Tongkat Ali: Benefits, Dosage, and Side Effects

Traditional herbal supplements are making their way back into contemporary medicine. People are considering their use more favorably alongside conventional medical treatments, as an adjunct to address existing health concerns. Traditionally used in ancient herbal medicine practices, tongkat ali has been used for its aphrodisiac, antibiotic, antimicrobial, and antioxidant properties and to promote general well-being. This article will consider the evidence behind such claims.

What is tongkat ali?

Eurycoma longifolia, commonly known as tongkat ali, is an herbal supplement derived from a tall, slender, shrubby tree that belongs to the Simaroubaceae family. Tongkat ali is aptly named after the shrub's long and twisted root, wherein 'ali' means ‘walking stick.' Commonly found across Southeast Asia, tongkat ali is native to Indonesia, Malaysia, Vietnam, Cambodia, Myanmar, Laos, and Thailand. Other common names include pasak bumi or long jack.

Traditionally used in ancient herbal medicine practices for centuries, tongkat ali is known for its numerous bioactive compounds, including alkaloids, quassinoids, peptides, eurycolactone, and eurycomalactone. Typically, the freshly cut roots are boiled and consumed for their aphrodisiac, antibiotic, antimicrobial, and antioxidant properties, as well as to promote general well-being.

Throughout this article, we consider the current evidence surrounding the use of tongkat ali to determine which potential health benefits are backed by medical research, and which aren’t.

4 potential benefits of tongkat ali

Tongkat ali has been involved in numerous research studies seeking to affirm or dispute the potential health benefits. By looking at these studies, we can ascertain the truth behind such claims and consider if and how this supplement can be effectively applied to our health.

It is important to note that large sample safety and efficacy studies are lacking, so findings are only preliminary and applicable to the specific participant groups represented in the trials. Much of the research into tongkat ali has been conducted on animals, making evidence for potential outcomes extremely limited. Information on use is inconsistent, with considerable variation in reported side effects, benefits, and appropriate dosages.

1. Improves male fertility and sexual performance

Infusions of tongkat ali root have been used for centuries in traditional medicine as an aphrodisiac for loss of sexual desire and as a treatment for impotence. Modern-day research suggests that this ancient remedy may have some merit, thought to enhance male fertility by increasing semen volume, sperm concentration, the percentage of morphologically normal sperm cells, and sperm motility.

One study determined tongkat ali may have implications for managing male infertility, finding that varying doses given in animal trials had a significant effect on both sperm count and levels of testosterone.

In one research study conducted in Kuala Lumpur, Malaysia, 76 male patients with an average 5.3-year history of infertility were given two capsules daily of 100 mg water-soluble extract of Eurycoma longifolia root; follow-up examinations were conducted every three months for three cycles. The extract of Eurycoma longifolia significantly improved sperm quality in these patients, including sperm concentration, motility, and morphology. This allowed for 11 spontaneous pregnancies throughout the study. Of these 11 pregnancies, six were achieved at the end of the first treatment cycle, and five at the end of the second treatment cycle. However, evidence to suggest that these pregnancies were a direct result of the treatment is inconclusive.

One randomized, double-blind, placebo-controlled study found improvements in erectile function, sexual libido, sperm motility, and semen volume following treatment with tongkat ali. The 12-week study was conducted with 109 male participants aged 30–55 and consisted of treatment with either 300 mg water extract of Eurycoma longifolia or placebo.

2. May boost athletic performance

Tongkat ali is claimed to boost athletic performance and promote muscle growth. It is often stated to enhance energy levels, eliciting a positive ergogenic effect, while reducing fatigue and improving endurance.

Findings from one pilot study examining the ergogenic effects of Eurycoma longifolia suggest that a water-soluble extract of Eurycoma longifolia increased lean body mass over the course of five weeks, while the placebo group experienced no increase in lean mass. However, more robust clinical trials are needed to establish the effects of Eurycoma longifolia on athletic performance and muscle growth.

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3. May reduce stress and anxiety

Tongkat ali may have positive effects on your mental health by potentially reducing stress and anxiety.

One research study sought to determine the effect of tongkat ali on stress hormones and psychological mood states in subjects under moderate stress. Results of this study indicate that daily supplementation with tongkat ali root extract improved stress hormone profiles and certain mood state parameters, with significant improvements found for tension, anger, and confusion.

4. May benefit bone health

One animal study found that Eurycoma longifolia extract could be a potential compound for osteoporosis, reducing degenerative changes by improving bone volume and reducing skeletal deterioration. An additional study determined that the use of tongkat ali elicited a better effect in stimulating bone formation, compared to control groups.

This research suggests tongkat ali may have potential applications in bone health, but further research is needed to substantiate this claim.

