Question: Hi there,

I'm a 34 year old male, sometimes prehypertensive (other times normal, especially after waking).
I'm considering a "sometimes" supplement (days I expect a sexual encounter/days leading up to one) that includes 75 mg of Tribulus Terrestris (minimum of 45% saponins).

According to my primary source for information on supplements, http://examine.com/supplements/Tribulus+terrestris/ , it is generally known to reduce blood pressure in humans (possibly due to ACE or kidney-protective properties). However, one study found that while aroused, rat blood pressure increased minimally (6-11%) for the duration of erections, but then went back to normal. (The study suggested this may be due to the increase of androgen/testosterone; would this mean that increase would translate to other forms of exercise?) A later human study found tribulus decreased blood pressure in hypertensive patients after several weeks. It also has cholesterol-lowering and anti-atherogenic properties according to some studies.

I'm wondering if the possible increase in BP during erections would be a concern for me. Let's say on the days I take it, sexual activity was no more than 4 hours. (Obviously, that is a long duration, and it's probably going to be much less than this, but I do occasionally do prolonged play, so I'm using that to be safe). And let's say I take the supplement approximately 3 out of every 7 days (sometimes more, sometimes less).

Do you see any concerns? My thoughts that this is a low dose, not every day, and the possible benefits likely outweigh a minimal increase in aroused/erection blood pressure, but I wanted a professional's opinion. Thanks for any advice you can provide!

Thanks very much! If you don't mind, I'll post the full ingredient list. This is a libido-enhancing product and I'm mainly using it for a bit of extra oomph in sexual situations (probably not constant supplementation even though I likely could). A lot of the supplements out there have things I'm not comfortable with - yohimbe, kola nut, or licorice, for example, which all could be risky for high blood pressure. This seems like a more natural approach with reasonable amounts, but I'd like to see if you think this would be safe for me. Since the tribulus is fine, my next biggest concern is the gingko, even though it's only 30 mg. I know it can increase bleeding (could it lead to stroke?), and I do take garlic (1,200 mg), fish oil (~3g) and some other herbs that can help keep the blood thin, but no massive amounts. Thanks for your input if this would be safe for me a few times a week!!

Epimedium Extract (Horny Goat Weed) (Epimedium brevicorum) (12:1 Concentrate min. 3% Icariin) (aerial parts/leaf) 975 mg *
XXXXXXX Puama (Ptychopetalum olacoides Benth.) (root/stem) 100 mg *

Maca (Lepidium meyenii) (root) 350 mg *

Tribulus terrestris extract (fruit) (min. 45% Saponins) 75 mg *

Panax Ginseng (root) 50 mg *

Damiana (Turnera diffusa) (leaf) 50 mg *

Ginkgo biloba Extract (leaf) (min. 24% ginkgoflavonglycosides) 30 mg *

Cayenne (Capsicum annuum) (40,000 SHU) (fruit) 125 mg *

Thanks so much Dr. Shehu!

One more followup if you don't mind.

This is embarrassing, so I'm sorry for the nature of this question, but it's been on my mind, so if you don't mind, I'd appreciate your input; I'm a bit embarrassed to ask my primary doctor in person.

I know when most people have sex, it's perhaps foreplay, then the actual sexual act, then done, so maybe 30 minutes to an hour (of course there are exceptions and people who go longer).

One of the reasons I'm concerned about BP during sex is I practice something called edging, which is essentially prolonged arousal (not a constant erection, but for quite a bit of the time) and working up towards orgasm, but then repeatedly backing off when close, and doing this over and over several times (could be a few; could be dozens), perhaps over hours (again, let's say XXXXXXX is usually four, though it often doesn't go *that* long).

I also sometimes use things like TENS devices, etc. that can mean long periods of sexual stimulation.

While my heart rate definitely speeds up some, etc., it certainly doesn't feel anywhere as intense as, say, when I exercise on the treadmill (not as fast a heartbeat, as much sweating, etc.), but it's of a longer duration.

I've thought about trying to get a blood pressure reading during this, but as with exercise, I think this would be A) impossible to actually take accurately and B) useless, as we use resting heart rate for BP monitoring. Am I correct in these assumptions?

Also, should I consider this like any other moderate exercise (ie. taking a 4 hour hike in the woods), whereas it's alright to have BP elevated a bit since it is activity, or is there something specific about sex where this prolonged stimulation would be more dangerous than other general activity?

I guess I want to know if repeated stimulation for this long is safe and considered like other activities/exercises.

Thank you, and I hope you aren't mortified by the question!

Hi there - I actually had a few followups, so I hope you don't mind the refill.

Don't worry - I don't stand with the techniques I have mentioned. While there are some cooldown periods, there are fairly long periods of sustained intensity (as to be blunt, I am into some oversensitivity and BDSM-type play as well, with use of TENS-like devices or with a partner). But as long as you think it's like other exercise and this isn't more concerning than, say, a prolonged hike, I'll try not to worry about it.

I have brought up a stress test with my primary care physician (on more than one occasion), but she keeps telling me she doesn't think it's necessary and that it might provoke my anxiety.

One other question I have. I have mentioned I take several small amounts of blood thinning foods to stay healthy, help prevent atherosclerosis, etc. - fish oil (3g/d) and garlic (1.2g/d) being the biggest dosages, but also relatively small amounts of turmeric, cayenne, arginine, grape seed extract, resveratrol, several different mushrooms, horny goat weed, and now possibly a small amount of gingko. Nothing prescription and no aspirin though (this is instead of aspirin).

We had discussed before that if my blood was too thin, I'd likely see bruising, bleeding gums, nosebleeds, slow clotting time, etc., which is not the case.

But if I ever had surgery or had to stop all these things for a few weeks, is there any evidence that there could be a rebound effect that might be dangerous? (ie. increased clotting since my body is used to all these things)

Thanks for your patience with my many questions.

Hi there,

I'll bring the stress test up again to the doctor. (That said, while I can't take my BP while exercising, I do feel just fine doing it - I just did a 2+ mile jog with periods of walking today.)

Thank you for reassurance that the sexual activities I've mentioned are safe.

Also thanks for the reassurance that the foods I'm supplementing with are fine unless I see symptoms of bleeding like excess bruising, bleeding gums, bleeding nose, etc. It's also great to know I don't have to worry about a rebound effect (as I think you do with medications). As far as I know, my liver is fine.

Finally, one further question about that supplement I mentioned earlier - if I did try it on an everyday basis (instead of occasionally or for a few days at a time), would it still be reasonable enough to be safe?

Thanks for all the wonderful help.