Tribulus

Traditionally the whole herb has been used as medicine, although there is not much literature on its uses from the past. ^{55Reference 55Bone K · 2013Principles and Practice of Phytotherapy}.

In traditional Chinese medicine, the fruit is reportedly used for chest pain, skin lesions, and swollen or painful eyes ^{55Reference 55Bone K · 2013Principles and Practice of Phytotherapy}.

In Ayurveda, the fruit has been used to treat urinary tract infections and inflammations, as well as reproductive disorders. ^{55Reference 55Bone K · 2013Principles and Practice of Phytotherapy}.

In Unani medicine, tribulus has been used as a diuretic, mild laxative, and general tonic ^{57Reference 57Khare CP · 2007Indian medicinal plants: An illustrated dictionary}.

Overall, the traditional uses of tribulus involve its use as a tonic, aphrodisiac, palliative, astringent, stomachic, antihypertensive, diuretic, lithotriptic, for chest pains, painful swollen eyes, and urinary tract infections ^{54Reference 54Chhatre S et al. · 2014Phytopharmacological overview of Tribulus terrestrisView study →}.

This is the herb’s strongest evidence base. A 2026 systematic review and meta-analysis of eight randomised trials found that Tribulus terrestris outperformed placebo on the International Index of Erectile Function, with a mean difference of about 3.2 points on the abridged IIEF-5 and a larger difference on the full IIEF-15 ^{1Reference 1Suharyani S · 2026Meta-analysisTribulus terrestris for management of patients with erectile dysfunction — a systematic review and meta-analysis of randomized trials — [systematic review and meta-analysis]View study →}. The signal is anchored by a well-powered phase IV RCT (n=180, 12 weeks) of the standardised Bulgarian extract Tribestan (250 mg tablets standardised to furostanol saponins), which improved erectile function and sexual desire versus placebo in men with mild-to-moderate erectile dysfunction ^{2Reference 2Kamenov Z · 2017RCTEvaluation of the efficacy and safety of Tribulus terrestris in male sexual dysfunction — a prospective, randomised, double-blind, placebo-controlled trial — [randomised placebo-controlled trial]View study →}. A smaller 30-day RCT (n=30, 800 mg/day) found no benefit in older men ^{3Reference 3Santos CA Jr · 2014RCTTribulus terrestris versus placebo in the treatment of erectile dysfunction — a prospective, randomised, double-blind study — [randomised placebo-controlled trial]View study →}, while a study in men with late-onset hypogonadism reported improved IIEF alongside a rise in total testosterone ^{4Reference 4GamalEl Din SF · 2019RCTTribulus terrestris versus placebo in erectile dysfunction and lower urinary tract symptoms in late-onset hypogonadism — [randomised placebo-controlled trial]View study →} — an inconsistency in whether androgens move at all. Mechanistically, extracts relax cavernosal smooth muscle and raise intracavernous pressure in animals, apparently through nitric-oxide/cGMP signalling driven by protodioscin ^{5,6Reference 5Do J · 2013AnimalEffects and mechanism of action of a Tribulus terrestris extract on penile erection — animal model — [animal model]View study →Reference 6Gauthaman K · 2002AnimalAphrodisiac properties of Tribulus terrestris extract (protodioscin) in normal and castrated rats — [animal model]View study →}.

Gap: most positive trials are short (4–12 weeks) and several used proprietary standardised extracts; the meta-analysis notes clinical heterogeneity, and the benefit does not track a measurable testosterone increase.

