Ashwagandha for Hormonal Balance: Testosterone, Women's Health & Fertility

In the quest for optimal health, hormonal balance often emerges as a cornerstone, influencing everything from our energy levels and mood to reproductive health and metabolic function. When hormones are out of sync, the ripple effects can be profound, leading to a myriad of uncomfortable symptoms and health challenges. Increasingly, individuals are turning to natural remedies, and among them, Ashwagandha (Withania somnifera) stands out as a powerful adaptogenic herb with a rich history in Ayurvedic medicine.

Known for its ability to help the body adapt to stress, Ashwagandha is gaining significant attention for its potential role in harmonizing the endocrine system[1]. This ancient herb isn't just about stress relief; emerging research suggests it can play a multifaceted role in supporting hormonal equilibrium across genders and life stages, from boosting testosterone in men to alleviating menopausal symptoms in women and even influencing thyroid function[1]. This comprehensive guide will delve into the science behind Ashwagandha's hormonal effects, exploring how this remarkable plant can be a valuable ally in your journey toward better health.

Understanding Hormonal Balance: Why It Matters

Hormones are chemical messengers produced by our endocrine glands, traveling through the bloodstream to tissues and organs, where they regulate nearly every physiological process. From metabolism and growth to sleep, mood, and reproduction, hormones orchestrate a delicate symphony within the body[4]. When this symphony falls out of tune, even slightly, it can lead to noticeable and often debilitating symptoms.

Maintaining hormonal balance is crucial for overall well-being. It ensures that our bodies function efficiently, our moods remain stable, and our reproductive systems operate optimally. Disruptions can arise from various factors, including chronic stress, poor diet, environmental toxins, aging, and certain medical conditions[1].

The Endocrine System and Adaptogens

The endocrine system is a complex network of glands that produce and secrete hormones. Key players include the adrenal glands (producing cortisol, adrenaline), thyroid gland (thyroid hormones), pituitary gland (master gland), and gonads (testosterone, estrogen, progesterone)[1]. These glands are interconnected, forming intricate feedback loops that maintain homeostasis.

Adaptogens are a unique class of herbs that help the body resist physical, chemical, and biological stressors by supporting the adrenal glands and modulating the hypothalamic-pituitary-adrenal (HPA) axis—the central stress response system[1]. Ashwagandha is a prime example of an adaptogen, working non-specifically to normalize physiological functions and restore balance without causing overstimulation or excessive suppression. Its adaptogenic properties are believed to be central to its ability to influence hormonal health.

Common Signs of Hormonal Imbalance

Recognizing the signs of hormonal imbalance is the first step toward addressing them. Symptoms can vary widely depending on which hormones are affected, but some common indicators include:

• Fatigue and low energy: Persistent tiredness, even after adequate sleep[4].
• Mood swings and irritability: Unexplained changes in mood, anxiety, or depression[1].
• Weight fluctuations: Difficulty losing or gaining weight despite lifestyle efforts[9].
• Sleep disturbances: Insomnia or disrupted sleep patterns[4].
• Changes in libido: Decreased sex drive.
• Digestive issues: Bloating, constipation, or diarrhea.
• Skin problems: Acne, dryness, or excessive oiliness.
• Hair loss or thinning.
• Irregular menstrual cycles (in women).
• Hot flashes and night sweats (in women).

If you experience several of these symptoms, it may be beneficial to consult a healthcare professional to investigate potential hormonal imbalances.

Ashwagandha and Testosterone: A Deep Dive for Men

Testosterone, the primary male sex hormone, plays a critical role in men's health, influencing muscle mass, bone density, fat distribution, red blood cell production, libido, and mood. As men age, testosterone levels naturally decline, often leading to symptoms such as reduced energy, decreased muscle mass, lower sex drive, and mood changes[3]. This is where the potential benefits of ashwagandha for testosterone become particularly interesting[3].

Research has increasingly focused on the herb's ability to support healthy testosterone levels, making ashwagandha testosterone a key area of study for male health[3].

