Supplementing with Cistanche: An Overview (+personal reflections)

Taxonomy: The genus Cistanche is in the family Orobanchaceae in the major group Angiosperms

Common species: Cistanche tubulosa, Cistanche derserticola, Cistanche salsa, Cistanche sinesis.

Other names: Rou Cong-Rong within Traditional Chinese Medicine

Cistanche is a parasitic herb that grows in arid regions of the northern hemisphere, such as China, Mongolia, Iran, and India. It commonly attaches to the roots of sand-fixing plants. There are 22 known species of cistanche throughout the world. Cistanche has a history of use in traditional Chinese medicine and is used as a supplement to improve various health parameters. In recent years it has garnered popular attention for use in improving sexual performance, however the long term cognitive health, MAOi, and liver supporting research should not be dismissed. Cistanche indicates to be a multi-faceted herb, which can both serve benefit but also make use for more isolated goals more difficult.

Cistanche contains a variety of valuable components, including phenylethanoid glycosides (PhGs) such as echinacoside, acetoside, and tubuloside B. These compounds have been shown to have some actions (mixed animal and human clinical trials) in antioxidation, neuroprotection, sexual function, and immune function. Additionally, cistanche has demonstrated a variety of health benefits, including neuroregeneration, neuroprotection, antioxidant activity, promotion of liver function, and enhancement of immune function, among other effects.

Many of these beneficial effects are mediated by the various PhGs in cistanche, with specific effects mediated by particular compounds which you will see as we discuss through each action below.

Sexual Performance and Blood Flow

A primary compound of interest is echinacoside, which is typically known as the main component of echinacea, and is abundant in cistanche and possesses vaso-relaxing activity. This is a likely reason for it’s reputation as the “Stalk Enlarger” simply by assisting blood flow. For just this reason Cistanche has been specifically studied for its potential as an aphrodisiac and various sexual performance parameters in animals. There is evidence suggesting that it may increase the activity of the NO-cGMP signal transduction pathway and increase cGMP levels in the corpus cavernosum smooth muscle in rats, human application is yet to be confirmed however anecdotal reports would support it. In a clinical trial of the branded "Memoregain" extract of Cistanche, participants were noted to have diastolic blood pressure drops between 6-7mmHg after 24 weeks of use, this effect was sustained until trial end at 48 weeks.
From the feedback we’ve had with Nice Supplement Co. “Cistanche Tubulosa 10:1” customers in store and online, the effect is not as significant or as reliable as with PDE5 inhibitors such as Icariin extracts, however provides other mood benefits than can promote its use.

Testosterone synthesis interactions

Regarding endogenous hormone production, cistanche tubulosa has demonstrated an effect in increasing Testosterone synthesis by multiple mechanisms. In one study published in Nature (see this link for the full paper and our summary), it wasproposed that the direct androgen receptor binding in the hypothalamus by a principle bioactive in Cistanche “Echinacoside” is a significant contributor to sex steroidal hormonemodulation seen with Cistanche supplementation. Animal study outcomes forCistanche supplementation include: increased secretion and circulating Luteinisinghormone, increased encoding for the enzymes responsible for synthesising Testosterone and other sex steroidal hormones (CYP11A1, CYP17A1,HSD3β, HSD17β), as well as increased total and circulatingTestosterone. Sperm quantity and quality improvements havealso been demonstrated, which are expected to be downstream outcomes of increased sex steroidal hormonal secretion. Protective effects against BPA induced damage on mice sperm quantity and quality was also significant.

Separately, other steroidic enzymes responsible for testosterone syntheis (5α-reductase-2, and aldo-keto reductase) have been demonstrated to be modulated by Cistanche supplementation. Furthermore, Cistanche deserticola extract has been shown to decrease the level of peripheral memory T cells and enhance levels of naive T cells.