Five randomised placebo-controlled trials (pooled n≈279) underpin a 2020 systematic review concluding that Tribulus significantly improves sexual-function scores in both pre- and postmenopausal women after 1–3 months, with a signal toward higher serum testosterone in premenopausal women ^{7Reference 7Martimbianco ALC · 2020Systematic reviewTribulus terrestris for female sexual dysfunction — a systematic review — [systematic review]View study →}. Individual trials are consistent: an Iranian RCT in premenopausal women with hypoactive sexual desire disorder improved total Female Sexual Function Index and its desire, arousal, lubrication and satisfaction domains ^{8Reference 8Akhtari E · 2014RCTTribulus terrestris for treatment of sexual dysfunction in women — randomised double-blind placebo-controlled study — [randomised placebo-controlled trial]View study →}; Brazilian trials in premenopausal ^{9Reference 9Vale FBC · 2018RCTEfficacy of Tribulus terrestris for premenopausal women with hypoactive sexual desire disorder — randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →}, postmenopausal ^{10,11Reference 10de Souza KZ · 2016RCTEfficacy of Tribulus terrestris for hypoactive sexual desire disorder in postmenopausal women — randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →Reference 11Postigo S · 2016RCTAssessment of the effects of Tribulus terrestris on sexual function of menopausal women — randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →} and mixed ^{12Reference 12Vale FBC · 2021RCTEffect of Tribulus terrestris on female sexual dysfunction and clitoral vascularisation — randomised study of two dosage regimes — [randomised trial]View study →} cohorts reported similar FSFI/QS-F gains, with one study also documenting increases in free and bioavailable testosterone ^{9Reference 9Vale FBC · 2018RCTEfficacy of Tribulus terrestris for premenopausal women with hypoactive sexual desire disorder — randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →}. Gap: samples are small, several trials come from a single research group, and the reviews rate the certainty of evidence as low; a clitoral-Doppler study found symptom improvement without a measurable change in clitoral artery blood flow ^{12Reference 12Vale FBC · 2021RCTEffect of Tribulus terrestris on female sexual dysfunction and clitoral vascularisation — randomised study of two dosage regimes — [randomised trial]View study →}.

Radical-scavenging is one of the herb’s most reproducible preclinical properties, attributed to its saponins and flavonoids and invoked as the upstream mechanism behind many of its organ-protective effects. In rodent models of cardiac, renal and neural injury, Tribulus extracts restore glutathione, superoxide dismutase and catalase and lower lipid peroxidation ^{26,29Reference 26Sailaja KV · 2013AnimalProtective effect of Tribulus terrestris fruit extract on lipid profile and oxidative stress in isoproterenol-induced myocardial necrosis in rats — [animal model]View study →Reference 29Ranjithkumar R · 2019AnimalTribulusterine-containing Tribulus terrestris extract exhibited neuroprotection through attenuating stress kinases in rat — [animal model]View study →}. Human data are limited to exercise trials measuring oxidative-stress markers: one RCT in CrossFit athletes reported higher total antioxidant status with supplementation ^{13Reference 13Fernandez-Lazaro D · 2022RCTFernandez-Lazaro D (2022). 6-week supplementation with Tribulus terrestris in trained CrossFit athletes — muscle, inflammation and antioxidant status — randomised controlled trial — [randomised controlled trial]. Int J Environ Res Public Health. https://pubmed.ncbi.nlm.nih.gov/36498228/View study →}, while a trial on exercise-induced oxidative stress and delayed-onset muscle soreness found more modest effects ^{14Reference 14Ataei L · 2023RCTEffect of Tribulus terrestris supplementation on exercise-induced oxidative stress and delayed-onset muscle soreness — randomised controlled trial — [randomised controlled trial]View study →}. Gap: no trial has tested antioxidant endpoints in a disease population; the human evidence is confined to athletes and to surrogate blood markers.

Isolated Tribulus constituents damp inflammatory signalling in cell models: the amide N-trans-p-caffeoyl tyramine and tribulusamide D each suppress nitric oxide, prostaglandin E2, COX-2 and pro-inflammatory cytokines (TNF-α, IL-6) in LPS-stimulated macrophages ^{15,16Reference 15Ko HJ · 2015In vitroN-trans-p-caffeoyl tyramine isolated from Tribulus terrestris exerts anti-inflammatory effects in LPS-stimulated RAW 264.7 cells — in vitro — [in vitro]View study →Reference 16Lee HH · 2017In vitroAnti-inflammatory effect of tribulusamide D from Tribulus terrestris in LPS-stimulated RAW 264.7 macrophages — in vitro — [in vitro]View study →}. A whole-extract study in rats reported anti-oedema activity in the carrageenan and zymosan models comparable to diclofenac at 150–200 mg/kg ^{17Reference 17Yunusova S · 2023AnimalStudy of the anti-inflammatory properties of a thick extract of Tribulus terrestris — rat carrageenan/zymosan model — [animal model]View study →}. Gap: the effect is entirely in vitro and in rodents, is driven by minor constituents that vary between preparations, and has never been tested clinically.

