Andro-Stack 850 by Optimum Nutrition

LIKELY INEFFECTIVE

• Muscle strength. Oral androstenedione, used in combination with resistance training, does not seem to improve muscle size or strength in healthy males. Details: Several small clinical trials in healthy males participating in resistance training programs show that taking androstenedione 100-300 mg daily for 2-3 months does not significantly increase muscle strength, muscle size, or lean body mass when compared with placebo (1365,1905,6000,7514).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Athletic performance. Although there has been interest in using oral androstenedione for athletic performance, there is insufficient reliable information about the clinical effects of androstenedione for this purpose.
• Erectile dysfunction (ED). Although there has been interest in using oral androstenedione for ED, there is insufficient reliable information about the clinical effects of androstenedione for this purpose.
• Exercise-induced muscle damage. Although there has been interest in using oral androstenedione for exercise-induced muscle damage, there is insufficient reliable information about the clinical effects of androstenedione for this purpose.
• Fatigue. Although there has been interest in using oral androstenedione for fatigue, there is insufficient reliable information about the clinical effects of androstenedione for this purpose.
• Sarcopenia. Although there has been interest in using oral androstenedione for sarcopenia, there is insufficient reliable information about the clinical effects of androstenedione for this purpose.
• Sexual desire. Although there has been interest in using oral androstenedione to improve sexual desire, there is insufficient reliable information about the clinical effects of androstenedione for this purpose.
• Sexual dysfunction. Although there has been interest in using oral androstenedione for sexual dysfunction, there is insufficient reliable information about the clinical effects of androstenedione for this purpose. More evidence is needed to rate androstenedione for these uses.

(Read more about ANDROSTENEDIONE)

LIKELY EFFECTIVE

• Vaginal atrophy. Intravaginal DHEA can reduce pain during intercourse and improve vaginal health in patients with this condition. Details: Clinical research shows that ovules or suppositories containing DHEA 0.25% to 1%, inserted vaginally once daily for 12 weeks, can reverse vaginal thinning, restore vaginal pH, and reduce pain during sexual intercourse by up to 15% when compared with placebo in patients with vaginal atrophy (21320,21429,21430,94576). A specific vaginal insert containing DHEA 0.5% (Intrarosa, Endoceutics Inc.) is an FDA approved drug used for reducing pain during sexual intercourse in patients with vaginal atrophy (94573,94576). Other clinical research shows that applying DHEA 10% cream (Diosynth) to the inner thighs daily for 12 months might improve vaginal atrophy by stimulating maturation of the vaginal epithelium in postmenopausal patients. It might also increase bone mineral density in these patients (4242).

POSSIBLY EFFECTIVE

• Aging skin. Oral and topical DHEA have been evaluated for treating aging skin, with promising results. Details: Some clinical research shows that taking DHEA 50 mg daily for 12 months increases epidermal thickness, sebum production, and skin hydration, and decreases facial skin pigmentation in elderly patients (6446). Other preliminary clinical research shows that applying 1% DHEA daily for 4 months improves the appearance of paper-like skin when compared with placebo in postmenopausal patients. It also improves sebum production, skin wrinkling, and skin appearance when compared with baseline (21428).
• Depression. Oral DHEA 30-500 mg daily for up to 8 weeks seems to improve symptoms of depression and dysthymia in patients with depression. Details: Canadian clinical practice guidelines recommend DHEA as a third-line treatment for depression (95691). Most clinical research shows that taking DHEA 30-500 mg daily for around 6-8 weeks improves symptoms of depression and dysthymia when compared with placebo (3270,3864,3892,4233,21404,21405). Additionally, a pooled analysis of these and 9 other clinical studies shows that DHEA can improve depressive symptoms when compared with placebo, although most of the trials evaluated in the analysis included patients without clinically diagnosed depression (104161). Other preliminary clinical research using lower doses of 5-20 mg daily over 3 weeks shows no improvement in depressive symptoms in psychotic patients (21406).
• Infertility. Oral DHEA appears to improve fertility outcomes, including pregnancy and live birth rates, in females undergoing assisted reproduction. However, it is unclear if oral DHEA can reduce the risk for miscarriage after in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). Details: Meta-analyses of clinical research show that taking DHEA, typically at a dose of 75 mg daily improves fertility outcomes for females undergoing assisted reproduction (96819,96820,96821,111227). One meta-analysis limited to randomized controlled trials in patients with poor ovarian response (POR) found that taking DHEA prior to IVF or ICSI treatments increases clinical pregnancy rates by 34% and the rate of live births or ongoing pregnancy by 88% when compared with placebo or no treatment (96820,111227,113072). Additionally, meta-analyses, including both randomized controlled trials and observational research, in patients with POR or diminished ovarian reserve (DOR) undergoing IVF or ICSI show that taking DHEA 50-90 mg daily is associated with improved markers of ovarian reserve and increased oocyte yields, fertilized oocytes, top-quality embryos, and transferred embryos when compared with control groups (111227,113072). Some observational research in older females with DOR has also found that taking DHEA 30 mg three times daily for 12 weeks before IVF cycles is associated with a greater number of retrieved oocytes, improved oocyte quality, and increased cumulative pregnancy rates (103185). Inclusion of lower quality research also supports these findings (21413,21414,88493,96819,96821,99923). Additionally, in females with various conditions of compromised fertility, some preliminary clinical research shows that taking DHEA 50-75 mg daily for at least 4 months may aid with natural conception, insemination-induced conception, and IVF pregnancy outcomes (21362). However, not all evidence shows that DHEA supplementation is beneficial for infertility (21415,88726,90304,111226). In one meta-analysis, DHEA supplementation was not linked to improvements in live birth rates (111227) In another meta-analysis, the benefits such as increased clinical pregnancy rates, live birth rates, oocyte yields, and number of embryos transferred dissipated upon subgroup analysis limited to higher quality randomized controlled trials (113072). Furthermore, a large clinical study shows that pretreatment with DHEA in infertile females with POR prior to IVF and embryo transfer does not improve the number of retrieved oocytes and the rates of clinical pregnancy, pregnancy loss, and cumulative live births when compared with placebo (111226). Observational research in older patients with DOR suggests that DHEA supplementation is not linked to improved clinical pregnancy or live birth rates when compared with a control group (103185). Other clinical research in females with primary ovarian insufficiency shows that taking DHEA 75 mg daily for 16 weeks might not improve follicle size when compared with placebo (21364). The effect of DHEA pretreatment on miscarriage rates after IVF or ICSI is not clear. One meta-analysis of randomized clinical research does not support the use of DHEA pretreatment for preventing miscarriage (96820). However, another meta-analysis and lower quality research suggests that DHEA supplementation reduces the risk of miscarriage by up to 50% (21418,96819,113072).

