Supplementation may be recommended for individuals with high oxidative stress or poor dietary intake. Vitamin E is a fat-soluble antioxidant known for its role in protecting cell membranes from lipid peroxidation. It also regenerates other antioxidants like Vitamin E, enhancing the body's overall antioxidant capacity. Vitamin C (ascorbic acid) is a water-soluble antioxidant that plays a key role in adrenal function and hormonal stability. Excess ROS can inhibit these enzymes, reducing testosterone output even when cholesterol and other precursors are present. Oxidative stress also affects steroidogenesis, the process of hormone synthesis. ROS directly inhibit the male reproductive function by increasing the effect of glucocorticoids on Leydig cells. Oxidative stress has been reported to increase the blood norepinephrine and cortisol levels. Many studies have reported that ROS disrupt sperm parameters in men with idiopathic infertility. Tell your healthcare provider if you have any side effect that bothers you or does not go away. Especially tell your healthcare provider if you take insulin, medicines that decrease blood clotting (blood thinners), or corticosteroids. Inform your healthcare provider of all medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Stop using Male Excel’s Testosterone Lipoderm Cream and call your healthcare provider immediately if you see any signs and symptoms of puberty in a child or changes in body hair. Early signs and symptoms of puberty have occurred in young children who have come in direct contact with testosterone by touching areas where men have used Male Excel’s Testosterone Lipoderm Cream. Male Excel l’s Testosterone Lipoderm Cream is a controlled substance (CIII) because it contains testosterone that can be a target for people who abuse prescription medicines. Twelve weeks of daily supplementation with 1.0 g of a musali extract in 40 healthy men, aged between 20 and 40 y, did not significantly increase testosterone concentrations compared with the placebo group. Daily supplementation with 800 mg of a tribulus extract for 30 d did not increase testosterone concentrations, while in the Neychev and Mitev study (54) in 21 participants aged 20 to 36 y, a tribulus extract at 2 doses, 10 mg ⸱ kg−1 ⸱ d−1 (3 divided doses) or 20 mg ⸱ kg−1 ⸱ d−1 (3 divided doses), did not increase testosterone concentrations after 4 wk of supplementation. Another study, which involved 148 idiopathic infertile men, indicated that the intake of oral antioxidants for 3 months significantly increased sperm concentration and motility after treatment. Reducing the oxidative stress with antioxidant supplements has the potential to improve semen parameters similar to the TMSC increase observed in the treatment group of this study. Participants supplemented with 2.4 g of maca (pulverized, dehydrated maca root) daily did not increase testosterone concentrations compared with the placebo group. The researchers examined testosterone concentrations in 60 stressed, healthy men and women with a mean age of 41 y. The 1 study that showed no effect of an ashwagandha extract, Shoden®, on testosterone concentrations in men was conducted by Lopresti et al. (51). Daily supplementation with 1.5 g Korean red ginseng (6-y-old ginseng, steamed, dried, and powdered) over 12 wk resulted in no significant between-group differences in testosterone concentrations.