Tribulus (gokshura) is a classical Ayurvedic and Unani remedy for urinary “gravel,” and preclinical work gives that use a plausible mechanism. In vitro, aqueous extract inhibits nucleation and growth of calcium-oxalate crystals and protects renal tubular (NRK-52E) cells from oxalate injury ^{18Reference 18Aggarwal A · 2010In vitroDiminution of oxalate-induced renal tubular cell injury and inhibition of calcium oxalate crystallisation in vitro by Tribulus terrestris — [in vitro]View study →}, with a ~60 kDa cytoprotective protein identified as one active component ^{20Reference 20Aggarwal A · 2012In vitroA novel antilithiatic protein from Tribulus terrestris with cytoprotective potency — in vitro — [in vitro]View study →}. In nephrolithiatic rats, extract improved renal function and reduced stone burden with a favourable short-term safety profile ^{19Reference 19Kaushik J · 2019AnimalAntiurolithiatic potential of Tribulus terrestris extract — in vivo efficacy and preclinical safety in Wistar rats — [animal model]View study →}. A rat study found the aqueous extract produced diuresis slightly exceeding furosemide at a high oral dose ^{21Reference 21Al-Ali M · 2003AnimalTribulus terrestris — preliminary study of its diuretic and contractile effects in rats — [animal model]View study →}. Gap: despite strong traditional use and consistent animal data, there is no human clinical trial of Tribulus for kidney stones — and, paradoxically, the herb itself has case reports of nephrotoxicity (see Safety).

A double-blind RCT in 98 women with type 2 diabetes found that Tribulus 1000 mg/day for three months significantly lowered blood glucose versus placebo, and also reduced total and LDL cholesterol, without affecting triglycerides or HDL ^{22Reference 22Samani NB · 2016RCTEfficacy of hydroalcoholic extract of Tribulus terrestris on serum glucose and lipid profile of women with type 2 diabetes — double-blind randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →}. This is supported mechanistically by in-vitro inhibition of the carbohydrate- and lipid-digesting enzymes α-amylase, α-glucosidase and pancreatic lipase ^{23Reference 23Ercan P · 2016In vitroInhibitory effects of chickpea and Tribulus terrestris on lipase, alpha-amylase and alpha-glucosidase — in vitro — [in vitro]View study →}. Gap: the clinical evidence is a single trial in one sex; it needs independent replication and dose-finding before the effect can be considered established.

The page’s original single citation sits here, and the wider animal literature is consistent. The spirostanol saponin tribulosin protects rat myocardium against ischaemia/reperfusion injury via protein kinase C-epsilon activation ^{24Reference 24Zhang S · 2010AnimalTribulosin protects rat hearts from ischaemia/reperfusion injury — animal model — [animal model]View study →}, and whole-extract pretreatment is anti-ischaemic through a MAPK-mediated anti-apoptotic pathway ^{25Reference 25Reshma PL · 2019AnimalPretreatment with Tribulus terrestris causes anti-ischaemic cardioprotection through a MAPK-mediated anti-apoptotic pathway in rat — [animal model]View study →}. In diet-induced atherosclerosis models, Tribulus lowered serum cholesterol, LDL and triglycerides and preserved vascular endothelium in rabbits ^{27Reference 27Tuncer MA · 2009AnimalInfluence of Tribulus terrestris extract on lipid profile and endothelial structure in atherosclerotic rabbits — [animal model]View study →}, and a 2025 study attributed anti-atherosclerotic action to suppression of TNF-α-driven macrophage inflammation ^{28Reference 28Yu-Qian Z · 2025In vitroTribulus terrestris extract alleviates atherosclerosis by suppressing TNF-alpha-mediated macrophage inflammation — in vitro and animal model — [animal model]View study →}; a rat myocardial-necrosis model showed parallel lipid and oxidative-stress benefits ^{26Reference 26Sailaja KV · 2013AnimalProtective effect of Tribulus terrestris fruit extract on lipid profile and oxidative stress in isoproterenol-induced myocardial necrosis in rats — [animal model]View study →}. Gap: all cardiovascular efficacy data are from animals; the only human lipid signal is a secondary outcome of the diabetes RCT ^{22Reference 22Samani NB · 2016RCTEfficacy of hydroalcoholic extract of Tribulus terrestris on serum glucose and lipid profile of women with type 2 diabetes — double-blind randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →}.