POSSIBLY INEFFECTIVE

• Aging. Oral DHEA, taken for up to 2 years, does not appear to improve bone health, quality of life, or sexual function in older adults. Details: Clinical research shows that DHEA, taken as 75 mg daily in males or 50 mg daily in females, for 2 years does not seem to improve body composition, bone mineral density (BMD), insulin sensitivity, or quality of life in people aged 60 years or older who have low DHEA-S levels (15027). Additionally, a pooled analysis of clinical trials shows that taking DHEA 50-1600 mg daily for up to 2 years does not improve body composition, bone health, sexual function, lipid and glycemic parameters, or quality of life in elderly males (88434).
• Muscle strength. Oral DHEA does not seem to improve muscle strength in adults. Details: While some clinical research shows that adults who take DHEA have increased muscle strength when measured by grip strength, leg press, chest press, and other measures, most clinical evidence shows that DHEA provides no benefit to muscle strength in younger and older adults (1365,10406,17617,21392,21419,21420,21421,47198).
• Physical performance. Oral DHEA does not seem to improve physical performance in elderly patients. Details: Most clinical research and a meta-analysis show that older adults who take DHEA do not have increased physical function or performance as measured by oxygen uptake, duration of exercise, balance, and ability to rise from a chair (17617,21420,21421). However, one clinical study shows that taking DHEA 50 mg daily for 6 months improves lower body strength and function by a small amount when compared with placebo in elderly frail females (21392). More research is needed to determine if DHEA is beneficial in specific populations.

