Women’s Health Update

by Tori Hudson, ND

Fenugreek Extract for Male Sexual Function

Sexual dysfunction in women is a common issue encountered in a women’s health practice, including hypoactive sexual desire disorder (low libido), female arousal disorder, female orgasmic disorder, and dyspareunia. Women can have one or more of the above conditions. A multitude of factors affect sexual function in a relationship, not the least of which is the emotional intimacy and connection between partners. The purpose of this report is not to discuss all of these issues, but in the spirit of this Townsend Letter issue dedicated to men’s health, I will report on two studies of fenugreek as it relates to male sexual function, and thus is relevant to those women who have men as sexual partners.

Trigonella foenum-graceum (fenugreek) is rich in saponins including diosgenin, yamogenin, gitogenin, tigogenin, and neotigogens. Traditional uses of fenugreek have included hormonal regulation, in particular for male impotence, as well as a galactagogue in lactating women. Most clinical studies have focused on its use in dyslipidemia and control of blood sugar. One previous unpublished randomized, double-blind study on fenugreek extract by Gencor Pacific demonstrated a significant increase in free testosterone and creatinine in healthy males.

Fenugreek Extract Improves Age-Related Androgen Decrease and Sexual Function in Men

This study examined the effects of a proprietary Trigonella foenum-graceum seed extract (fenugreek) on symptoms related to androgen insufficiency, sexual function. and serum androgen levels in midlife and aging healthy men. This double-blind, randomized, 12-week clinical trial compared the extract of fenugreek with placebo 43- to 75-year-old men. Men were excluded if there was one or more of the following conditions: diagnosed with erectile dysfunction or any disability that may limit sexual function; had received any testosterone or anabolic steroid for a sexual disorder in the previous 6 months; on anticoagulant therapy or levodopa for Parkinson’s or calcipotriene for psoriasis; had severe renal and/or hepatic insufficiency, genital anatomical deformities, uncontrolled diabetes, history of spinal cord injury, major psychiatric disorder, any abnormal sexual characteristics, diagnosis of prostate cancer, benign prostatic hypertrophy, history of genital surgery, acute genitourinary disorder, current or past history of alcohol and/or drug abuse, or suspected chickpea allergy.

The measure used to assess the primary outcome was the Aging Male Symptom (AMS) questionnaire which consists of 17 questions in 3 subscales (psychological, somatic, and sexual). The subscales and the total score were used to assess symptoms, and the questionnaire was used at baseline and at 6 weeks and 12 weeks. The secondary outcome was the quality of sexual function, and the assessment tool was the Derogatis Interview for Sexual Functioning-Self Report (DISF-SR) questionnaire, used at baseline and week 12. In addition, secondary outcomes included serum total and calculated free testosterone, sex hormone-binding globulin (SHBG), DHEA-S, androstenedione, estradiol, and prolactin. Labs were drawn at baseline, 6 weeks, and 12 weeks. Sleep quality, the fatigue index, and physical activity were also measured.

The active treatment group received fenugreek seed extract at a dose of 600 mg/day for 12 weeks. While 120 men were initially enrolled, 111 completed the study, with 55 in the active treatment group and 56 in the placebo group.

In terms of general health, there were no changes in sleep patterns, fatigue score, physical activity, or body mass index for either group. The average AMS total score showed a significant difference between the 2 groups, with fenugreek significantly reducing symptom severity; and the most significant changes observed were in the somatic and sexual function domains of the AMS. In the DISF-SR questionnaire, treatment with fenugreek seed extract showed a significant improvement in sexual function, including desire, arousal, and frequency of morning erections. The current study also demonstrated that this fenugreek seed extract statistically significantly increased serum total and free testosterone and was observed in all ages. It is thought that the reduction in symptom severity and increase in somatic and sexual function were related to the increase in serum testosterone. There were no changes in DHEA-S, androstenedione, estradiol, prolactin, or liver function with fenugreek.

Comment

: After age 40, testosterone concentrations decrease in men at a rate of 1% to 2% per year. While it is variable between individuals, it does relate to reduced hypothalamic gonadotropin-releasing hormone outflow, alterations in androgen feedback and a decrease in testicular tissue response, and a reduction in sexual activity and desire. Decreased testosterone levels are also linked to risk of developing metabolic syndrome, weight gain, cognitive decline, muscle weakness, increased abdominal fat, joint pain, hot flushes, sleep disturbances, fatigue, depression, decreased body hair, and low bone density. The combination of low testosterone and the array of symptoms mentioned is referred to as aging male syndrome (AMS), andropause, partial androgen deficiency of the aging male (PADAM), and late-onset hypogonadism (LOH). The incidence reported in studies varies from as little as 2.1% of men aged 40 to 70 to 39% of men greater than 45 years old.

