Are Testosterone Boosters Safe?
Are Testosterone Boosters Safe? The Evidence-Based Truth Utah Men Need to Know
Arsenal Men's Health | Clinician-Reviewed Medical Content
Reviewed by Courtney LaSumner Bass, NP | Board-Certified Nurse Practitioner
If you've ever felt the effects of declining energy, reduced sex drive, or frustrating gym sessions that don't yield results, you've probably encountered advertisements for testosterone boosters. These supplements promise to restore your masculine vitality naturally—no prescriptions, no needles, no doctor visits required.
But here's the critical question every Utah man should ask before spending his hard-earned money: Do testosterone boosters actually work, and are they safe?
At Arsenal Men's Health, we believe you deserve straight answers backed by peer-reviewed science—not marketing hype. This comprehensive guide examines what the research actually says about over-the-counter testosterone boosters versus clinician-supervised testosterone replacement therapy (TRT).
What Exactly Are Testosterone Boosters?
Testosterone boosters are dietary supplements marketed to increase your body's natural testosterone production. Unlike prescription testosterone replacement therapy, these products don't contain actual testosterone. Instead, they typically combine various vitamins, minerals, and herbal extracts that manufacturers claim can stimulate hormone production.
A comprehensive analysis published in the World Journal of Men's Health examined 50 popular testosterone booster supplements and identified 109 unique ingredients across these products, with an average of 8.3 ingredients per supplement. The study found significant variability in both formulations and evidence supporting their claims.
Common Ingredients in Testosterone Boosters
The most frequently marketed ingredients include:
D-Aspartic Acid (DAA): An amino acid involved in testosterone synthesis and release
Tribulus Terrestris: A Mediterranean plant extract traditionally used as an aphrodisiac
Ashwagandha (Withania somnifera): An adaptogenic herb from Ayurvedic medicine
Fenugreek: An herb claimed to inhibit enzymes that convert testosterone to estrogen
Zinc and Magnesium: Essential minerals involved in hormone production
Vitamin D: Often included due to its role in steroid hormone synthesis
DHEA (Dehydroepiandrosterone): A precursor hormone produced by the adrenal glands
The Critical FDA Distinction
Important: Unlike FDA-approved medications, dietary supplements do not undergo rigorous clinical trials to verify safety, efficacy, or manufacturing quality before reaching consumers.
The FDA explicitly states that supplements "are not intended to treat, diagnose, prevent, or cure diseases." This regulatory gap means manufacturers can make marketing claims without providing substantial clinical evidence, leaving consumers to navigate uncertain territory.
What Does the Scientific Research Actually Show?
A landmark 2023 systematic review published in the International Journal of Impotence Research examined 52 peer-reviewed studies on 27 proposed testosterone boosting ingredients. The findings were sobering for the supplement industry.
The Evidence Breakdown
When researchers analyzed the available human clinical data on popular testosterone booster ingredients:
Only 24.8% of studied ingredients showed any increase in testosterone levels
10.1% of ingredients actually DECREASED testosterone levels
18.3% showed no change whatsoever
The remainder had insufficient or conflicting evidence to draw conclusions
Morgado A, et al. "Do 'testosterone boosters' really increase serum total testosterone? A systematic review." Int J Impot Res. 2023;35:763-779.
Ingredient-by-Ingredient Analysis
Tribulus Terrestris
Despite widespread marketing claims, multiple systematic reviews have found no convincing evidence that Tribulus terrestris increases testosterone levels in humans. A comprehensive review in the Journal of Ethnopharmacology concluded that while animal studies showed some promise, human clinical trials consistently failed to demonstrate testosterone elevation.
Santos HO, et al. "Beyond tribulus (Tribulus terrestris L.): the effects of phytotherapics on testosterone, sperm and prostate parameters." J Ethnopharmacol. 2019;235:392-405.
Ashwagandha
Ashwagandha shows the most promising evidence among herbal testosterone boosters. Some studies suggest modest testosterone increases in men with fertility issues or under significant stress. However, these effects have primarily been observed in specific populations, not the general male population, and the long-term safety profile remains undefined.
One study noted approximately a 14.7% greater increase in testosterone compared to placebo—modest, but measurable. However, it remains unclear whether this translates to meaningful symptom improvement.
Fenugreek
Research on fenugreek has produced inconsistent results. An 8-week study of 44 participants showed that while 34% of those taking fenugreek experienced some change from baseline, these changes were not statistically significant when compared to placebo groups. The Medical News Today summary of current evidence notes that "participants who have taken fenugreek supplements have not shown statistically significant changes in testosterone levels."