LIKELY INEFFECTIVE

• Cognitive function. Oral DHEA does not improve cognitive function or prevent cognitive decline in most populations. Details: In the majority of clinical research, taking DHEA orally does not seem to improve cognitive function or decrease cognitive decline in healthy people over the age of 50 (3893,11334,14862,21333,21445), in peri- or post-menopausal women (6011,21397,21445), in patients with HIV (47435), or in young healthy adults when given as an acute dose (21399). However, preliminary clinical research shows that taking DHEA 50 mg daily for 4 weeks may improve certain measures of visual spatial performance and memory when compared with placebo in middle aged and elderly females (21396,21398).
• Sjogren syndrome. Oral DHEA does not appear to improve symptoms with this condition. Details: Clinical research shows that taking DHEA 50-200 mg daily for 4-12 months does not benefit symptoms of primary Sjogren syndrome when compared with placebo (21354,21358,21363,21365).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Addison disease. It is unclear if oral DHEA is beneficial in patients with this condition. Details: Some preliminary clinical research shows that taking DHEA up to 50 mg daily for up to 12 months improves symptoms of Addison disease, including reversing the loss of bone mineral density (BMD) and lean mass, but without improving cognitive function (8595,21387). However, taking DHEA 50 mg daily for 12 weeks does not appear to improve cognitive or sexual function, body composition, or BMD, although it may improve mood and fatigue (7614,21330,21356).
• Adrenal insufficiency. It is unclear if oral DHEA is beneficial in patients with primary or secondary adrenal insufficiency. Details: Some clinical research shows that taking low-dose DHEA, 20-50 mg daily, improves feelings of well-being, skin and hair, pubic hair growth, and sexuality in females with adrenal insufficiency or androgen deficiency due to hypopituitarism (3231,8593,17218,21317,21370,21385). However, other clinical research shows that taking low-dose DHEA for 3-12 months has little to no effect on quality of life, body composition, physical performance, cardiac function, depression, anxiety, and sexual arousal in patients with primary or secondary adrenal insufficiency (17218,21351,21357,21360,21386,21388,21389). Also, there is contradictory evidence about the effects of DHEA on plasma lipid levels in patients with adrenal insufficiency (21348,21351).
• Athletic performance. It is unclear if oral DHEA can improve sprint performance. Details: Preliminary clinical research in female recreationally trained athletes shows that taking DHEA 100 mg daily for 4 weeks does not improve sprint performance when compared with placebo (99925).
• Cardiovascular disease (CVD). Observational research has found that low DHEA levels are linked to a greater risk for CVD, but it is unclear if supplementation with oral DHEA is beneficial. Details: A meta-analysis of population research shows that patients with CVD and lower blood levels of DHEA-S have a worse overall prognosis when compared with patients with higher levels. Patients with the lowest levels have a 47% increased risk of future mortality events, including a 58% increased risk of fatal cardiovascular events. There was also a 42% increased risk of nonfatal cardiovascular events (96817). In elderly males, population research also shows that low serum levels of DHEA and DHEA-S are associated with an increased risk of coronary heart disease (CHD) but not cerebrovascular disease (90303).
• Cervical dysplasia. It is unclear if intravaginal DHEA is beneficial in patients with cervical dysplasia. Details: Preliminary clinical research shows that DHEA 150 mg intravaginally for up to 6 months reverses dysplasia in 83% of treated females with low-grade cervical dysplasia when compared to baseline (21426). The validity of these findings is limited by the lack of a comparator group.
• Chronic fatigue syndrome (CFS). It is unclear if oral DHEA is beneficial in patients with CFS. Details: Preliminary clinical research shows that oral DHEA 25-100 mg daily for 6 months improves symptoms of CFS by 8.5% to 26% when compared to baseline (7559). The validity of these findings is limited by the lack of a comparator group.
• Chronic obstructive pulmonary disease (COPD). It is unclear if oral DHEA is beneficial in patients with COPD. Details: A small clinical study shows that taking DHEA 200 mg daily for 3 months increases walking distance and improves lung function in patients with COPD when compared to baseline (21395). The validity of these findings is limited by the lack of a comparator group.
• Cocaine dependence. It is unclear if oral DHEA is beneficial for reducing cocaine cravings. Details: A small clinical study shows that taking DHEA 100 mg daily for 12 weeks, in addition to cognitive-behavioral group counseling, does not reduce cocaine craving when compared with counseling alone in cocaine-dependent participants (21411).
• Crohn disease. It is unclear if oral DHEA is beneficial for inducing Crohn disease remission. Details: A small clinical study shows that taking DHEA 200 mg daily for 8 weeks reduces symptoms in some patients with Crohn disease when compared to baseline. Remission occurred in 6 of 7 Crohn patients (21416). The validity of these findings is limited by the small study size and lack of a comparator group.
• Diabetes. Although there has been interest in using oral DHEA for diabetes, there is insufficient reliable information available about the clinical effects of DHEA for this purpose.
• Erectile dysfunction (ED). It is unclear if oral DHEA is beneficial in patients with ED. Details: Preliminary clinical research shows that taking DHEA orally for 24 weeks improves erectile function, orgasmic function, sexual desire, and overall sexual satisfaction in patients with ED. DHEA seems to be beneficial for idiopathic ED or ED secondary to hypertension, but doesn't seem to provide benefit for ED related to diabetes or neurological disorders (793,8596).
• Exercise-induced muscle damage. It is unclear if oral DHEA is beneficial for reducing muscle damage from exercise. Details: Preliminary clinical research shows that taking DHEA 50 mg twice daily for 5 days improves delayed-onset muscle soreness and reduces post-training blood creatinine kinase levels when compared with placebo in young males completing a 5-day exercise training program (88375).
• Fibromyalgia. It is unclear if oral DHEA is beneficial for improving fibromyalgia symptoms. Details: Preliminary clinical research shows that taking DHEA 50 mg daily for 3 months does not reduce fibromyalgia symptoms when compared with placebo in postmenopausal patients with fibromyalgia (21355).
• HIV/AIDS. Small clinical studies suggest that oral DHEA may improve mental health and quality of life in patients with HIV/AIDS, but DHEA does not seem to improve CD4 counts or body composition. Details: Population research shows that levels of DHEA seem to be lower in patients with more severe HIV/AIDS, suggesting that DHEA could be a marker for disease severity. Some evidence suggests that lower DHEA levels are associated with an increased risk of disease progression and AIDS (8598,14278,14279). Some clinical research shows that taking DHEA 50-500 mg daily for 2-4 months might improve mental health and quality of life when compared with placebo (3864,8598,14277,21390). However, taking DHEA in doses up to 2.25 grams daily does not appear to improve CD4 counts, muscle mass, or bone mass when compared with placebo (3865,14277,21390).
• Menopausal symptoms. Oral DHEA might reduce hot flashes and intravaginal DHEA might improve vaginal atrophy and sexual activity; however, oral DHEA does not seem to improve psychological symptoms associated with menopause. Details: Some research shows that taking DHEA 10-25 mg daily for 12 months improves subjective vasomotor symptoms such as hot flashes, as well as psychological symptoms and sexuality (11464,21417). Also, administering a daily ovule containing DHEA (Vaginorm, Recipharm) 3.5-13 mg intravaginally for 12 weeks appears to reverse vaginal atrophy and improve sexual activity in postmenopausal patients with vaginal atrophy (21442). However, other clinical research shows that taking DHEA 50 mg daily for up to 26 weeks does not improve mood, fatigue, cognition, sexual function, or sense of well-being in post- or peri-menopausal patients when compared with placebo (6011,21361). Additionally, a pooled analysis of clinical research shows that DHEA taken orally does not improve psychological symptoms related to menopause (88492).
• Metabolic syndrome. It is unclear if oral DHEA is beneficial for reducing risk for metabolic syndrome. Details: Preliminary clinical research shows that taking DHEA 50 mg daily for 6 months or 100 mg daily for 3 months decreases weight, abdominal fat, and blood pressure and reduces cholesterol, glucose, and insulin levels when compared with placebo in overweight elderly patients (12215,21350).
• Muscular dystrophy. It is unclear if oral DHEA is beneficial in patients with myotonic dystrophy type I. Details: Taking DHEA 100 or 400 mg daily for 12 weeks might not affect muscle strength in patients with myotonic dystrophy type I when compared with placebo (21334). However, intravenous DHEA-S 200 mg daily for 8 weeks appears to improve daily function, muscle strength, and heart function compared with baseline (21434). The validity of this finding is limited by the lack of a control group.
• Obesity. It is unclear if oral DHEA is beneficial for reducing body weight in patients who are obese or overweight. Details: Preliminary clinical research shows that taking DHEA 40 mg sublingually twice daily for 8 weeks, or 1600 mg by mouth for 28 days, does not affect body weight or body composition when compared with placebo in obese adults (21410,21427). Also, preliminary clinical research shows that taking DHEA 50-100 mg daily for 3-12 months does not affect central adiposity in older individuals when compared with placebo (21349).
• Opioid withdrawal. It is unclear if oral DHEA is beneficial in patients with heroin withdrawal. Details: Preliminary clinical research shows that taking DHEA 100 mg daily as adjunct to standard therapy for 12 months does not improve drug withdrawal symptoms in heroin addicts when compared with standard therapy alone (21412).
• Osteoporosis. It is unclear if oral DHEA is beneficial in patients with osteoporosis; any benefit may depend on individual patient characteristics. Details: There is contradictory evidence about the effectiveness of DHEA 50-100 mg daily for improved bone mineral density (BMD) in older adults with osteoporosis or osteopenia (12563,12564,21392), as well as the effectiveness of DHEA for improved BMD in females with anorexia nervosa (12562,21393). One pooled analysis shows that DHEA does not improve BMD in postmenopausal patients (88492), while another shows that DHEA can increase hip BMD in healthy older females, but not males (103186). The reason for these discrepant findings is unclear, but may relate to different patient populations, durations of therapy, and DHEA doses assessed in the included studies. Additionally, most of the studies included in these analyses were of low quality and inadequate statistical power.
• Parkinson disease. Although there has been interest in using oral DHEA for Parkinson disease, there is insufficient reliable information available about the clinical effects of DHEA for this purpose.
• Partial androgen deficiency. It is unclear if oral DHEA is beneficial for symptom improvement in patients with this condition. Details: Preliminary clinical research shows that taking DHEA 25 mg daily for one year might clinically improve mood, fatigue, and joint pain in older males with partial androgen deficiency when compared to baseline (21331). Other preliminary clinical research shows that taking DHEA 50 mg twice daily for 4 months does not improve erectile or sexual function when compared with placebo in hypoandrogenic males (21424).
• Parturition. Intravenous DHEA before the onset of labor may shorten the time to labor onset and shorten labor duration. Details: Clinical research shows that intravenous DHEA-S 100 mg daily for 3 days, or given twice weekly until the onset of labor starting after 38 weeks of gestation, increases cervical ripening and shortens the time to onset of labor and the duration of labor when compared with a control in nulliparous women (21384,21431). Also, intravenous DHEA 50-200 mg given multiple times until the onset of labor starting after 37 weeks of gestation appears to shorten the time to delivery in primiparous and multiparous women (21432,21433). It is unclear if oral DHEA is beneficial for this purpose.
• Rheumatoid arthritis (RA). It is unclear if oral DHEA is beneficial in patients with RA. Details: Preliminary clinical research shows that taking oral DHEA 200 mg for 16 weeks does not reduce symptoms of RA in elderly patients (21422). However, other clinical research in a small number of premenopausal females with RA shows that taking DHEA 50 mg daily for 12 weeks improves quality of life, but not disease activity, when compared with placebo (104159).
• Schizophrenia. It is unclear if oral DHEA is beneficial in patients with schizophrenia. Details: Some research shows that taking DHEA orally improves both negative and positive symptoms in patients with schizophrenia. It may be more effective in females (9692). However, other clinical research shows no benefit (21423).
• Sexual dysfunction. It is unclear if oral or intravaginal DHEA is beneficial for improving sexual dysfunction in males or females. Details: DHEA may be modestly beneficial in some postmenopausal patients with decreased libido or dyspareunia. Preliminary clinical research shows that taking DHEA 50-100 mg daily, or a single dose of DHEA 300 mg, improves sexual desire when compared to baseline (9906,21443). Additional clinical research shows that use of intravaginal DHEA (Vaginorm, Recipharm) at concentrations of 0.25% to 1% daily for 12 weeks might improve sexual function when compared with placebo (47361). However, a pooled analysis shows that DHEA is not associated with improvements in libido or sexual function (88414,88492). DHEA has also been evaluated in other patient populations. Small clinical studies show that taking DHEA doesn't seem to influence response to sexual stimuli in sexually functional premenopausal women (8594) or improve libido in individuals age 40-70 years (21449). Preliminary clinical research in males with hypoactive sexual desire disorder (HSDD) shows that taking DHEA 50 mg twice daily for 6 weeks does not improve erectile or sexual function when compared with placebo (88414). In adults with midlife-onset or HIV-associated depression, preliminary clinical research shows that taking DHEA 90-500 mg daily for 3-8 weeks may improve sexual function and libido when compared with placebo (3864,21405).
• Systemic lupus erythematosus (SLE). Most small clinical studies suggest that oral DHEA may modestly improve symptoms in patients with SLE, but some conflicting research exists. Details: Some clinical research shows that taking DHEA has little to no effect on disease activity in patients with mild to moderate SLE (21425,21447). However, small clinical studies and a meta-analysis of these studies show that taking DHEA in conjunction with conventional treatment may help improve frequency of flare-ups, muscle ache, oral ulcers, and quality of life, reduce corticosteroid doses needed (2113,2114,2136,6068,6447,12561,12574,21346,21447), and improve bone mineral density (6068,6097,6447,21394).
• Ulcerative colitis. It is unclear if oral DHEA is beneficial for inducing ulcerative colitis remission. Details: A small clinical study shows that taking DHEA 200 mg daily for 8 weeks reduces symptoms of ulcerative colitis when compared to baseline in some patients with ulcerative colitis. Remission occurred in 6 of 13 ulcerative colitis patients (21416). The validity of these findings is limited by the small study size and the lack of a comparator group. More evidence is needed to rate DHEA for these uses.