How Ashwagandha May Boost Testosterone Levels

Several mechanisms are proposed for how Ashwagandha may positively influence testosterone:

• Stress Reduction: Chronic stress leads to elevated cortisol levels. Cortisol and testosterone have an inverse relationship; high cortisol can suppress testosterone production[1]. By acting as an adaptogen and reducing cortisol, Ashwagandha may create a more favorable environment for testosterone synthesis[1]. Studies have shown significant reductions in cortisol levels in individuals supplementing with Ashwagandha[1].
• Antioxidant Properties: Oxidative stress can damage Leydig cells in the testes, which are responsible for testosterone production[1]. Ashwagandha's potent antioxidant compounds, particularly withanolides, may protect these cells from damage, thereby preserving their function[20].
• Luteinizing Hormone (LH) Modulation: Some research suggests Ashwagandha may stimulate the production of luteinizing hormone (LH) by the pituitary gland. LH signals the testes to produce testosterone.
• Improved Testicular Function: Ashwagandha may directly support the health and function of the testes, leading to more efficient testosterone production[3].

Multiple clinical trials have investigated the effects of Ashwagandha on male hormones[6]. One notable study published in Fertility and Sterility found that men taking Ashwagandha for infertility experienced a significant increase in testosterone levels, alongside improvements in sperm quality[3]. Another study in the Journal of the International Society of Sports Nutrition observed that resistance-trained men supplementing with Ashwagandha showed a greater increase in testosterone compared to a placebo group[3]. These findings strongly support the use of ashwagandha and testosterone for men seeking to optimize their hormonal health[3].

Impact on Male Fertility and Reproductive Health

Beyond just testosterone levels, Ashwagandha has shown promise in improving various parameters related to male fertility. For men struggling with infertility, Ashwagandha may offer a natural avenue for support.

Studies have demonstrated that Ashwagandha supplementation can lead to improvements in:

• Sperm Count: An increase in the total number of sperm[6].
• Sperm Motility: Enhanced ability of sperm to move effectively[6].
• Sperm Morphology: Improvement in the shape and structure of sperm[6].
• Semen Volume: An increase in the total volume of ejaculate[6].
• Libido: Many men report an increase in sex drive, often correlated with improved testosterone levels and reduced stress[1].

These effects are largely attributed to the herb's ability to reduce oxidative stress in the seminal plasma, improve antioxidant enzyme activity, and balance reproductive hormones[1]. The potential for ashwagandha fertility benefits for men is a significant area of interest, offering hope for couples trying to conceive[6].

Dosage and Forms for Men

For men looking to support testosterone levels and fertility, typical dosages of Ashwagandha extract range from 300 mg to 600 mg per day, often standardized to contain a certain percentage of withanolides (e.g., 5% withanolides). It's commonly taken in capsule form. Some studies have used higher doses, but starting with a moderate dose and observing effects is generally recommended. Consistency is key, with benefits often becoming noticeable after several weeks to a few months of regular use. Always consult with a healthcare provider to determine the appropriate dosage and form for your individual needs.

Ashwagandha for Women's Hormonal Health

While often highlighted for its effects on male hormones, Ashwagandha offers equally compelling benefits for women's hormonal health, addressing a range of concerns from menopausal symptoms to PCOS and fertility. The herb's adaptogenic nature makes it particularly well-suited to help women navigate the hormonal fluctuations that occur throughout their lives[10].

Navigating Menopause with Ashwagandha

Menopause is a natural biological process marking the end of a woman's reproductive years, characterized by a significant decline in estrogen and progesterone. This hormonal shift can lead to a variety of uncomfortable symptoms, including hot flashes, night sweats, mood swings, anxiety, sleep disturbances, and vaginal dryness[1]. The potential of ashwagandha menopause support is gaining recognition.

Ashwagandha's adaptogenic and stress-reducing properties can be particularly beneficial during this transition:

• Stress and Anxiety Reduction: Menopause can be a stressful period, and Ashwagandha's ability to lower cortisol levels can help mitigate anxiety and improve mood stability[1].
• Improved Sleep: Many women experience insomnia or disrupted sleep during menopause[4]. By promoting relaxation and reducing stress, Ashwagandha may help improve sleep quality[1].
• Mood Support: The herb's influence on neurotransmitters like serotonin and GABA can help alleviate mood swings and feelings of depression often associated with hormonal fluctuations[2].
• Hot Flashes: While not a direct estrogen replacement, by supporting the HPA axis and reducing overall stress, Ashwagandha may indirectly help in managing the severity and frequency of hot flashes for some women[1].

