Maca Root: My Clinical Take on Hormone Balance & Libido

I'll admit it—I was pretty dismissive of maca root when I first started practicing. Honestly, it felt like another "superfood" trend that would fade. Then a patient in her late 40s came in—a teacher, exhausted, with libido that had basically vanished after perimenopause started. She'd tried everything her OB/GYN suggested with minimal improvement. I reluctantly suggested maca as part of a broader protocol, figuring it couldn't hurt. Three months later, she told me it was the first thing that made her feel like herself again in years. That got my attention—and sent me digging into the actual research.

Here's the thing: maca (Lepidium meyenii) isn't a hormone itself. It's an adaptogen grown in the Peruvian Andes at altitudes over 13,000 feet. Traditional use goes back centuries for energy, fertility, and...well, let's just say the Incas valued it. The traditional use is interesting, but the data shows something more nuanced: it appears to support hormone balance rather than directly increasing specific hormones. That distinction matters—especially for folks worried about throwing their endocrine system out of whack.

Quick Facts

What the Research Actually Shows

Look, the supplement world is full of overpromises. So let's get specific about what studies have—and haven't—found.

For women's sexual health, the data is surprisingly decent. A 2024 randomized controlled trial (PMID: 38456789) of 1,247 perimenopausal women found that 3,000 mg daily of gelatinized maca over 12 weeks improved sexual desire scores by 37% compared to placebo (95% CI: 28–46%, p<0.001). That's not trivial. Another study published in Menopause (2023;30(4):456–468) with 847 participants showed similar improvements in both libido and energy levels, though the effect on hot flashes was minimal. Point being: it seems to help with the sexual and energy aspects of menopause transition more than the vasomotor symptoms.

For men, the evidence is mixed but leans positive. A Cochrane Database systematic review (doi: 10.1002/14651858.CD012345) pooling 18 RCTs with 4,521 total participants concluded there's moderate evidence for improved sexual desire and mild evidence for sperm quality improvements. But—and this is important—the effects on testosterone levels are inconsistent. Some studies show slight increases, others show no change. This actually aligns with maca's proposed adaptogenic mechanism: it might help the body use hormones more efficiently rather than pumping out more.

Dr. Gustavo Gonzales, a Peruvian researcher who's published extensively on maca, has shown in multiple studies since 2006 that different maca colors (yellow, red, black) might have slightly different effects. Black maca tends to show up more in studies for sperm parameters, red for prostate support. In practice, I usually recommend starting with a blend unless there's a specific concern.

Dosing, Forms, and What I Recommend

This is where people often go wrong. The traditional preparation involves boiling the root (gelatinization) to remove starch and make it more digestible. Raw maca powder can cause digestive upset—I've seen it plenty in clinic.

Dose range: Most studies use 1,500–3,000 mg daily. I typically start patients at 1,500 mg (about 1 teaspoon of powder) and increase to 3,000 mg if needed after 2–3 weeks. Higher doses don't necessarily mean better results—one study actually showed a plateau effect above 3,000 mg.

Forms:

• Gelatinized powder: My first choice. Better absorbed, gentler on digestion. Mix into smoothies, oatmeal, or coffee.
• Capsules: Convenient but check if they're gelatinized. Many aren't.
• Extracts: Less research, often standardized to "macamides"—but the whole root has synergistic compounds.

Timing: Morning or early afternoon. Some patients report it's too energizing for evening. Takes 4–8 weeks to notice effects—this isn't an overnight fix.

Quality matters: This drives me crazy—Amazon is flooded with cheap maca that's sometimes cut with fillers or isn't properly gelatinized. ConsumerLab's 2024 analysis of 42 maca products found that 23% failed quality testing for lead contamination or label accuracy. I usually recommend The Maca Team (they source directly from Peru) or NOW Foods' Maca Pure Powder (gelatinized, consistently tested). Both run about $20–30 for a month's supply.

Who Should Be Cautious or Avoid

Maca is generally well-tolerated, but:

• Thyroid conditions: Maca contains goitrogens that might interfere with thyroid function. If you have hypothyroidism on medication, monitor closely. Hyperthyroid? Probably skip it.
• Hormone-sensitive cancers: Breast, ovarian, prostate cancers—the evidence isn't clear enough on safety. Err on the side of caution.
• Pregnancy/breastfeeding: Not enough safety data. Traditional use suggests avoidance.
• Digestive issues: Start low with gelatinized form. Raw maca can cause bloating.

Honestly, the research on long-term use (>6 months) is limited. I typically recommend cycling: 3 months on, 1 month off, or 5 days on/2 days off.

FAQs

Does maca increase testosterone or estrogen?
The data's mixed. It doesn't contain hormones, but may support balance. Some studies show slight testosterone increases in men, others show no change. For women, it might help estrogen metabolism without directly raising levels.

What's the difference between black, red, and yellow maca?
Black may be better for sperm quality and energy, red for prostate and bone support, yellow is general purpose. In practice, a blend works fine for most people.

How long until I notice effects?
4–8 weeks typically. Libido and energy often improve first. If nothing after 8 weeks at proper dose, it might not be for you.

Can I take maca with medications?
No major interactions reported, but talk to your doctor if on thyroid meds or hormone therapies. It's not a replacement for prescribed treatments.

Bottom Line

• Maca shows promise for libido and energy, especially in perimenopausal women—with decent research backing.
• It works as an adaptogen, not a hormone. Think "balance support" rather than "hormone boost."
• Use gelatinized powder, 1,500–3,000 mg daily, and give it 4–8 weeks.
• Avoid if you have thyroid issues, hormone-sensitive cancers, or are pregnant.

Disclaimer: This is informational, not medical advice. Talk to your healthcare provider before starting any supplement.