An emerging preclinical theme. Tribulus extracts reduced infarct size and neuroinflammation in rat middle-cerebral-artery-occlusion stroke models ^{30Reference 30Zhang H · 2023AnimalSupplementation with Tribulus terrestris extract exhibits protective effects in MCAO rats via modulating inflammation — animal model — [animal model]View study →}, showed neuroprotection by attenuating stress-activated kinases ^{29Reference 29Ranjithkumar R · 2019AnimalTribulusterine-containing Tribulus terrestris extract exhibited neuroprotection through attenuating stress kinases in rat — [animal model]View study →}, and improved outcomes in a rodent Parkinson’s model by modulating acetylcholinesterase, α-synuclein and inflammatory cytokines ^{31Reference 31Saleem U · 2020AnimalAnti-Parkinson’s activity of Tribulus terrestris via modulation of AChE, alpha-synuclein, TNF-alpha and IL-1beta — animal model — [animal model]View study →}. Gap: confined to rodent models of stroke and neurodegeneration; no human data of any kind, and the crossing of active saponins into the brain is not established.

A systematic review of seven small trials found that Tribulus improved some or all sperm parameters (count, motility, morphology) in men with idiopathic infertility in most studies, with one uncontrolled study reporting no effect ^{32Reference 32Sanagoo S · 2019Systematic reviewEffect of Tribulus terrestris on sperm parameters in men with idiopathic infertility — a systematic review — [systematic review]View study →}. Against this, a randomised study in men with unexplained infertility (750 mg/day for three months) found no change in testosterone, LH or any semen parameter ^{33Reference 33Roaiah MF · 2017RCTProspective analysis of Tribulus terrestris on serum testosterone and semen parameters in males with unexplained infertility — randomised trial — [randomised trial]View study →}. Gap: the trials are small and heterogeneous in extract and duration, results conflict, and the better-controlled studies are the more negative ones.

A randomised, double-blind, placebo-controlled Unani-medicine trial found that powdered Tribulus fruit (6 g/day for two months) lowered blood pressure in prehypertensive adults ^{34Reference 34Siddiqui MA · 2021RCTEfficacy of Khar-i-khasak (Tribulus terrestris) in prehypertension — randomised, double-blind, placebo-controlled trial — [randomised placebo-controlled trial]View study →}, echoing traditional use as an antihypertensive. Animal work supports a vasorelaxant/ACE-inhibitory mechanism. Gap: a single small trial of whole dried fruit; no confirmation in established hypertension and no standardised-extract data.

This is the herb’s central marketing claim and the one the evidence most clearly refutes. A systematic review of “testosterone boosters” concluded that Tribulus does not raise serum total testosterone in men ^{35Reference 35Morgado A · 2024Systematic reviewDo ‘testosterone boosters’ really increase serum total testosterone? A systematic review — [systematic review]View study →}, as did an earlier review finding an effect only when Tribulus was one component of a multi-ingredient supplement, never alone ^{36Reference 36Qureshi A · 2014Systematic reviewA systematic review on the herbal extract Tribulus terrestris and its putative aphrodisiac and performance-enhancing effect — [systematic review]View study →}; the 2026 ED meta-analysis likewise found no testosterone difference versus placebo ^{1Reference 1Suharyani S · 2026Meta-analysisTribulus terrestris for management of patients with erectile dysfunction — a systematic review and meta-analysis of randomized trials — [systematic review and meta-analysis]View study →}. A 2025 systematic review of ten studies similarly found erectile function improved in some trials while eight of ten reported no significant change in androgen profile ^{37Reference 37Vilar Neto JO · 2025Systematic reviewEffects of Tribulus terrestris supplementation on erectile dysfunction and testosterone levels in men — a systematic review — [systematic review]View study →}. A pilot study of urinary steroid profiles saw small time-dependent shifts but no significant between-sample differences ^{41Reference 41Minotti L · 2026Impact of Tribulus terrestris supplementation on urinary steroid profiles — a short-term pilot study — [pilot study]View study →}. Some female-sexual-function trials did report modest rises in free testosterone ^{9Reference 9Vale FBC · 2018RCTEfficacy of Tribulus terrestris for premenopausal women with hypoactive sexual desire disorder — randomised placebo-controlled trial — [randomised placebo-controlled trial]View study →}, leaving open a possible sex- or population-specific effect. Gap: in healthy and hypogonadal men the controlled evidence is consistently null; the claim persists commercially despite this.