A study published in the Journal of Obstetrics and Gynaecology Research indicated that Ashwagandha supplementation could significantly improve menopausal symptoms, including hot flashes, night sweats, and mood disturbances, in perimenopausal women[10]. This highlights the promising role of ashwagandha and menopause in enhancing quality of life.

Supporting PCOS Management

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, characterized by hormonal imbalances (often elevated androgens), irregular periods, and insulin resistance. PCOS ashwagandha research is exploring how this herb can offer support.

Ashwagandha may help manage PCOS symptoms through several mechanisms:

• Stress Reduction: Women with PCOS often experience higher levels of stress, which can exacerbate symptoms[1]. Ashwagandha's adaptogenic effects can help reduce cortisol, thereby potentially improving overall hormonal balance[1].
• Androgen Reduction: While more research is needed, some evidence suggests that by regulating stress hormones, Ashwagandha might indirectly help in reducing elevated androgen levels, which are a hallmark of PCOS[1].
• Insulin Sensitivity: Although not a primary mechanism, some studies indicate Ashwagandha's potential to improve insulin sensitivity, which is crucial for PCOS management.
• Inflammation Reduction: PCOS is often associated with chronic low-grade inflammation, and Ashwagandha's anti-inflammatory properties may be beneficial[13].

By addressing stress and potentially influencing androgen levels, Ashwagandha can be a complementary therapy in a holistic approach to managing PCOS[1].

Ashwagandha and Female Fertility

For women struggling with conception, ashwagandha and fertility is an area of growing interest. While direct mechanisms for improving ovarian function are still being explored, Ashwagandha's indirect benefits are significant:

• Stress Reduction: Chronic stress can disrupt the delicate hormonal balance required for ovulation and conception[1]. By lowering cortisol, Ashwagandha can help normalize the HPA axis, potentially improving the chances of regular ovulation and successful implantation[1].
• Improved Libido and Sexual Function: Ashwagandha has been shown to improve sexual function and satisfaction in women, which can be beneficial for couples trying to conceive[10].
• Overall Hormonal Balance: By supporting the endocrine system's ability to adapt to stress, Ashwagandha helps create a more balanced hormonal environment conducive to fertility[1].

While Ashwagandha is not a direct fertility treatment, its ability to reduce stress and promote overall well-being can be a valuable component of a comprehensive fertility plan[1]. Many women use ashwagandha for women to support their reproductive health journey[10].

Ashwagandha's Role in Stress Reduction and Estrogen Balance

Beyond specific conditions, Ashwagandha's fundamental role in stress reduction is paramount for overall female hormonal health. The chronic elevation of cortisol due to stress can disrupt the production of other hormones, including estrogen and progesterone, leading to imbalances that manifest as irregular cycles, PMS, and mood disturbances[1]. By buffering the body's response to stress, Ashwagandha helps maintain a more stable hormonal environment[1].

While Ashwagandha does not directly increase or decrease estrogen levels in a significant way like hormone replacement therapy, its ability to reduce stress and support adrenal health indirectly contributes to a more balanced endocrine system, allowing the body to better regulate its own estrogen production and metabolism[1].

Ashwagandha and Thyroid Function

The thyroid gland, located in the neck, produces hormones that regulate metabolism, energy levels, and body temperature. Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can have widespread effects on health[5]. The relationship between ashwagandha and thyroid health has garnered attention, particularly for its potential benefits in subclinical hypothyroidism[5].

How Ashwagandha Interacts with Thyroid Hormones

Ashwagandha's influence on thyroid function is primarily linked to its adaptogenic properties and its ability to modulate the HPA axis. Chronic stress can negatively impact thyroid function by suppressing TSH (Thyroid-Stimulating Hormone) production and impairing the conversion of inactive T4 to active T3[1].

Several studies have explored the impact of ashwagandha for thyroid function:

• Subclinical Hypothyroidism: Research suggests that Ashwagandha may be beneficial for individuals with subclinical hypothyroidism, a condition where TSH levels are slightly elevated but T3 and T4 levels are still within the normal range[5]. A study published in the Journal of Alternative and Complementary Medicine found that subjects with subclinical hypothyroidism who took Ashwagandha experienced significant improvements in TSH, T3, and T4 levels compared to a placebo group[5].
• Stress-Related Thyroid Dysfunction: By reducing cortisol and supporting adrenal health, Ashwagandha may help alleviate stress-induced thyroid dysfunction, allowing the thyroid gland to function more optimally[1].