(Read more about DHEA)

POSSIBLY EFFECTIVE

• Sexual dysfunction. Oral tribulus seems to improve sexual experience in females with hypoactive sexual desire disorder (HSDD) or sexual dysfunction. Some research also shows that oral tribulus improves sexual function in males. Details: Clinical research in premenopausal and postmenopausal patients with HSDD shows that taking tribulus 250 mg three times daily (Androsten, Herbarium) for 3 months improves overall satisfaction and lubrication, as well as pain, desire, sexual arousal, and ability to reach orgasm, when compared with placebo (92027,97331,97332). Other preliminary clinical research in females with HSDD shows that taking tribulus extract 7.5 mg daily for 4 weeks improves sexual desire, arousal, satisfaction, orgasm, pain, and lubrication when compared with placebo (92022). A nonblinded clinical study comparing tribulus dosing regimens shows that taking oral tribulus 280 mg, either once daily or in three divided daily doses, for 90 days results in similar improvements in sexual dysfunction, regardless of menopausal status. However, neither dosing schedule increases clitoral blood flow when compared with baseline (108551). Tribulus has also been studied in males. One clinical study in males with erectile dysfunction, with or without HSDD, shows that taking tribulus (Tribestan, Sopharma AD) 500 mg three times daily for 3 months improves sexual desire and intercourse satisfaction when compared with placebo (97330).