Antioxidant and Liver Support

Acetoside has demonstrated potent antioxidant action valuable for preventing lipid peroxidation, as well as enhancing superoxide dismutase activity (SOD) which is the most plausible mechanism for its role in liver support.

Anti-fatigue, Stress and Mood Support

Cistanche has been reported to have MAO inhibitory activity in vitro, which is the likely mechanism of action by which we are seeing mood, stress and anti-depressant supporting activities. Do note, like rhodiola rosea this should be carefully managed around psychiatric medications in which could potentiate select medication potency. This is another prime example of why all supplements should be cross-checked with your accredited medical provider before use.

The state of the research

The effects of cistanche are still being studied, and some care should be taken extrapolating data from differing species of cistanche as but there is evidence to suggest that it may be a valuable supplement for improving a variety of health parameters. It has been a “vitality” and “longevity” mainstay in Traditional Chinese Medicine for as far back as records can be found (thousands of years), however only just in the last decade has a body of scientific research been taking shape.

Take note as of current a lot of the mechanistic research is drawn from animal literature, with a few human clinical trials - primarily regarding mood and anti-fatigue applications for the branded extract "MemoRegain".

Personal reflections and anecdotes on my experience with Cistanche

For me, Cistanche is one of those herbs that just finds itself regularly in the foundation of both my nootropic and hormone support stacking.

On the mood I find it slightly more “finnicky” than rhodiola and seeming to be leaning more adrenaline and slightly fuse shortening, however much like Tongkat ali that more high-adrenaline folks (like myself) it does have a great place when you want a really good boost to the day. This sort of effect leads me to supplement it much more in a pulsing manner (as I do with Tongkat also), but does make it into the stack once or twice a week very reliably. Regarding dosing, I tend to lean on just one capsule (400mg) of our 10:1 extract which I find comparable in effects to 200mg of the high potency echinacoside and acetoside standardised extract Nootropics Depot provide. During some anecodotal testing (just running different extracts in isolation), 20:1 extracts failed to yield any discernable difference and perhaps felt more “flat” on the mood side. Without the literature supporting benefits of higher extraction ratios or what varying concentrations of echinacoside or acetoside or other compounds that may yeild. - at NSC the philosophy is to lean toward the safer bet.

On the blood flow side, I don’t find cistanche to be a standout compared to the likes of icariin, pomegranate, or simple nitric oxide precursor stacking, however my enthusiasm of icariin extracts also tends to over shadow many other sexual performance related compounds. It’s what I would consider “perhaps noticeable” within realm of placebo in an isolated use case. THAT SAID… we have a select number of customers both in the UK and NZ that have reported excellent erectile blood flow improvement without any priming of that outcome from my behalf. When multiple seperate or distinct feedbacks of the same nature come back, I generally call that signal worth paying attention to at the least. Just with the consideration that there may be other sources of information generating noise to the signal such as big trend in social media chat on cistanche of 2022 (much of which coming from “Ergogenic Health”).

Regarding liver function, I cannot comment personally as my liver bloodwork has always come back excellent. Any statement would be irrelevant. I have had no interactions with customers that have used it in an isolated manner for liver applications. I could only say the research looks convincing and I’ll always gladly take a boost in SOD, even if momentarily.

An area I would be interested to see future research on is the gut benefits, having stumbled across one rat study showing a very niche improvement. Do note some persons may have very very mild laxative response to echinacoside extracts such as cistanche (according to literature), hence we recommend extra care if stacking alongside herbs such as Fadogia or Pomegranate which also influence gut “rate of passing” shall we say.

On that merry note, I’ll leave you for now. Hopefully this was an interesting if not insightful read, or at the very least made you ask some further questions. Linked below are a few good research papers to start a literature rabbit hole on. Feel free to email for my full database.

- Thomas Kirk, Cofounder and R&D guy for NSC

RELEASE: 30th April 2023
UPDATE 1: 18th May 2023 - testosterone synthesis section updates.

This article will be updated with further research in the future.

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