The mechanism is thought to involve a reduction in oxidative stress and inflammation, as well as a direct stimulatory effect on thyroid hormone production or conversion[1].

Considerations for Hypothyroidism and Hyperthyroidism

While promising for subclinical hypothyroidism, it's crucial to approach Ashwagandha use with caution, especially for individuals with diagnosed thyroid conditions or those on thyroid medication.

• Hypothyroidism (on medication): If you are already taking thyroid hormone replacement medication (e[5].g., levothyroxine), adding Ashwagandha could potentially alter your thyroid hormone levels, necessitating an adjustment in medication dosage[5]. Regular monitoring of thyroid hormones by a healthcare provider is essential[5].
• Hyperthyroidism: Ashwagandha's potential to increase thyroid hormone levels means it should generally be avoided by individuals with hyperthyroidism (overactive thyroid), as it could exacerbate symptoms[5].

Always consult with your endocrinologist or healthcare provider before starting Ashwagandha if you have a thyroid condition or are taking thyroid medication[5]. Self-medicating can lead to adverse effects and interfere with prescribed treatments.

The Science Behind Ashwagandha's Hormonal Effects

Ashwagandha's remarkable ability to influence hormonal balance isn't a mystical phenomenon; it's rooted in complex biochemical interactions within the body. Understanding these mechanisms provides a clearer picture of how this adaptogen exerts its wide-ranging effects.

Adaptogenic Properties and Cortisol Reduction

The primary mechanism through which Ashwagandha impacts hormones is its adaptogenic nature. Adaptogens help the body maintain homeostasis by modulating the stress response system, specifically the hypothalamic-pituitary-adrenal (HPA) axis[1]. When faced with chronic stress, the HPA axis becomes overactive, leading to persistently high levels of cortisol, the "stress hormone[1]."

Elevated cortisol can wreak havoc on hormonal balance:

• It can suppress the production of sex hormones like testosterone and estrogen[1].
• It can interfere with thyroid hormone conversion and sensitivity[5].
• It can contribute to insulin resistance.

Ashwagandha helps to "normalize" the HPA axis, reducing excessive cortisol secretion[1]. By bringing cortisol levels down, it indirectly allows other hormonal systems to function more optimally, thereby supporting the balance of testosterone, estrogen, and thyroid hormones[1]. This fundamental action underpins many of its observed benefits for hormonal health.

Antioxidant and Anti-inflammatory Mechanisms

Chronic inflammation and oxidative stress are silent disruptors of hormonal balance. They can damage endocrine glands, impair hormone receptor function, and interfere with hormone synthesis and metabolism.

Ashwagandha is rich in powerful antioxidants, including its key bioactive compounds, withanolides. These antioxidants neutralize harmful free radicals, protecting cells and tissues from oxidative damage. Its anti-inflammatory properties help to quell chronic inflammation throughout the body[13]. By reducing both oxidative stress and inflammation, Ashwagandha creates a healthier internal environment for hormone production and function, further contributing to overall hormonal equilibrium[1].

Key Bioactive Compounds (Withanolides)

The therapeutic effects of Ashwagandha are largely attributed to a group of naturally occurring steroids called withanolides. These compounds are found predominantly in the root of the plant and are responsible for many of its pharmacological activities, including its adaptogenic, anti-inflammatory, antioxidant, and immunomodulatory effects[12].

Different withanolides may have specific actions within the body. For example, some withanolides are believed to interact with GABA receptors, contributing to its anxiolytic (anxiety-reducing) effects[1]. Others may directly influence steroidogenesis (the process of producing steroid hormones) or protect cells from damage. When choosing an Ashwagandha supplement, looking for products standardized to a certain percentage of withanolides (e.g., 5% withanolides) ensures a consistent and potent dose of these active compounds.

How to Incorporate Ashwagandha for Hormonal Support

Integrating Ashwagandha into your daily routine for hormonal support requires careful consideration of dosage, form, and potential interactions. While generally well-tolerated, it's essential to use it responsibly.