POSSIBLY INEFFECTIVE

• Athletic performance. Oral tribulus does not seem to improve athletic performance. Details: Small clinical studies in athletes show that taking tribulus orally, alone or in combination with other ingredients such as androstenedione, most often as 450-770 mg daily for 5-8 weeks, does not seem to enhance body composition or exercise performance when compared with placebo or a control group (7514,13255,92029,108552).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. It is unclear if oral tribulus is beneficial for angina. Details: Preliminary clinical research shows that taking a tribulus extract orally might reduce symptoms of angina when compared with a control (3931).
• Atopic dermatitis (eczema). Oral tribulus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Some preliminary clinical research shows that taking tribulus orally in combination with 9 other herbs (Zemaphyte) daily for 8 weeks reduces redness and skin lesions in adults and children with nonexudative atopic dermatitis (12627,12628). However, other research shows no effect (12630). It is unclear if these effects are due to tribulus, the other ingredients, or the combination.
• Bacterial vaginosis. Topical tribulus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with bacterial vaginosis shows that using a specific vaginal suppository (Forzajeh) containing tribulus, myrtle, fennel, and tamarind daily for 1 week is as effective as metronidazole vaginal suppository for improving vaginal discharge volume and odor, pelvic pain, cervical inflammation, and vaginal pH (100339). It is unclear if these effects are due to tribulus, the other ingredients, or the combination.
• Benign prostatic hyperplasia (BPH). Oral tribulus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with BPH shows that taking a combination supplement (Prostalyn, East India Pharmaceutical Works Ltd.) containing tribulus 600 mg and curry leaf (Murraya koenigii) 600 mg twice daily for 12 weeks improves prostate symptoms when compared to baseline, with no difference when compared to tamsulosin 400 mcg daily. This supplement also seems to reduce prostate volume by around 2 mL (92033).
• Cancer. Although there is interest in using oral tribulus for cancer, there is insufficient reliable information about the clinical effects of tribulus for this condition.
• Chronic fatigue syndrome (CFS). Although there is interest in using oral tribulus for CFS, there is insufficient reliable information about the clinical effects of tribulus for this condition.
• Diabetes. It is unclear if oral tribulus is beneficial for diabetes. Details: Preliminary clinical research in females with type 2 diabetes who are taking oral hypoglycemic agents shows that taking tribulus extract powder 500 mg twice daily for 3 months modestly reduces fasting glucose and postprandial glucose levels, but not glycated hemoglobin, when compared with placebo. However, the validity of these findings is limited by the difference in diabetes severity between groups at baseline (97327).
• Erectile dysfunction (ED). It is unclear if oral tribulus is beneficial for ED. Research is conflicting. Details: Clinical research in patients with ED shows that taking tribulus (Tribestan, Sopharma AD) 500 mg three times daily for 3 months does not provide a clinically beneficial improvement in erectile function when compared with placebo (97330). Other clinical research shows that taking tribulus 400 mg twice daily for 30 days does not improve erectile function when compared with placebo (92031). However, one preliminary clinical study in patients with partial androgen deficiency shows that taking tribulus 250 mg three times daily for 3 months improves erectile function when compared to baseline (92028). Tribulus has also been studied in combination with other ingredients. Preliminary clinical research shows that taking a combination supplement (Tradamix TX1000, Tradapharma Sagl) containing tribulus 450 mg, brown algae 300 mg, and chitosan 250 mg twice daily for 3 months improves sexual satisfaction, desire, ejaculation function, and sexual quality of life when compared with placebo in patients with mild-to-moderate ED (92030). It is unclear if these effects are due to tribulus, the other ingredients, or the combination.
• Exercise-induced muscle damage. It is unclear if oral tribulus is beneficial for exercise-induced muscle damage. Details: Clinical research in a small number of healthy, untrained males shows that taking tribulus 500 mg daily for 2 weeks prior to performing resistance exercise reduces markers of muscle damage, including creatine phosphokinase (CPK) and lactate dehydrogenase (LDH), but does not reduce levels of the inflammatory markers interleukin-6 (IL-6) or C-reactive protein (CRP), when compared with placebo (103236). However, another small clinical study in male CrossFit athletes shows that taking tribulus 770 mg capsules (Quamtrax Pharmaceuticals) daily for 42 days does not reduce CPK but does improve CRP and oxidant status when compared with placebo (111747). However, it is unclear whether any improvements are clinically significant. A very small crossover clinical study in trained male athletes shows that taking 20 mg/kg/day of tribulus in 3 divided doses 30 minutes before meals with 500 mL of water for 4 weeks does not reduce muscle soreness after intensive aerobic exercise when compared with placebo (111746).
• Gonorrhea. Although there is interest in using oral tribulus for gonorrhea, there is insufficient reliable information about the clinical effects of tribulus for this condition.
• Hypercholesterolemia. Although there is interest in using oral tribulus for hypercholesterolemia, there is insufficient reliable information about the clinical effects of tribulus for this condition.
• Hypertension. It is unclear if oral tribulus can lower blood pressure. Details: In patients with pre-hypertension, clinical research shows that taking powdered tribulus fruit 2 grams three times daily for 2 months reduces systolic and diastolic blood pressure by 6 and 5 mmHg, respectively, when compared with placebo (105245). It is unclear what effect Tribulus may have in patients with diagnosed hypertension.
• Kidney stones (nephrolithiasis). Although there is interest in using oral tribulus for kidney stones, there is insufficient reliable information about the clinical effects of tribulus for this purpose.
• Male infertility. It is unclear if oral tribulus is beneficial for male infertility; the available research is conflicting. Details: Case series suggest that taking a specific tribulus product (Tribestan, Sopharma) 250 mg three times daily for 30 days improves ejaculate volume, sperm concentration, and sperm motility in patients with infertility due to oligoasthenozoospermia (78865), and improves libido and erections in patients with primary hypogonadism (78868). Conversely, a small clinical study in patients with oligozoospermia shows that taking tribulus granules 6 grams daily for 60 days does not improve sperm count when compared with placebo (92032). In patients with idiopathic infertility, taking tribulus 250 mg three times daily for 3 months does not increase sperm concentration, sperm motility, serum testosterone levels, or luteinizing hormone levels (97328). The difference in these findings might be due to the small study sizes, as well as the variable etiology of infertility.
• Menopausal symptoms. Oral tribulus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research shows that taking a combination product containing tribulus 40 mg, ginger, saffron, and Ceylon cinnamon (Aphrodit, Goldaru Company) twice daily for 4 weeks improves mental and physical symptoms during menopause, but not genitourinary symptoms, when compared with placebo (97326). It is not clear if this effect is due to tribulus, the other ingredients, or the combination.
• Osteoporosis. Although there is interest in using oral tribulus for osteoporosis, there is insufficient reliable information about the clinical effects of tribulus for this condition.
• Polycystic ovary syndrome (PCOS). Oral tribulus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical study shows that taking tribulus extract (Tribulus forte, Mediherb, Integra Healthcare Ltd) 245 mg daily along with other ingredients and lifestyle modification during the follicular phase of the menstrual cycle for 3 months improves some symptoms of PCOS, including a 33% reduction in oligomenorrhea or amenorrhea and a 43-day reduction in the duration between menstrual cycles, when compared with lifestyle modification alone. Taking tribulus with other ingredients also improves quality of life by about 30% and reduces body mass index by 1 kg/m2 when compared with placebo. Although the conception rate increased 4-fold in patients taking the combination product, the live birth rate was similar to those taking placebo. (97216). It is unclear if these effects are due to tribulus, the other ingredients, or the combination.
• Premature ejaculation. Oral tribulus has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a combination product containing tribulus, 5-HTP, winter savory, and chanca piedra (EiacuMev, Farmaceutica Mev) daily for 3 months improves time to ejaculation by 30 seconds and reduces symptoms related to premature ejaculation when compared to control (97016). More evidence is needed to rate tribulus for these uses.

