Protodioscin from herbal plant
Tribulus terrestris L improves the male sexual functions, probably
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,
Int. J. Impotence Research v9, supp 1 (1997)
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.
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
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
Finally, questionnaires were distributed to all men with ED to
determine whether there was any improvement in their sexual functions
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.
|| 101.5 ± 14.3
|| 41.8 ± 22.6
|| 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).
[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.
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
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
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.
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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Protodioscin, the main active component in Tribulus terrestris L.
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