Recommended Dosages and Forms (Root Powder, Extract)

Ashwagandha is available in various forms, including raw root powder, capsules, tinctures, and teas. The most common and well-researched forms are standardized root extracts, which ensure a consistent concentration of active compounds (withanolides).

• Standardized Extracts (e.g., KSM-66, Sensoril): These are often preferred due to their consistent potency. Dosages typically range from 300 mg to 600 mg per day, standardized to 2.5-10% withanolides.
  • For stress and cortisol reduction: 300-500 mg of a 5% withanolide extract, once or twice daily[1].
  • For testosterone support: 600 mg of a 5% withanolide extract per day, often split into two doses[3].
  • For thyroid support (subclinical hypothyroidism): 600 mg daily[5].
• Root Powder: If using raw root powder, dosages can be higher, typically 1-3 grams per day, mixed into water, milk, or smoothies. However, the potency can vary more than with standardized extracts.

It's always best to follow the manufacturer's recommendations on the product label or consult with a healthcare professional for personalized guidance.

Best Time to Take Ashwagandha

The best time to take Ashwagandha can depend on your individual goals and how your body responds.

• For stress reduction and general hormonal balance: Many people take Ashwagandha in the morning to help manage daily stress, or in the evening to promote relaxation and improve sleep[1]. Some find a split dose (morning and evening) most effective.
• For sleep: Taking it 30-60 minutes before bedtime can help with its calming effects[4].
• With or without food: Ashwagandha can generally be taken with or without food. If you experience any digestive upset, taking it with a meal may be helpful.

Consistency is more important than the exact timing. Regular daily intake over several weeks to months is usually required to experience the full benefits.

Potential Side Effects and Precautions

Ashwagandha is generally considered safe for most people when taken at recommended doses. However, some individuals may experience side effects:

• Mild digestive upset: Nausea, stomach pain, or diarrhea.
• Drowsiness: Especially at higher doses, due to its calming effects.
• Allergic reactions: Though rare, some individuals may be allergic.

Precautions:

• Pregnancy and Breastfeeding: Ashwagandha is traditionally used as an abortifacient in high doses and is generally not recommended during pregnancy. There is insufficient research on its safety during breastfeeding, so it's best to avoid it.
• Autoimmune Diseases: As Ashwagandha can stimulate the immune system, individuals with autoimmune conditions (e[12].g., rheumatoid arthritis, lupus, Hashimoto's thyroiditis) should consult their doctor before use, as it could theoretically exacerbate symptoms.
• Thyroid Conditions: As discussed, individuals with hyperthyroidism or those on thyroid medication should exercise extreme caution and consult a physician[5].
• Diabetes: Ashwagandha may lower blood sugar levels, so diabetics should monitor their glucose carefully and consult their doctor, as medication adjustments might be necessary[14].
• Blood Pressure: It may slightly lower blood pressure, so those with low blood pressure or on blood pressure medication should be cautious.
• Surgery: Discontinue Ashwagandha at least two weeks before any scheduled surgery due to its potential effects on blood sugar and central nervous system[14].

Who Should Avoid Ashwagandha?

• Pregnant and breastfeeding women.
• Individuals with hyperthyroidism.
• Those with autoimmune diseases (unless cleared by a doctor).
• People on immunosuppressant drugs.
• Individuals with severe liver disease (rarely, liver injury has been reported).

Always, and without exception, consult a healthcare professional before starting any new supplement, especially if you have underlying health conditions, are taking medications, or are pregnant or breastfeeding.

Frequently Asked Questions About Ashwagandha and Hormones

As interest in Ashwagandha grows, so do questions about its specific effects on the endocrine system. Here are some common inquiries regarding Ashwagandha and hormones.

Does Ashwagandha increase estrogen?

Ashwagandha is not known to directly increase or decrease estrogen levels significantly in the way that hormone replacement therapy would. Its primary influence on female hormones is indirect, mainly through its adaptogenic effects[10]. By reducing stress and lowering cortisol, Ashwagandha can help create a more balanced hormonal environment where the body can better regulate its own estrogen production and metabolism[1]. For women experiencing hormonal imbalances due to stress, this can lead to more stable estrogen levels, but it's not an estrogen booster itself[1].

How long does it take for Ashwagandha to balance hormones?