(Read more about TRIBULUS)

POSSIBLY UNSAFE ...when used orally. Androstenedione has been associated with significant side effects, including increased risk of breast, pancreatic, and prostate cancer (672,3861,6000). In addition, there are safety concerns that the potency and purity of androstenedione products can differ significantly from the product labeling (10641).

CHILDREN: LIKELY UNSAFE
when used orally. Androstenedione could potentially cause premature closure of the bone growth plates and precocious puberty (674,111132).

PREGNANCY: LIKELY UNSAFE
when used orally. Androstenedione might induce labor (673).

LACTATION:
Insufficient reliable information available; avoid using.

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POSSIBLY SAFE ...when used orally and appropriately, short-term. Most studies have been small and lasted from a few weeks to 6 months, with usual doses of 50 mg daily (793,1635,2133,3231,4249,4251,4252,4253,4254,4255,9691)(9692,10986,12215,12564,14277,21416,88726,90304,99925). Some studies have also used oral DHEA with apparent safety for 12-24 months (2113,6446,10406,11464,12561,15027,88492). ...when used intravaginally and appropriately. Intravaginal ovules of DHEA 3.25 mg to 13 mg have been safely used for up to 12 weeks (21320,21429,21430). ...when used topically and appropriately. A DHEA cream 1% to 10% has been safely used for up to 12 months (4242,21428).

POSSIBLY UNSAFE ...when used orally in high doses or long-term. There is concern that long-term use or use of amounts that cause higher than normal physiological DHEA levels might increase the risk of prostate cancer (2111,12565), breast cancer (10370,10401,10403), or other hormone-sensitive cancers (6445). In some cases, 50-100 mg daily can produce slightly higher than normal physiological DHEA levels (4249,4251). There is insufficient reliable information available about the safety of using DHEA intravenously or intramuscularly.

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when used orally. DHEA can cause higher than normal androgen levels (2133,4249,4251,4253), which might adversely affect pregnancy or a nursing infant.

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LIKELY UNSAFE ...when the spine-covered fruit is used orally. There have been reports of bilateral pneumothorax and bronchial polyp after oral consumption of the spine-covered fruit (818).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Animal research suggests that tribulus might adversely affect fetal development (12674); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

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ESTROGENS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, androstenedione might increase the effects and adverse effects of estrogens.  Details Androstenedione is a precursor to estrogen and seems to increase estrogen levels (1905,3861,6000,7236,8138,19563,97845,111132,111134). However, androstenedione is converted to estrogen only in low estrogen environments. Patients taking estrogen do not have low estrogen levels because of the estrogen treatment. Therefore, androstenedione is unlikely to be converted to estrogen in these patients. However, until more is known, use with caution or avoid using.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.  Details Human and laboratory research show that DHEA and DHEA-S can inhibit platelet aggregation (19109,19127).

ANTIDEPRESSANT DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might increase the risk of psychiatric adverse events when used with antidepressants.  Details In a human case report, the use of a selective serotonin reuptake inhibitor (SSRI) with DHEA caused a manic episode (7023). Concern for this interaction may be greater in younger individuals with higher baseline DHEA levels.

AROMATASE INHIBITORS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might interfere with the clinical effects of aromatase inhibitors.  Details DHEA is a potent estrogen agonist, which may antagonize the anti-estrogen activity of aromatase inhibitors (10401).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might increase the levels of drugs metabolized by CYP3A4.  Details Some preliminary evidence shows that DHEA may inhibit CYP3A4 (1389); however, the clinical significance of this potential interaction is not known.

ESTROGENS Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might increase the effects and adverse effects of estrogen therapy.  Details DHEA is a precursor to estrogen and androgen and is metabolized into those substances. In clinical research, DHEA supplements increase the levels of these hormones (6012,7614,8593,10986,12651,12564,15027,21321,21323,21324)(21325,21326,21327,21328,21330,21331,21356,21364,21389,21393)(21397,21398,21417,21419,21427,47273,47348,88375,90304). Also, in clinical research, estrogen-progestin oral contraceptives and conjugated estrogens reduce blood levels of DHEA and DHEA-S (21372,21373,21374,21437,21438). The clinical significance of these findings is unclear.

