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Protodioscin from herbal plant Tribulus terrestris L improves the male
sexual functions, probably via DHEA
A.
Adimoelja and P. Ganeshan Adaikan
Airlangga University, Indonesia and National University of Singapore
in 6th Biennial Asian-Pacific Meeting on Impotence in Kuala Lumpur, Malaysia
(1997)
Int. J. Impotence Research v9, supp 1 (1997)
SUMMARY
An interesting
correlation of dehydroepiandrosterone-sulphate (DHEA-S) level with the
incident of low sex drive and higher occurrence of impotence was discovered
in studies with patients diagnosed with diabetes mellitus. To test further
the relationship between DHEA-S and erectile dysfunction (ED), we conducted
a clinical trial of 30 non-diabetic men with ED, 30 non-diabetic men without
ED and 15 diabetic men with ED. These men are given extract of Tribulus
terrestris (Libilov) at 3 x 250 mg / day for 3 weeks. The DHEA-S levels, as
well as other blood and liver parameters were evaluated.
We found a significant
increase of DHEA-S levels in diabetic and non-diabetic subjects after
treatment, and a significant increase in the frequency of successful
intercourse by 60% in both the diabetic and non-diabetic groups with or
without ED.
INTRODUCTION
Tribulus terrestris L (TTL)
is a herbal plant native to Bulgaria and China that has a long history as a
powerful aphrodisiac and as a traditional medicine for treating male
infertility (1,6). Recently, a chemical compound isolated from TTL called
protodioscin (2) has been identified, purified and standardized as a
phytochemical agent. In a multi-center, placebo-controlled, randomized,
double-blind clinical trial, protodioscin proved to be an effective form of
treatment for male infertility (2,6,7).
It is known that
sufficient dehydroepiandrosterone (DHEA) in the epididymis is necessary for
the maturation process of spermatozoa (5). Furthermore, it has been
speculated that in some idiopathic oligoasthenoteratozoospermia, male
infertility is due to the low concentration of DHEA in the epididymis. In
another clinical trial protodioscin is proved to increase the serum DHEA
level of infertile men, without any change in the level of testosterone and
other androgens. It is also shown that liver and kidney functions do not
change significantly by protodioscin (1,2,6,7). The study concludes that
protodioscin in TTL could be the precursor of DHEA in patients with low
serum level of this hormone. As TTL has been known for its aphrodisiac
quality, speculations have been made that its mechanism of action involves
the conversion of protodioscin to DHEA. In turn, DHEA may increase cell
membrane integrity and functions (3,4), thereby resulting in better sexual
performance and the general feeling of well-being.
MATERIALS AND METHODS
The incident of erectile
dysfunction (ED) is five times greater in patients diagnosed with diabetes
mellitus as compared to non-diabetic patients. The correlation of lowered
DHEA-sulphate (DHEA-S) in the diabetic patients and the increased frequency
of ED in these patients suggests that improvement in DHEA-S level may
constitute a treatment for ED.
This trial evaluated the
DHEA-S levels of 30 non-diabetic male patients diagnosed with ED, 30
non-diabetic patients without ED, and 15 diabetic patients without ED. The
group of non-diabetics with ED as well as the group of diabetics with ED
were treated with TTL 3 times daily for 3 weeks (Libilov, 250 mg). The serum
DHEA-S, testosterone, FSH, LH, prolactin, cholesterol, triglyceride,
creatinine, Hb, and glucose levels, as well as liver and kidney functions
were evaluated before and after treatment. These parameters were
statistically tested (t-test for paired samples) to determine their
statistical significance.
Finally, questionnaires
were distributed to all men with ED to determine whether there was any
improvement in their sexual functions
RESULTS
There was a significant
difference (p < 0.01) in the serum DHEA-S levels in the non-diabetic men
(101.5 ± 14.3) as compared to the diabetic patients without ED (77.5 ±
28.7). There was also a significant difference (p < 0.01) in the DHEA levels
of non-diabetic men without ED with those with ED (41.8 ± 22.6).
Furthermore, there was a significant difference in the serum DHEA-S levels
of the diabetic patients without ED as compared to those with ED (32.2 ±
22.6). These data were summarized in Table I below.
|
Parameter |
[DHEA-S] in µg/dl |
|
without ED |
with ED |
|
Non-diabetics |
101.5 ± 14.3 |
41.8 ± 22.6 |
|
Diabetics |
77.5 ± 28.7 |
32.2 ± 24.8 |
Table I.
[DHEA-S] concentration in µg/dl of non-diabetics with and without ED, and
diabetics with and without ED before treatment with TTL (Libilov).
After treatment with TTL
(Libilov), there were significant increases in the serum DHEA-S levels in
the diabetic patients with and without ED (Table II).
|
Parameter |
[DHEA-S] in µg/dl |
|
Before Treatment |
After Treatment |
|
Non-diabetics with ED |
41.8 ± 22.6 |
77.6 ± 25.9 |
|
Diabetics with ED |
32.2 ± 24.8 |
50.0 ± 32.0 |
Table II.
[DHEA-S] concentration in µg/dl of non-diabetics and diabetics with ED
before and after treatment with TTL (Libilov).
There were no significant
differences observed in the hormone (testosterone, FSH, LH and prolactine),
cholesterol, triglycerides, and Hb levels, as well as in the liver (SGPT,
SGOT, Gamma GT) and kidney (creatinine and urea) functions before and after
TTL treatment in all ED patients.
During treatment, there
was a significant increase in the frequency of successful sexual intercourse
in 60% of the ED patients. This effect was reported from day 10 of treatment
and onwards by both the diabetic and non-diabetic ED patients.
CONCLUSION
TTL improved the sexual
drive in 60% of the ED cases. As this improvement in sexual function is
accompanied by a significant improvement in the DHEA levels of these
patients, we surmised that the improvement in the sex drive of these
patients were linked to the conversion of protodioscin, the active
ingredient of the TTL extract, into DHEA-S.
The role of DHEA-S in
general health and sense of well-being was suggested by its varying levels
in patients diagnosed with diabetes as compared to normal men. Further
correlation of DHEA with sexual functions was shown by its decreased level
in those also diagnosed with ED.
Increasing the serum DHEA-S
level, thus, should improve the sexual functions in patients diagnosed with
ED. This hypothesis was directly supported by our clinical trial: treatment
with TTL extract (Libilov) resulted in improvement in the frequency of
successful sexual intercourse in men (diabetics and non-diabetics alike)
diagnosed with ED. This improvement in sexual function was accompanied by an
increased level of serum DHEA-S in these ED patients.
The mechanism of DHEA-S
in improving the sexual functions of the treated patients is hypothesized to
include improvement of cell membrane integrity and function at the cellular
level, to improvement of circulation, health and sense of well-being that
indirectly result in improved sex drive. Further research into the direct
mechanism of the action of DHEA-S is warranted.
ACKNOWLEDGEMENTS
The authors wished to
thank PT Teguhsindo Lestaritama, Jakarta, Indonesia for its support by
providing the TTL extract Libilov (250 mg) for this clinical trial; Prodia
Clinical Laboratory, Surabaya for its continual support in evaluating the
biochemical parameters in this study; and Dr. I. Haryono, M.D. for the
statistical evaluation of the data.
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