The time it takes for Ashwagandha to exert its effects on hormonal balance can vary significantly among individuals, depending on the severity of the imbalance, individual physiology, and consistency of use. While some people may notice subtle improvements in stress levels or sleep within a few weeks, more profound hormonal changes, such as improvements in testosterone or thyroid levels, typically require consistent supplementation for at least 4-8 weeks, and often up to 3-6 months[1]. Patience and consistent daily intake are key to experiencing the full benefits.

Can Ashwagandha affect birth control?

There is currently no strong scientific evidence to suggest that Ashwagandha directly interferes with the effectiveness of hormonal birth control (pills, patches, rings, implants). Ashwagandha's primary mechanism is modulating the stress response, not directly altering the synthetic hormones in contraceptives[1]. However, given the complexity of hormonal interactions and individual variability, it's always prudent to consult with your doctor or pharmacist if you are taking birth control and considering Ashwagandha, especially if you are concerned about unintended pregnancy. They can provide personalized advice based on your specific health profile and medications.

Is Ashwagandha safe for long-term use?

Ashwagandha has been used safely in Ayurvedic medicine for thousands of years, suggesting a good safety profile for long-term use in healthy individuals at recommended doses. Modern clinical studies often involve continuous use for several months, with generally good tolerability. However, "long-term" can be subjective. For continuous use beyond six months, it's advisable to periodically check in with a healthcare professional to ensure it remains appropriate for your health goals and to monitor for any potential, albeit rare, side effects or interactions. As with any supplement, occasional breaks might also be considered.

Conclusion: Ashwagandha as a Holistic Hormonal Ally

Hormonal balance is a dynamic and intricate process, essential for every facet of our health and well-being. From the vitality of men's testosterone levels to the delicate dance of women's reproductive hormones and the metabolic regulation of the thyroid, maintaining equilibrium is paramount[3]. Ashwagandha, with its esteemed status as an adaptogen, emerges as a compelling natural ally in this pursuit.

Its multifaceted mechanisms, primarily centered on modulating the stress response and reducing cortisol, allow it to indirectly yet profoundly influence a wide spectrum of hormones[1]. For men, the evidence for ashwagandha testosterone benefits, including increased levels and improved fertility parameters, is robust[3]. For women, it offers support in navigating the challenges of menopause, managing PCOS symptoms, and fostering an environment conducive to fertility by alleviating stress and promoting overall endocrine harmony[1]. Furthermore, its potential to support thyroid function, particularly in cases of subclinical hypothyroidism, adds another layer to its impressive profile[5].

While the scientific understanding of Ashwagandha's full hormonal impact continues to evolve, the existing research, combined with centuries of traditional use, paints a clear picture of a powerful herb capable of helping the body adapt, restore balance, and thrive. As with any potent natural remedy, informed and responsible use is key. Always consult with a healthcare professional before incorporating Ashwagandha into your regimen, especially if you have existing health conditions or are on medication. By doing so, you can harness the ancient wisdom of Ashwagandha to support your journey toward optimal hormonal health and overall vitality[15].

References

1. Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012 Jul;34(3):255-62. doi: 10.4103/0253-7176.106022. PMID: 23439798.

2. Andrade C, Aswath A, Chaturvedi SK, Srinivasa M, Raguram R. A double-blind, placebo-controlled evaluation of the anxiolytic efficacy of an ethanolic extract of withania somnifera. Indian J Psychiatry. 2000 Jul;42(3):295-301. PMID: 21407960.

3. Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. J Int Soc Sports Nutr. 2015 Nov 25;12:43. doi: 10.1186/s12970-015-0104-9. PMID: 26609282.

4. Deshpande A, Irani N, Balkrishnan R, Benny IR. A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep Med. 2020 Aug;72:28-36. doi: 10.1016/j.sleep.2020.03.012. PMID: 32540634.

5. Sharma AK, Basu I, Singh S. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. J Altern Complement Med. 2018 Mar;24(3):243-248. doi: 10.1089/acm.2017.0183. PMID: 28829155.

6. Ahmad MK, Mahdi AA, Shukla KK, Islam N, Rajender S, Madhukar D, Shankhwar SN, Ahmad S. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertil Steril. 2010 Aug;94(3):989-96. doi: 10.1016/j.fertnstert.2009.04.046. PMID: 19501822.