FULVESTRANT (Faslodex) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might interfere with the anti-estrogen effects of fulvestrant.  Details DHEA is a potent estrogen agonist (10401). Some research shows that it can overcome the estrogen receptor antagonist action of fulvestrant in estrogen-receptor positive cancer cells (10370).

TAMOXIFEN (Nolvadex) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might interfere with the anti-estrogen effects of tamoxifen.  Details DHEA is a potent estrogen agonist. Some research shows that it can overcome the estrogen receptor antagonist activity of tamoxifen in estrogen-receptor positive cancer cells (10370,10403).

TESTOSTERONE Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, DHEA might increase the effects and side effects of testosterone therapy.  Details DHEA is a precursor to estrogen and androgen and is metabolized into those substances. In clinical research, DHEA supplements increase the levels of these hormones (6012,7614,8593,10986,12651,12564,15027,21321,21323,21324)(21325,21326,21327,21328,21330,21331,21356,21364,21389,21393)(21397,21398,21417,21419,21427,47273,47348,88375,90304,99924,99925,104162). The clinical significance of these findings is unclear.

TRIAZOLAM (Halcion) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D DHEA can increase blood levels of triazolam.  Details Administration of DHEA 200 mg daily for two weeks was shown to inhibit the cytochrome P450 3A4 (CYP3A4) metabolism of triazolam. This inhibition appears to be due to DHEA-S, rather than DHEA (1389).

TUBERCULOSIS VACCINE Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D DHEA might reduce the effectiveness of the tuberculosis vaccine.  Details Animal research shows that high doses of DHEA can reduce the efficacy of the Bacillus Calmette-Guérin (BCG) tuberculosis vaccine (21316).

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ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Taking tribulus with antidiabetes drugs might increase the risk of hypoglycemia.  Details Clinical research shows that Tribulus can lower blood glucose levels in adults with type 2 diabetes who are taking antidiabetes medications (97327).

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking tribulus with antihypertensive drugs might increase the risk of hypotension.  Details Animal research shows that tribulus can lower blood pressure by inhibiting angiotensin-converting enzyme (ACE) (12673). Tribulus has also demonstrated hypotensive effects in pre-hypertensive adults (105245).

LITHIUM Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, tribulus might increase the levels and clinical effects of lithium.  Details Tribulus is thought to have diuretic properties (12681). Due to these potential diuretic effects, tribulus might reduce excretion and increase levels of lithium. The dose of lithium might need to be decreased.

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General ...Orally, androstenedione may be unsafe.
Serious Adverse Effects (Rare):
Orally: hepatotoxicity; breast and endometrial cancer (females); pancreatic and prostate cancer (males); and adverse genitourinary effects.

Cardiovascular ...Orally, there is some concern that androstenedione might increase risk of heart disease in men. Androstenedione decreases high-density lipoprotein (HDL) cholesterol (1905,6000,7236,31279,111134).

Dermatologic ...Orally, androstenedione might cause acne in men by decreasing endogenous testosterone production and increasing estrogen. In women, androstenedione might cause male-pattern baldness, hair growth, acne, and coarsening of the skin (674,111132).

Endocrine ...Orally, androstenedione might decrease endogenous testosterone production and increase estrogen in men (1905,3861,6000,7236,8138,97845). Changes in testosterone levels are variable and might depend on length of supplementation and age (1905,3861,6000,7236,8138,31250,97845,111132). In women, androstenedione can increase testosterone levels (19563,19564,111132). Theoretically, these changes can affect behavior and physical characteristics.

Genitourinary ...Orally, androstenedione possibly alters levels of estrogen and testosterone in men (1905,3861,6000,7236,8138,97845,111132,111134). Theoretically, this might cause decreased spermatogenesis, gynecomastia, testicular atrophy, and prostate hypertrophy (6000,31266,111132). There is one case report of two episodes of priapism associated with androstenedione use in a 30-year-old man (5089). Also, there is one case report of severe oligospermia, reduced libido, impotence, and testicular atrophy in a 29-year-old male recreational bodybuilder using androstenedione (97844). In women, androstenedione may theoretically cause clitoral hypertrophy and menorrhea (674,31266,31280,111132).

Hepatic ...Orally, androstenedione might cause hepatotoxicity. Testosterone derivatives similar to androstenedione have been associated with hepatic toxicity (3861). Consider monitoring liver function tests (LFTs) in patients using androstenedione.

Oncologic ...Orally, androstenedione might potentially increase the risk of pancreatic and prostate cancer in men (672,6000). There is preliminary evidence that androstenedione might stimulate prostate cancer cell growth (672,8138,31280,31283). However, population research shows that higher blood levels of androstenedione is not associated with an increased risk of prostate cancer in mean with enlarged prostates (97841). Some androstenedione products are combined with other supplements such as dehydroepiandrosterone, puncture vine, saw palmetto, indole-3-carbinol, and chrysin (DION) to lessen the effects of androstenedione on increased levels of estradiol and DHT. However, this combination does not seem to help (8138). In women, androstenedione can increase testosterone levels. Theoretically, this might increase the risk of breast and endometrial cancer (31273).

Psychiatric ...There is some concern that androstenedione might cause or worsen depression in women. Some women with severe major depression seem to have increased endogenous androstenedione concentrations; however, it is not known if supplements can actually cause this adverse effect (6796).

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General ...Orally and topically, DHEA seems to be well tolerated when used in typical doses, short-term. However, there is some concern that long-term oral use of DHEA may be linked to a greater risk for cancer.
Most Common Adverse Effects:
Orally: Acne, headache, insomnia, mood changes, and nausea. In females, masculinization symptoms including deepening of the voice, increased size of genitals, irregular menses, oily skin, reduced breast size, and unnatural hair growth. In males, aggression, breast tenderness or enlargement (gynecomastia), urinary urgency, and testicular wasting.
Serious Adverse Effects (Rare):
Orally: Possible increased risk for cardiovascular events and various types of cancer.