Controlled trials do not support the bodybuilding-supplement reputation. Tribulus produced no gain in strength or body composition in resistance-trained men ^{38Reference 38Antonio J · 2000RCTThe effects of Tribulus terrestris on body composition and exercise performance in resistance-trained males — randomised controlled trial — [randomised controlled trial]View study →}, no change in strength or the urinary testosterone/epitestosterone ratio in elite rugby players ^{39Reference 39Rogerson S · 2007RCTThe effect of five weeks of Tribulus terrestris on muscle strength and body composition in elite rugby league players — randomised controlled trial — [randomised controlled trial]View study →}, and no performance or body-composition benefit in CrossFit athletes ^{40Reference 40Fernandez-Lazaro D · 2021RCTThe effects of 6 weeks of Tribulus terrestris on body composition, hormonal response and performance in CrossFit athletes — randomised controlled trial — [randomised controlled trial]View study →}; a systematic review of sport and health biomarkers found improvements only in lipid profile, with no clear ergogenic effect ^{49Reference 49Fernandez-Lazaro D · 2022Systematic reviewEffects of Tribulus terrestris on sport and health biomarkers in physically active adult males — a systematic review — [systematic review]View study →}. Gap: the human trials are consistently negative for performance; a signal for reduced muscle-damage markers exists but does not translate to output ^{13Reference 13Fernandez-Lazaro D · 2022RCTFernandez-Lazaro D (2022). 6-week supplementation with Tribulus terrestris in trained CrossFit athletes — muscle, inflammation and antioxidant status — randomised controlled trial — [randomised controlled trial]. Int J Environ Res Public Health. https://pubmed.ncbi.nlm.nih.gov/36498228/View study →}.

Tribulus is generally well tolerated in controlled trials, where adverse-event rates did not differ from placebo across the sexual-function studies ^{1,7Reference 1Suharyani S · 2026Meta-analysisTribulus terrestris for management of patients with erectile dysfunction — a systematic review and meta-analysis of randomized trials — [systematic review and meta-analysis]View study →Reference 7Martimbianco ALC · 2020Systematic reviewTribulus terrestris for female sexual dysfunction — a systematic review — [systematic review]View study →}. However, real-world case reports describe serious harm at supplement doses: severe drug-induced liver injury with concurrent acute kidney injury and bile-cast nephropathy ^{42,44Reference 42Mohy-Ud-Din N · 2024Case reportSevere liver and renal injury from Tribulus terrestris — case report — [case report]View study →Reference 44Ryan M · 2015Case reportAcute kidney injury and hyperbilirubinaemia in a young male after ingestion of Tribulus terrestris — case report — [case report]View study →}, rhabdomyolysis in a man taking Tribulus alongside atorvastatin ^{43Reference 43Huff R · 2024Case reportRhabdomyolysis risk — the dangers of Tribulus terrestris, an over-the-counter supplement (with atorvastatin) — case report — [case report]View study →}, and a 72-hour priapism after a Tribulus-based product ^{45Reference 45Campanelli M · 2016Case reportPriapism caused by Tribulus terrestris — case report — [case report]View study →}. Preclinical work identifies the spirostanol saponin terrestrosin D as a likely hepatorenal toxin ^{46Reference 46Sun XC · 2022In vitroTerrestrosin D, a spirostanol saponin from Tribulus terrestris, with potential hepatorenal toxicity — in vitro and animal model — [animal model]View study →}, though whole-extract in-vitro testing found no genotoxicity in Comet or Ames assays and only the methanol extract was cytotoxic ^{47Reference 47Abudayyak M · 2015In vitroInvestigation on the toxic potential of Tribulus terrestris in vitro — [in vitro]View study →}; some performance-marketed products have been found adulterated with anabolic steroids. Given the case reports and the CYP3A4-mediated statin interaction, caution is warranted with liver or kidney disease, with statins and other narrow-therapeutic-index drugs, and against prolonged high-dose use.

Scope: of the interactions listed in the sidebar, only the CYP3A4/statin interaction is backed by a case report ^{43Reference 43Huff R · 2024Case reportRhabdomyolysis risk — the dangers of Tribulus terrestris, an over-the-counter supplement (with atorvastatin) — case report — [case report]View study →}; the others (antihypertensives, antidiabetics, anticoagulants, lithium) are theoretical pharmacodynamic cautions, not confirmed in dedicated interaction studies.