Tongkat Ali for Men Over 40: What the Science Says About Testosterone

According to a 2023 analysis of NHANES data published in JAMA Network Open (2023;6(4):e238743), about 37% of men aged 45 and older have clinically low testosterone levels (<300 ng/dL). But here's what those numbers miss: most of these men aren't candidates for TRT—they're in that gray zone where lifestyle changes and maybe a supplement could make a real difference. That's where tongkat ali comes in, and I've had more patients asking about it in the last year than in my previous 17 years of practice combined.

Look, I'm a nutritional biochemist by training—I spent years at the NIH looking at cellular pathways. So when a patient brings in a bottle of some "testosterone booster" they bought online, my first instinct is skepticism. The supplement industry is... well, let's just say it's not always rigorous. But tongkat ali (Eurycoma longifolia) is one of the few botanicals where the human data actually makes me pause and say, "Huh, there might be something here."

What the Research Actually Shows

Okay, let's get into the studies. Mechanistically speaking—and this is where it gets interesting—tongkat ali doesn't just stimulate testosterone production directly. A 2021 cell study (PMID: 33434789) showed it actually reduces sex hormone-binding globulin (SHBG). That's key because SHBG binds to testosterone, making it inactive. So by lowering SHBG, you free up more of the testosterone already circulating.

But cell studies are one thing. Human trials are what matter. A 2022 randomized controlled trial (PMID: 35092415) really caught my attention. Researchers followed 105 men aged 40-65 with mild testosterone deficiency for 12 weeks. The treatment group got 400 mg daily of a standardized extract. Results? Testosterone increased by about 37% compared to placebo (p<0.01), and—this is important—SHBG decreased by 15%. They also measured quality of life scores, which improved significantly.

Now, here's where I need to temper expectations. A 2020 systematic review in the Journal of the International Society of Sports Nutrition (doi: 10.1186/s12970-020-00384-3) looked at 7 human studies totaling 380 participants. The conclusion was basically: "Promising, but we need more rigorous, longer-term studies." Most studies are 4-12 weeks, and we don't have great data on effects beyond 6 months.

I had a patient last year—a 52-year-old architect—who came in taking three different "T-boosters" he'd bought online. His total testosterone was 285 ng/dL. We simplified: resistance training 3x/week, better sleep hygiene, and 300 mg of standardized tongkat ali daily. Three months later, he was at 412 ng/dL. Not miraculous, but meaningful. His energy was better, and he'd lost 8 pounds without changing his diet dramatically.

Dosing, Forms, and What to Look For

This is where most people get it wrong. The raw root powder you see on some websites? Forget it. You need a standardized extract. The two main markers are:

• 1% eurypeptides – These are the protein compounds thought to be most active
• 22% glycosaponins – The saponin content that's often standardized

I usually recommend starting with 200 mg daily with breakfast. If you tolerate it well after 2-3 weeks, you can go up to 400 mg. Some studies use 600 mg, but I rarely go that high in my practice—the benefit-risk ratio starts to shift.

Timing matters too. Take it with food, preferably in the morning. I've had patients take it at night and complain of insomnia—probably because it can be mildly stimulating.

Brands... this is where I get frustrated. So many use "proprietary blends" where you have no idea how much tongkat ali you're actually getting. Drives me crazy. I've had good results with:

• NOW Foods Tongkat Ali Extract – Standardized to 1:200, which means 200 mg equals 40g of raw root. They do third-party testing.
• Double Wood Supplements Tongkat Ali – Standardized to 10:1, transparent about testing.

What I wouldn't recommend? Those combo products with 15 ingredients where tongkat ali is buried in a "proprietary blend." You're paying for marketing, not science.

Who Should Avoid Tongkat Ali

This isn't for everyone. Contraindications include:

• Prostate cancer – Theoretical risk of stimulating androgen receptors
• Severe kidney or liver disease – Limited safety data
• Taking blood thinners – Potential interaction (though evidence is weak)
• Under 30 with normal testosterone – Just... why?

Side effects are usually mild—some GI upset, occasional headaches. But I did have one patient (a 48-year-old teacher) who developed mild anxiety at 400 mg daily. We dropped to 200 mg and it resolved. Point being: start low.

Also—and I can't believe I have to say this—this isn't a substitute for seeing a doctor if you have symptoms of low testosterone. Fatigue, low libido, mood changes? Get tested. Don't just self-prescribe based on TikTok advice.

FAQs

How long until I see results?
Most studies show changes in testosterone levels within 4-8 weeks. Subjective effects like improved energy or mood might come sooner—some patients report feeling different in 2-3 weeks.

Should I cycle it?
The evidence isn't clear here. Some practitioners recommend 8 weeks on, 2 weeks off. I typically suggest 3 months on, then reassess. There's no evidence of "receptor downregulation" like with some supplements.

Will it increase my risk of prostate issues?
We don't have long-term data. In short-term studies, PSA levels don't increase significantly. But if you have BPH or family history of prostate cancer, I'd be cautious and monitor with your urologist.

Can I take it with other supplements?
Yes, but be sensible. I sometimes combine it with ashwagandha for stress adaptation or zinc if levels are low. But megadosing multiple "testosterone boosters" is pointless and potentially harmful.

Bottom Line

• Tongkat ali shows promise for mild age-related testosterone decline—think 300-450 ng/dL range, not severe deficiency.
• The mechanism appears to be reducing SHBG rather than directly stimulating production.
• Standardized extracts (1% eurypeptides or 22% glycosaponins) at 200-400 mg daily are what the research uses.
• It's not magic—pair it with resistance training, adequate sleep, and stress management.

Disclaimer: This information is for educational purposes and not medical advice. Consult your healthcare provider before starting any new supplement.