7. Choudhary D, Bhattacharyya S, Bose S. Efficacy and Safety of Ashwagandha (Withania somnifera (L.) Dunal) Root Extract in Improving Memory and Cognitive Functions. J Diet Suppl. 2017 Nov 2;14(6):599-612. doi: 10.1080/19390211.2017.1284970. PMID: 28471731.

8. Tiwari S, Gupta SK, Pathak AK. A double-blind, randomized, placebo-controlled trial on the effect of Ashwagandha (Withania somnifera dunal.) root extract in improving cardiorespiratory endurance and recovery in healthy athletic adults. J Ethnopharmacol. 2021 May 10;272:113929. doi: 10.1016/j.jep.2021.113929. PMID: 33600918.

9. Choudhary D, Bhattacharyya S, Joshi K. Body Weight Management in Adults Under Chronic Stress Through Treatment With Ashwagandha Root Extract: A Double-Blind, Randomized, Placebo-Controlled Trial. J Evid Based Complementary Altern Med. 2017 Jan;22(1):96-106. doi: 10.1177/2156587216641830. PMID: 27055824.

10. Dongre S, Langade D, Bhattacharyya S. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Improving Sexual Function in Women: A Pilot Study. Biomed Res Int. 2015;2015:284154. doi: 10.1155/2015/284154. PMID: 26504795.

11. Jahanbakhsh SP, Manteghi AA, Emami SA, Mahyari S, Gholampour F, Mohammadpour AH, Sahebkar A. Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial. Complement Ther Med. 2016 Aug;27:25-9. doi: 10.1016/j.ctim.2016.05.001. PMID: 27515872.

12. Tharakan A, Shukla H, Benny IR, Tharakan M, George L, Koshy S. Immunomodulatory Effect of Withania somnifera (Ashwagandha) Extract-A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants. J Clin Med. 2021 Aug 18;10(16):3644. doi: 10.3390/jcm10163644. PMID: 34441940.

13. Auddy B, Hazra J, Mitra A, Abedon B, Ghosal S. A Standardized Withania Somnifera Extract Significantly Reduces Stress-Related Parameters in Chronically Stressed Humans: A Double-Blind, Randomized, Placebo-Controlled Study. JANA. 2008;11(1):50-56.

14. Andallu B, Radhika B. Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Indian J Exp Biol. 2000 Jun;38(6):607-9. PMID: 11116534.

15. Lopresti AL, Drummond PD, Smith SJ. A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha (Withania somnifera) in Aging, Overweight Males. Am J Mens Health. 2019 Mar-Apr;13(2):1557988319835985. doi: 10.1177/1557988319835985. PMID: 30854916.

16. Ziegenfuss TN, Kedia AW, Sandrock JE, Raub BJ, Kerksick CM, Lopez HL. Effects of an Aqueous Extract of Withania somnifera on Strength Training Adaptations and Recovery: The STAR Trial. Nutrients. 2018 Nov 20;10(11):1807. doi: 10.3390/nu10111807. PMID: 30463324.

17. Chengappa KNR, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal R. Randomized placebo-controlled adjunctive study of an extract of withania somnifera for cognitive dysfunction in bipolar disorder. J Clin Psychiatry. 2013 Nov;74(11):1076-83. doi: 10.4088/JCP.13m08413. PMID: 24330893.

18. Pingali U, Pilli R, Fatima N. Effect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy human participants. Pharmacognosy Res. 2014 Jan;6(1):12-8. doi: 10.4103/0974-8490.122912. PMID: 24497737.

19. Chengappa KNR, Brar JS, Gannon JM, Schlicht PJ. Adjunctive Use of a Standardized Extract of Withania somnifera (Ashwagandha) to Treat Symptom Exacerbation in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study. J Clin Psychiatry. 2018 Jul 10;79(5):17m11826. doi: 10.4088/JCP.17m11826. PMID: 29995356.

20. Bhattacharya A, Ghosal S, Bhattacharya SK. Anti-oxidant effect of Withania somnifera glycowithanolides in chronic footshock stress-induced perturbations of oxidative free radical scavenging enzymes and lipid peroxidation in rat frontal cortex and striatum. J Ethnopharmacol. 2001 Jan;74(1):1-6. doi: 10.1016/s0378-8741(00)00309-3. PMID: 11137343.