Testosterone deficiency syndrome (TDS) is "a clinical and biochemical syndrome associated
with advancing age and characterized by symptoms of a deficiency in serum testosterone
levels". TDS can cause a significant decrease in quality of life and has many adverse effects
on multiple organs in terms of men's health. In addition to the detrimental effect of sexual
functions, men with TDS tend to have increased waist circumference, hyperglycemia,
hypertriglyceridemia, hyperlipidemia, and a history of diabetes. TDS can be treated with
testosterone replacement therapy (TRT). TRT should be initiated on an individualized basis in
TDS patients who have clinical signs and symptoms of androgen deficiency if the benefits of
treatment appear to outweigh the potential risks and only after thorough discussion with the
patient. Different preparations of testosterone are currently available. The majority of
clinical data shows that TRT is very safe and effective. There is currently no evidence that
testosterone treatment increases the risk of prostate disease using modern guidelines.
However, the fear of prostate cancer and the risk of erythrocytosis may represent the main
limitations of TRT in aging men. Additionally, TRT cannot improve the function of Leydig
cells (which produce testosterone), but only compensate for the lack of testosterone.
Limited research has focused on the use of herbal medicine to improve male health,
particularly to increase testosterone levels and support healthy sexual function. Despite the
increasing availability of effective conventional medical treatments, plant-derived and
herbo-mineral remedies continue to be a popular alternative for men seeking to improve sexual
function.
Trigonella foenum-graecum Linn, also known as fenugreek, is an aromatic annual plant that
reaches heights of 30-60 cm. It is found wild in Kashmir, Punjab, and the upper Gangetic
plains, and is widely cultivated in many parts of India. It is used internally as an
abortifacient, antispasmodic, appetite stimulant, blood cleanser, laxative, tonic, and
expectorant. It is also indicated externally for abscesses, boils, galactagogue, and for its
demulcent and emollient properties. The seeds contain diosgenin along with three minor
steroidal saponins (similagenin, savsalpogenin, and yuccagenin), choline, trimethylamine (a
sex hormone in frogs), vitamins (A, B2, B6, B12, D), lysine, l-tryptophan rich proteins,
mucilaginous fiber, coumarin, fenugreekine, nicotinic acid, sapogenins, phytic acid,
scopletin and trigonelline, calcium, iron, β-carotene, and other vitamins and essential oils.
Previous studies have suggested that Trigonella foenum-graecum seed extract has positive
effects on sexual health and quality of life, and that it demonstrates anabolic and
androgenic activity in young patients. It is believed that these positive effects are due to
increased testosterone, including free testosterone, and that Trigonella foenum-graecum seed
extract may be an effective treatment for the symptoms of possible testosterone deficiency in
aging men. The basis for this androgenic activity may be due to the fact that Trigonella
foenum-graecum seeds contain soluble steroidal saponins, specifically furostanol glycosides,
which are responsible for complexing cholesterol in the cell membrane. Other studies have
found that Trigonella foenum-graecum increases testosterone and free testosterone, suggesting
that it may be an incomplete 5-alpha reductase and aromatase inhibitor. The investigators
investigated the efficacy and safety of a mixed extract of Trigonella foenum-graecum seed and
lespedeza cuneata (TFG) for the treatment of TDS.