Vitamin D and Zinc
The 2023 systematic review found no robust evidence supporting cholecalciferol (Vitamin D) as a testosterone booster despite being the most commonly studied ingredient (10 studies reviewed). Similarly, zinc supplementation may only benefit men with documented zinc deficiency—it does not increase testosterone in men with adequate zinc status.
The Amazon Marketplace Reality Check
A revealing 2020 study published in The Journal of Sexual Medicine analyzed Amazon's top-selling testosterone boosters using ReviewMeta analysis software to filter potentially fraudulent reviews. The results were striking:
After filtering for authenticity:
91% decrease in users reporting increased libido
93% decrease in reports of improved strength/endurance
89% decrease in reports of improved sports ability
60% decrease in reports of improved erections
Complete elimination of reports of improved work performance
Balasubramanian A, et al. "Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements." J Sex Med. 2020;17(1):115-122.
Are Testosterone Boosters Safe? Understanding the Risks
The question of safety extends beyond simple efficacy. Even if testosterone boosters don't significantly raise testosterone levels, that doesn't automatically make them harmless. The scientific literature documents several concerning potential adverse effects.
Documented Safety Concerns by Ingredient
Tribulus Terrestris: Liver and Kidney Toxicity
Case reports published in peer-reviewed journals document serious hepatotoxicity (liver damage) and nephrotoxicity (kidney damage) associated with Tribulus terrestris consumption. A 2024 case study in ACG Case Reports Journal described a 46-year-old man who developed severe jaundice requiring hospital admission after taking Tribulus supplements for two months. His total bilirubin peaked at 48 mg/dL with concurrent kidney dysfunction.
Mohy-ud-din N, Jonassaint N. "Severe Liver and Renal Injury From Tribulus Terrestris." ACG Case Rep J. 2024;11(1):e01244.
The National Institutes of Health LiverTox database notes that Tribulus terrestris is known to be toxic to grazing animals, causing a distinctive liver injury pattern called "geeldikkop" or hepatogenous photosensitivity. While human cases are fewer, the database concludes that "high doses should be considered potentially injurious, particularly in patients with pre-existing liver disease."
Ashwagandha: Emerging Hepatotoxicity Concerns
Multiple case reports from the United States, Japan, Iceland, and India have documented liver injury associated with ashwagandha supplements. A 2023 report in Nutrients described a patient who developed acute hepatitis with elevated liver enzymes after one year of ashwagandha use, requiring plasmapheresis treatment.
The authors note that "the long-term effects of ashwagandha are unknown" and emphasize that "while it's possibly safe to take for up to three months, more research is needed about long-term use."
Björnsson HK, et al. "Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury." Nutrients. 2023;15(6):1304.
Fenugreek: Immune System Effects
Research indicates that fenugreek may cause decreased white blood cell counts, potentially impacting immune function. This is particularly concerning for men with existing immune conditions or those taking immunosuppressive medications.
Zinc and Magnesium: Dose-Dependent Toxicity
While these minerals are essential nutrients, the doses found in some testosterone boosters can exceed safe upper limits. High zinc intake can cause gastrointestinal distress, dizziness, and headaches. Prolonged excessive zinc consumption interferes with copper and iron absorption and can alter immune function. High-dose magnesium supplements may cause diarrhea and, in rare cases, can result in magnesium toxicity—a potentially life-threatening condition.
The Hidden Danger of Multi-Ingredient Formulas
A 2022 analysis in Androgens: Clinical Research and Therapeutics highlighted a critical concern: "There are no studies evaluating the safety or efficacy profile of those formulations including these elements together." Most testosterone boosters combine 8 or more ingredients, yet the combined effects have never been evaluated.
The researchers note that "the use of multiple agents confounds the interpretation of beneficial results, if present, but it also raises the risk of adverse events, including anaphylaxis, liver damage, and renal or neurological damage."
Corona G, et al. "Testosterone Boosters: How Real Are Their Effects?" Androgens. 2022;3(1):62-75.
Testosterone Replacement Therapy: The Evidence-Based Alternative
In stark contrast to unregulated supplements, testosterone replacement therapy (TRT) has been rigorously studied in clinical trials for decades. When prescribed and monitored by qualified healthcare providers for men with documented hypogonadism, TRT demonstrates clear benefits with well-characterized safety profiles.