Cardiovascular ...Incidences of arrhythmia (21334,47540), chest pain (21332,21333), palpitations (21332,21333,88492), hypertension, and transient ischemic attacks (21353,21354,47300) have been reported. DHEA has also been found to decrease high-density lipoprotein (HDL) levels (21344,21345,21346,21347,21348,21349) and increase triglycerides (21334).

Dermatologic ...Acne has been the most commonly reported adverse effect in human research, particularly in females (2113,2114,4242,7614,7559,12561,12574,21346,21351,21354)(21355,21356,21357,21358,21360,21361,21362,21363,21364,47300)(47355,47409,90304,103185). However, it is generally mild and may be treated by reducing the dose (7559). Incidences of contact dermatitis (47402), acneiform dermatitis (2113), greasy hair and skin (17218,21351,21355,21363,21387,21389,47355), keratosis (47402), skin rash (12574,21361,21363), erythema (21334), scalp itching (17218,21357), and skin spots (21387) have also been reported. Increased hair growth and hirsutism have been noted in several clinical trials, including the development of mild mustache in females (2114,4242,12561,12574,17218,21346,21351,21354,21355,21358) (21361,21362,21363,21370,21387,21389,21415,47300). Increased perspiration and odor have also been reported in human research (17218,21354,21356,21357).

Endocrine ...In postmenopausal patients, high doses of DHEA (1600 mg daily) induced insulin resistance, reportedly due to increased androgen levels that occurred during supplementation (21324).

Gastrointestinal ...Gastrointestinal disturbances such as nausea, diarrhea, and abdominal discomfort have been noted in human research (2111,6098,7559,12574,21348,21358,21386).

Genitourinary ...In older adults, elevated and severe urinary symptoms (as evidenced by scores of more than 20, using the American Urological Association Symptom Index for Benign Prostatic Hyperplasia [International Prostate Symptom Score]) and urinary tract infection were reported (21353). Rare incidences of abnormal menses (2114) and increased discharge (21415) have been reported. DHEA has been associated with hematuria (47300).

Hepatic ...Elevated liver enzymes have been reported following DHEA supplementation (21364,47300). However, an analysis of multiple studies in varied patient populations taking DHEA supplements found no elevations in liver enzymes (107791).

Musculoskeletal ...Incidences of asthenia, arthralgia, and myalgia, including calf cramps, have been reported (12574,21354,21358,21365,47355).

Neurologic/CNS ...In humans, dizziness, fatigue, malaise, sleep disturbances, increased dreaming, night sweats, restlessness, "painful spots," and a crawling scalp sensation have been reported (3865,21354,21363,21389). There is a case of seizure associated with DHEA use in a 30 year-old female with fragile X syndrome and no history of convulsive disorder who used DHEA to try to improve ovarian production (47344).

Ocular/Otic ...In patients with Sjögren syndrome, maculae lesions, ocular pain and dryness, and painful eye exams have been reported (21358,21363,21365).

Oncologic ...Preclinical research suggests that DHEA may increase the risk of cancer, particularly prostate, liver, breast, and pancreatic cancers (2111,10370,10401,10403,12565,21332,21333,21334,47251,47256)(47366,47388,47539). High concentrations of DHEA in postmenopausal patients have been associated with an increased risk of breast cancer (2115,6445).

Psychiatric ...DHEA-induced mania has been reported (5870,6102,7023,21383). Clinical studies have also reported anxiety, nervousness, irritability, emotional change, and depression in patients receiving DHEA (2114,21358,21360,21370).

Pulmonary/Respiratory ...Increased cough and nasal congestion have been noted in human research (3865,11334). A report of acute respiratory failure was made in clinical study evaluating the use of DHEA in patients with myotonic dystrophy (type 1) (21334).

Other ...Perceived increases in weight gain have been reported with use of DHEA (2114,21361).

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General ...Orally, tribulus seems to be well tolerated.
Serious Adverse Effects (Rare):
Orally: Cases of liver and kidney injury, seizures, and chronic painful erection with impaired sexual function have been reported. Pneumothorax and bronchial polyp after consuming the spine-covered tribulus fruit have been reported.

Gastrointestinal ...Orally, tribulus can cause abdominal pain, cramping, nausea, vomiting, diarrhea, and constipation (92022,92027). However, in one study, the rates of these gastrointestinal complaints were similar for patients taking tribulus and those receiving placebo (92022).

Genitourinary ...In one case report, a patient taking two tribulus tablets (unknown dose) daily for 15 days presented to the local emergency department with a painful erection lasting 72 hours. The priapism was resolved with medical management; however, post-episode sexual function was impaired (92023).

Hepatic ...In one case report, a patient drinking tribulus water 2 liters daily for two days presented with lower limb weakness, seizures, hepatitis, and acute kidney injury. The patient's condition improved after hemodialysis and discontinuation of tribulus water (92069).

Neurologic/CNS ...Orally, tribulus has been reported to cause general excitation and insomnia. These symptoms were reversed upon discontinuation of the drug or decreasing the dose (78867). In one case report, a patient drinking tribulus water 2 liters daily for two days presented with lower limb weakness, seizures, hepatitis, and acute kidney injury. The patient's condition improved after hemodialysis and discontinuation of tribulus water (92069).

Pulmonary/Respiratory ...In one case report, a patient developed a bilateral pneumothorax after consuming the spine-covered fruit of tribulus (818). In another case report, a patient developed a polyp in the lobar bronchus of the right interior lobe due to the presence of a tribulus fruit spine (78852).

Renal ...In one case report, a patient drinking tribulus water 2 liters daily for two days presented with lower limb weakness, seizures, hepatitis, and acute kidney injury. The patient's condition improved after hemodialysis and discontinuation of the tribulus water (92069). In another case report, a healthy male taking one tribulus tablet (unknown dose) daily for a few months for bodybuilding purposes developed hyperbilirubinemia followed by acute kidney failure 2-3 weeks later. The patient was managed with intravenous fluids and a low-salt, low-protein diet (92025).

Other ...In one case report, gynecomastia was observed in a male weightlifter taking an herbal combination product containing tribulus. However, it is not clear if this adverse effect can be attributed to tribulus alone (78859).

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