Tongkat ali side effects

Side effects from tongkat ali range from mild to severe and can include:

• headaches
• nausea
• vomiting
• restlessness
• insomnia
• fatigue

Other rare but potentially severe side effects depending on individual circumstances may include changes to blood pressure, blood sugar levels, and liver toxicity.

However, there is extremely limited safety and toxicity data on tongkat ali available from human studies. Most research studies utilize doses of 200 mg per day with no severe adverse effects, but available studies often focus on short-term use, making safety data on long-term use inconclusive. Due to a lack of data, tongkat ali is not recommended for pregnant and lactating women, men with breast or prostate cancer, individuals with diabetes, heart disease, kidney disease, liver disease, or sleep apnea, and children.

Interaction with other medications

Precautions should be taken with tongkat ali use, including for those with a suppressed immune system, as well as people taking blood pressure medication, diabetes medication, hormone therapies, anticoagulants, antidepressants, or stimulants.

The bioavailability (absorption rate) of propranolol (a common antihypertensive medication) is significantly decreased when consumed alongside tongkat ali supplements. It is always advised to discuss the use of any additional health supplements with your healthcare provider, especially in the context of existing medications and health conditions, who can assess the risks and benefits based on your individual case.

Does tongkat ali increase testosterone?

Low testosterone comes as a result of male testicles not producing enough testosterone. This can occur for many reasons, including damage to the testicles, infection, autoimmune disease, hormonal changes, or aging. Low testosterone can cause muscle loss, low libido, fatigue, and depressed mood.

It is primarily treated with testosterone replacement therapy (TRT), being one of the most commonly prescribed treatments for men over 60 years old. However, TRT is not without its risks, and tongkat ali’s use as a ‘testosterone booster’ is well documented. Some studies consider tongkat ali to be a safe and natural alternative to TRT, restoring serum testosterone levels with limited adverse effects.

One particular study gave 76 men suffering from late-onset hypogonadism (low testosterone) 200 mg of a standardized water-soluble extract of tongkat ali for 1 month, finding an increase in serum testosterone concentration. However, an additional study into otherwise healthy males without low testosterone failed to find an increase, and findings from animal studies have been inconclusive.

Tongkat ali should not be used as a replacement for medical treatment, and additional clinical trials are needed to evaluate tongkat ali effectiveness in addressing low testosterone.

Tongkat ali for erectile dysfunction: does it work?

According to one meta-analysis, the effects of tongkat ali on erectile dysfunction were inconsistent across groups and not significant. Further efficacy trials are needed to support this claim.

How to choose supplements

The number one priority for choosing tongkat ali supplements is the quality and purity of formulations.

Regulations for the commercial use of tongkat ali are not standardized, which can lead to significant differences in the concentration levels of active ingredients across products on the market.

For this reason, it is important to choose a reputable brand and a product that has clear information about the sourcing and extraction methods. Transparent reporting of ingredients and additives is of particular importance.

Look for any documentation that addresses compliance with relevant local regulations, taking special consideration of manufacturers who utilize third-party testing to verify the potency and clarity of the product, alleviating bias.

How to use tongkat ali

Tongkat ali comes in capsule form, loose powder, effervescent, tablets, and various coffees or teas. Each different form comes with specific recommendations for use, so it's advised to adhere to the manufacturer's recommendations.

• Always consult with a healthcare provider before starting a new supplement regime.
• Take tongkat ali at the same time each day, maintaining a consistent routine.
• Ensure you stay well-hydrated throughout use.
• Pay attention to how your body responds to tongkat ali, looking out for any negative reactions or adverse effects.

Recommended dosage

Tongkat ali may be considered safe to use in small doses; 200 mg per day has elicited no adverse events across human studies. Always take note of the manufacturer's recommendations for use. Of utmost importance, follow the advice given by your healthcare provider, as they can determine the most appropriate dose and timing based on your unique medical history and personal health goals.

When to take tongkat ali

This may come down to personal preference; some people prefer to take tongkat ali in the morning given its potential effect on mood and energy levels. It is advised to take tongkat ali at the same time each day. Taking it alongside food may help slow down supplement absorption, potentially reducing the risk of side effects relating to the gastrointestinal system.

How long does it take to work?

Information on how long tongkat ali takes to work is extremely varied, with considerable inconsistencies across medical research studies. Variation may stem from differences in use, variations in individual physiology, differing dose regimes, and the specific health concerns being addressed. It is advisable to maintain a consistent regime as outlined by your healthcare provider and stay attuned to any changes in your health.

Although there is a body of research that considers tongkat ali supplementation effects on health, research is inconsistent, and human studies are lacking. It is extremely important to consult your healthcare provider before beginning any new supplement regimen, especially considering potential interactions between existing co-morbidities and medications.