Tribulus Terrestris for Sexual Function

Verdict: Weak, low-quality evidence of modest benefit

Tribulus terrestris may modestly improve sexual desire and function in men and women already diagnosed with sexual dysfunction, but the supporting trials are small, low-quality, and partly industry-funded, so the evidence remains weak and far from conclusive.

C 🟠 C Weak Evidence Published with Warning

🔬Why this grade7-layer evidence engine

The signal is real but thin. A 2026 meta-analysis (PMID 40360723, 8 RCTs) found statistically significant gains in erectile-function scores (IIEF-5 MD 4.21; IIEF-15 MD 15.88), and randomized trials in women report improved desire and arousal, including a placebo-controlled trial in postmenopausal women with hypoactive desire (PMID 27760089) and a female systematic review (PMID 32736394, n=279). The benefit appears largely independent of testosterone, which is not reliably raised.

Study quality caps the grade at weak. A 2025 systematic review (PMID 40219032) rated half its trials low-quality and found only 3 of 5 erectile-dysfunction studies positive; the female review (PMID 32736394) graded overall certainty 'very low'; a key male RCT (PMID 28364864) was industry-funded by the maker of Tribestan; and one female RCT (PMID 34142638) lacked a placebo arm.

Authorities are unconvinced. EU EFSA authorizes no health claims and has flagged the herb for possible safety (CMR) concerns; the US FDA, NIH Office of Dietary Supplements, Harvard Health, and the sexual-medicine specialty society (ISSM) are all cautious, calling the evidence mixed and insufficient. Guideline-backed options such as PDE5 inhibitors and lifestyle change remain first-line.

⚖️

Scoring transparency

All scores computed by a 7-layer evidence engine — fully auditable
Raw score 0.59
D
C
B
A
S
← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
C · Published with Warning
Confidence
78%
Broadly consistent
Evidence level
E2
Multiple high-quality MAs (≥2 independent, consistent)

How strongly each layer supports this effect

lower = less supportive
L5 Clinical bodiesAuthoritative stance
0.40
L1 ExamineGlobal benchmark
0.50
L11 AI re-checkIndependent read
0.50
L3 MechanismPlausibility
0.65
L2 PubMedPrimary literature
0.75
Against Mixed Supports
View the full decision path (audit trail)
  1. compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.588
  2. tier_from_score — 依分數區間映射至 tier letter
  3. apply_hec_rules — 高品質 SR/MA 顯示 positive (2 篇 > 0 negative)
  4. tier_strict_requirement_check — | B→C 因 scope.conflation_risk=true 且 L11 獨評較低 (B7-2 tier cap)
  5. detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
  6. decide_status — 依 tier + dispute 結果決定 status

📄PubMed studies (6)L2 · primary research & systematic reviews

Tribulus terrestris for management of patients with erectile dysfunction: a systematic review and meta-analysis of randomized trials
PMID: 40360723 2026 統合分析 n = 8
Finding: TT significantly improved IIEF-5 (MD 4.21, p<0.00001) and IIEF-15 (MD 15.88, p=0.0004) vs placebo; no significant difference in testosterone levels.
Effect size: MD 4.21 IIEF-5; MD 15.88 IIEF-15
View on PubMed
Effects of Tribulus (Tribulus terrestris L.) Supplementation on Erectile Dysfunction and Testosterone Levels in Men-A Systematic Review of Clinical Trials
PMID: 40219032 2025 系統性回顧 n = 10
Finding: Only 3/5 studies showed ED improvement; 8/10 showed no testosterone change; 50% of included studies rated low quality on Jadad scale.
🟠 Limited quality
View on PubMed
Tribulus Terrestris for Female Sexual Dysfunction: A Systematic Review
PMID: 32736394 2020 系統性回顧 n = 279
Finding: Both pre- and postmenopausal women showed significant sexual function score improvements after 1-3 months; certainty of evidence rated 'very low'.
🟠 Limited quality
View on PubMed
Effect of Tribulus Terrestris in the Treatment of Female Sexual Dysfunction and Clitoral Vascularization. Results of a Randomized Study Comparing Two Different Dosage Regimes
PMID: 34142638 2021 RCT (open-label) n = 104
Finding: Both dosage groups improved across all FSFI domains (p<0.05) except 'satisfaction' in the 94 mg TID premenopausal subgroup.
🟠 Limited quality
View on PubMed
Efficacy of Tribulus terrestris for the treatment of hypoactive sexual desire disorder in postmenopausal women: a randomized, double-blinded, placebo-controlled trial
PMID: 27760089 2016 RCT (double-blind) n = 36
Finding: Significant improvements in desire (p<0.01), arousal/lubrication (p=0.02), pain (p=0.02), and anorgasmia (p<0.01) vs placebo; free testosterone increased (p<0.05).
View on PubMed
Evaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction-A prospective, randomized, double-blind, placebo-controlled clinical trial
PMID: 28364864 2017 RCT (double-blind) n = 180
Finding: TT improved IIEF significantly vs placebo (MD 2.70, 95% CI 1.40-4.01, p<0.0001); also improved sexual desire (p=0.0038) and orgasmic function (p=0.0325).
⚠️ Industry-funded Effect size: MD 2.70 IIEF
View on PubMed

🏛️Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …

L4a US FDA
Cautious
L4b EU EFSA
Against
L4d TW TFDA / 衛福部
Cautious
須由中醫師處方使用(白蒺藜,衛署藥製字第011641號);未經確認其食用安全性前,不得供為食品原料使用。 source↗
L5a NIH Office of Dietary Supplements
Cautious
L5d Harvard Health
Cautious
L5e Specialty Society (condition-mapped)
Cautious
PMID 100% verifiedevery citation checked via NCBI Entrez
🔬6 PubMed studiesindependently re-checked by multiple sub-agents
engine_version: v1.0 claim_id: CLM-COND-sexual-function-INT-tribulus-terrestris-001 繁體中文版 →