Clinical study recommendations

As mentioned on our main page, we do support clinical studies and general research into tongkat ali. Here some recommendations we made for an ongoing trial.

The only relevant laboratory tests would be for plasma testosterone, sex hormone binding globulin, and free testosterone. The test for free testosterone is more expensive than the one for plasma testosterone, and (as far as I know) it cannot be done at every clinical laboratory. But certainly, the test for free testosterone would be the most relevant.

For a meaningful result, it would be best to test for free testosterone at base (before the first dosage of tongkat ali is used), and after the third or forth on-cycle.

You could split the participants in 2 groups.

Group 1 has an on-cycle of 6 days, followed by 3 days off. The second laboratory test should be done at the fourth day of the fourth on-cycle.

Group 2 has an on-cycle of 10 days, followed by 5 days off. The second laboratory test should be done at the seventh day of the third on-cycle.

Standard dosage should be 1 gram. However, it would be best to let participants at the age of 50 or older start with 0.5 gram for the first 3 days. It can happen to older people that starting with 1 gram may cause slight nausea. I have never heard of younger people getting nauseated even at an initial dose of 1 gram.

Please note that tongkat ali works on libido, not on erectile capability. Therefore, those of your patients who are using Viagra or another phosphodiesterase type 5 inhibitor (or alprostadil) should be encouraged to continue to use these agents when intending to have intercourse.

As tongkat ali stimulates libido, its effectiveness should be asserted through a questionnaire that should ask the following questions:

1. During a tongkat ali on-cycle, did you have sexual intercourse more often than on average during the past year? If yes, how much more often?

2. During a tongkat ali on-cycle, was sexual intercourse more satisfying than on average during the past year? If yes, how many times was it more satisfying than on average?

3. Would you rate any sexual intercourse during the tongkat ali trial as your best sexual experience for a long time, possibly for years?

The questionnaire should be presented twice, at the middle of the trial, and at the end.

Precautions should be taken so that participants do not have wrong expectations. Because tongkat ali works on the hormonal pathway, there is no direct effect like the one that can be achieved with Viagra. It is not that one ingests a dosage of tongkat ali extract, and an hour or two later, one would have improved libido or sexual functionality.

Testosterone usually exerts its mental effect in a rather sporadic fashion. This applies to baseline endogenous testosterone just as it does to artificially enhanced testosterone levels (through the use of tongkat ali), or to testosterone replacement therapy (it also applies to the abuse of anabolic steroids). There needs to be a trigger event for sexual arousal, which would be hard to plan indeed.

Participating patients should be aware of this. Waiting for an effect to kick in within a specific time frame would only cause a certain degree of tenseness or nervousness, which would be accompanied by a release of corticosteroids, which in turn would suppress the effect of testosterone.

It would be best if participants ingest their daily dosages of tongkat ali extract at once with a meal. For those who prefer a full breakfast, this should be at breakfast time. For others, it should be at lunch. Testosterone surges, however, may be felt anytime, with early morning the most likely occurrence.

It is essential that study participants observe off-cycles (intermediate times without using tongkat ali extract). This will be necessary because of the control function the hypothalamus has over the hormonal system. If the hypothalamus senses increased levels of any hormone, it will start to down-regulate this hormone through a variety of mechanisms.

This mechanism is what causes penile and testicular shrinkage in men who use exogenous testosterone, especially those who abuse anabolic steroids. The penile and testicular shrinkage sets in as the body shuts down the testosterone production in its own testicles if it senses increased plasma levels of testosterone or free testosterone.

However, tongkat ali, if anything, has the opposite effect on the penis and testicles, especially during on-cycles. Short-term (6 to 10 days) increased levels of testosterone may stimulate spermatogenesis, especially in older study participants.

Some people use the term "negative feedback mechanism" for this hypothalamic control function. You may want to check this at the following URL:

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/basics/control.html

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Copyright 2010 Sumatra Pasak Bumi / www.tongkatali.org - Last updated: October 30, 2010