methodological quality, as measured by the Jadad score, for a significant proportion of clinical trials.
Short study durations (predominantly 1–3 months)
Heterogeneity in extract standardization, plant part used, and geographic origin of raw material
Composition is strictly linked with the origin of the plant; geographical regions significantly influence herbal drug composition.
Lack of common standards could be a reason for differences in pharmacological activity and composition of T. terrestris preparations.

References

Health Conditions

Health conditions that Tribulin may help support.

No conditions available.

Body Systems

Body systems that Tribulin may help support.

No body systems available.