What the Clinical Research Shows
A 2024 systematic review and meta-analysis published in Frontiers in Endocrinology analyzed randomized controlled trials from 1990 to 2023 and found that TRT significantly improves erectile function scores in men with hypogonadism without negative effects on prostate health markers or urinary function.
Xu Z, et al. "An updated systematic review and meta-analysis of the effects of testosterone replacement therapy on erectile function and prostate." Front Endocrinol. 2024;15:1335146.
A meta-analysis of 16 randomized controlled trials found that TRT in men with hypogonadism:
Significantly improved quality of life scores
Increased lean body mass
Decreased total cholesterol
Did NOT increase the number of serious adverse events compared to placebo
Guo C, et al. "Efficacy and safety of testosterone replacement therapy in men with hypogonadism: a meta-analysis study of placebo-controlled trials." Exp Ther Med. 2016;11(3):853-863.
Documented Benefits of Properly Supervised TRT
The Therapeutics and Clinical Risk Management published a comprehensive review documenting that TRT may produce a wide range of benefits for men with hypogonadism, including:
Improvement in libido and sexual function
Increased bone mineral density
Enhanced muscle mass and strength
Improved body composition (reduced body fat)
Better mood and reduced depressive symptoms
Increased red blood cell production
Enhanced cognitive function
Improved quality of life
Bassil N, et al. "The benefits and risks of testosterone replacement therapy: a review." Ther Clin Risk Manag. 2009;5(3):427-448.
The Critical Importance of Medical Supervision
The American Urological Association and the Endocrine Society both endorse testosterone therapy for patients exhibiting clear signs of hypogonadism—but with appropriate medical supervision. A 2024 National Institute for Health and Care Research evidence synthesis emphasized that ongoing monitoring ensures:
Accurate diagnosis: Blood tests confirm genuinely low testosterone levels before treatment
Appropriate dosing: Treatment is individualized based on your body's response
Safety monitoring: Regular lab work tracks red blood cell counts, PSA, and other health markers
Outcome optimization: Treatment adjustments ensure you're achieving therapeutic benefits
Cruickshank M, et al. "The effects and safety of testosterone replacement therapy for men with hypogonadism: the TestES evidence synthesis and economic evaluation." Health Technol Assess. 2024;28(43):1-210.
OTC Boosters vs. TRT: Key Differences Every Man Should Know
Understanding the fundamental differences between these approaches is essential for making informed decisions about your health:
Evidence Quality
OTC Boosters: Limited human studies, inconsistent results, mostly based on animal research or small trials
TRT: Decades of randomized controlled trials, systematic reviews, and meta-analyses in peer-reviewed journals
Regulatory Oversight
OTC Boosters: No FDA pre-market approval required; quality and consistency vary between manufacturers
TRT: FDA-approved formulations with strict manufacturing standards and labeled dosing
Mechanism of Action
OTC Boosters: Attempt to stimulate your body's own testosterone production through indirect pathways
TRT: Directly replaces deficient testosterone with bioidentical hormone to achieve therapeutic levels
Medical Supervision
OTC Boosters: Self-administered without baseline testing or ongoing monitoring
TRT: Requires diagnosis, ongoing lab monitoring, and provider oversight for safety
Cost Transparency
OTC Boosters: Monthly costs of $30-$100+ with uncertain results
TRT: Clear pricing with measurable outcomes and provider accountability
Who Should Consider Professional Testosterone Evaluation?
If you're experiencing symptoms that prompted you to research testosterone boosters, those same symptoms may indicate a genuine hormone deficiency that deserves proper medical evaluation. Consider consulting a men's health provider if you're experiencing:
Persistent fatigue despite adequate sleep
Decreased sex drive or erectile difficulties
Loss of muscle mass or strength despite regular exercise
Increased body fat, particularly around the midsection
Mood changes, irritability, or depression
Difficulty concentrating or "brain fog"
Reduced bone density or unexplained injuries
Important: These symptoms can also indicate other medical conditions, including thyroid disorders, depression, sleep apnea, or diabetes. Self-treating with OTC supplements may delay diagnosis of an underlying condition that needs proper treatment.
The Bottom Line: Making an Informed Decision
The scientific evidence is clear: most over-the-counter testosterone boosters fail to deliver on their marketing promises. A 2024 editorial in The Aging Male concluded: "While TRT remains a well-supported treatment for male testosterone deficiency, the evidence for the efficacy and safety of over-the-counter testosterone-boosting supplements is lacking, with concerns about adverse effects."