Testosterone replacement therapy is the standard treatment in men who are defined as androgen deficient, but there are few large-scale clinical trials on the efficacy of testosterone treatment in older males, and some studies suggest potential health risks, including prostate cancer.

The current study is the first study of fenugreek seed extract in aging males and the treatment of possible androgen deficiency. There are earlier studies in younger men, also showing increases in total and free testosterone.

Fenugreek seed extract, at a dose used in this study, seems a viable alternative to testosterone replacement therapy, at least in this 45 and older age group of men with androgen deficiency symptoms and low testosterone levels, and especially in men for whom testosterone is unwise or contraindicated.

Rao A, Steels E, Inder W, et al. Testofen, a specialized Trigonella foenum-graceum seed extract reduces age-related symptoms of androgen decrease, increases testosterone levels and improves sexual function in healthy aging males in a double-blind randomised clinical study. Aging Male. 2016;19(2):134–142.

Fenugreek plus Mineral Formulation and Male Libido

The purpose of this study was to evaluate the effects of a formulation on fenugreek combined with magnesium, zinc, and pyridoxine in health men with low libido, but without erectile dysfunction. Healthy heterosexual men aged 25 to 52 who were interested in increasing their libido were recruited for this 6-week study. There were initially 60 men in the study, with 54 participants completing it, 27 in treatment arm and 27 in the placebo arm. The average age was 42.3 years and included men in a stable sexual relationship and sexually active for at least 6 months. Men were excluded if they had any physical disability affecting sexual function, received any treatment or therapy for any sexual disorder within the previous 6 months, were on coumadin/heparin/dalteparin/enoxaparin or other anticoagulant therapy, were on levodopa for Parkinson’s disease or calcipotriene for psoriasis, diagnosed with hypertension and on antihypertensive medications, or diagnosed with severe renal or hepatic insufficiency/genital anatomical deformities/uncontrolled diabetes/history of spinal cord injury/uncontrolled psychiatric disorder or abnormal secondary sexual characteristics. Men with prostate cancer or benign prostate hypertrophy or history of genital surgery were also excluded. Those who had current or a history of chronic alcohol and/or drug abuse or a suspected chickpea allergy were excluded as well.

The active treatment group received a tablet containing 300 mg of fenugreek extract, 17 mg magnesium, 15 mg elemental zinc, and 5 mg pyridoxine. The primary efficacy outcome was the DISF-SR for males and the self-report version of the Derogatis Interview for Sexual Functioning. All men completed the questionnaire at the beginning of the study and again at weeks 3 and 6. For the domains of sexual cognition/fantasy, sexual arousal, and sexual behavior/experiences, men gave responses in the range of 0 to 8 for each of 5 questions. For the orgasm domain, they were asked to give a response from 0 to 4 for each of the 6 questions. Fasting blood cholesterol and PSA were drawn at baseline, and serum testosterone and prolactin were drawn at baseline and 6 weeks. A quality-of-life assessment was also taken at baseline and at 6 weeks.

Overall, there was a positive effect on aspects of libido in the treatment group. For all four ,domains there were statistically significant increases in the treatment group at week 6. As early as week 3, there were statistically significant improvements in the treatment group in the domains of sexual arousal, sexual behavior, and orgasm. In addition, the majority of the men in the treatment group had positive changes in full erections, including ability, intensity, and duration of orgasm. No significant changes occurred in the placebo group in any domains. There was also a positive effect on quality of life, with self-reports of satisfaction with muscle strength, energy, and well-being, but not any effect on mood or sleep in the treatment group. Serum testosterone levels remained within the normal reference range after treatment in both the active and placebo groups.

Comment

: This study, published prior to the study discussed first in this column, provides support for using fenugreek extract in improving libido, arousal, and orgasm in health middle-aged men. This study used 300 mg of fenugreek extract daily, while the other study used 600 mg/day. The name of the proprietary product discussed is Testofen, a standardized extract of fenugreek. It is also possible that the 3 added nutrients in the current study, while quite low in the amounts, might play a role in testosterone production and sexual function and be an important aspect of the formulation.

Steels E, Rao A, Vitetta L. Physiological aspects of male libido enhanced by standardized Trigonella foenum-graceum extract and mineral formulation. Phytother Res. 2011;25(9):1294–1300.

Dr. Tori Hudson graduated from the National College of Naturopathic Medicine (NCNM) in 1984 and has served the college in many capacities over the last 28 years. She is currently a clinical professor at NCNM and Bastyr University; has been in practice for over 30 years; and is the medical director of the clinic A Woman’s Time in Portland, Oregon, and director of research and development for Vitanica, a supplement company for women. She is also a nationally recognized author, speaker, educator, researcher, and clinician.