Agarwal A, et al. "Navigating the unregulated terrain of testosterone boosters: a growing concern in men's health." Aging Male. 2024;27(1):2312176.
When evaluating your options, consider these evidence-based recommendations:
Don't self-diagnose: Get proper laboratory testing to determine if you actually have low testosterone
Be skeptical of marketing claims: If a supplement sounds too good to be true, it probably is
Understand the risks: Even "natural" supplements can cause serious adverse effects
Consider proven treatments: If you have documented low testosterone, evidence-based TRT may be appropriate
Work with qualified providers: Medical supervision ensures safe, effective treatment tailored to your needs
The Arsenal Men's Health Approach
At Arsenal Men's Health, we believe Utah men deserve access to evidence-based care—not marketing hype. Our approach combines:
Comprehensive laboratory testing to accurately assess your hormone levels
Board-certified clinician oversight from providers who specialize in men's health
Personalized treatment protocols based on your individual needs and goals
Ongoing monitoring and optimization to ensure safe, effective results
Convenient telehealth consultations designed for busy Utah professionals
Ready to get real answers about your testosterone levels? Schedule a free consultation with Arsenal Men's Health to discuss whether TRT or other evidence-based treatments might be right for you.
Get Started: (385) 666-6292 | info@arsenalmenshealth.com
Trusted by 1,200+ Utah Men | Board-Certified Provider | Discreet Telehealth
References
1. Clemesha CG, Thaker H, Samplaski MK. 'Testosterone Boosting' Supplements Composition and Claims Are not Supported by the Academic Literature. World J Mens Health. 2020;38(1):115-122.
2. Morgado A, Mendes M, Figueiredo A, et al. Do "testosterone boosters" really increase serum total testosterone? A systematic review. Int J Impot Res. 2023;35:763-779.
3. Balasubramanian A, Thirumavalavan N, Srivatsav A, et al. Testosterone Imposters: An Analysis of Popular Online Testosterone Boosting Supplements. J Sex Med. 2020;17(1):115-122.
4. Corona G, Rastrelli G, Guaraldi F, et al. Testosterone Boosters: How Real Are Their Effects? Androgens. 2022;3(1):62-75.
5. Agarwal A, Parekh N, Sharma R, et al. Navigating the unregulated terrain of testosterone boosters: a growing concern in men's health. Aging Male. 2024;27(1):2312176.
6. Mohy-ud-din N, Jonassaint N. Severe Liver and Renal Injury From Tribulus Terrestris. ACG Case Rep J. 2024;11(1):e01244.
7. Björnsson HK, et al. Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury. Nutrients. 2023;15(6):1304.
8. National Institutes of Health. Tribulus. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2022.
9. Xu Z, Chen X, Zhou H, et al. An updated systematic review and meta-analysis of the effects of testosterone replacement therapy on erectile function and prostate. Front Endocrinol. 2024;15:1335146.
10. Guo C, Gu W, Liu M, et al. Efficacy and safety of testosterone replacement therapy in men with hypogonadism: a meta-analysis study of placebo-controlled trials. Exp Ther Med. 2016;11(3):853-863.
11. Bassil N, Alkaade S, Morley JE. The benefits and risks of testosterone replacement therapy: a review. Ther Clin Risk Manag. 2009;5(3):427-448.
12. Cruickshank M, Hudson J, Hernández R, et al. The effects and safety of testosterone replacement therapy for men with hypogonadism: the TestES evidence synthesis and economic evaluation. Health Technol Assess. 2024;28(43):1-210.
13. Santos HO, Howell S, Teixeira FJ. Beyond tribulus (Tribulus terrestris L.): the effects of phytotherapics on testosterone, sperm and prostate parameters. J Ethnopharmacol. 2019;235:392-405.
14. Kuchakulla M, Narasimman M, Soni Y, et al. A systematic review and evidence-based analysis of ingredients in popular male testosterone and erectile dysfunction supplements. Int J Impot Res. 2020;32:646-653.
15. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and Management of Testosterone Deficiency: AUA Guideline. J Urol. 2018;200(2):423-432.
Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Treatment decisions should be made by a licensed medical provider based on individual patient evaluation. Results vary by individual. Arsenal Men's Health provides clinician-prescribed treatments; prescriptions are at the sole discretion of the treating provider.
