Mais les résultats doivent être attendus longtemps et il n'y a généralement pas de temps doxycycline prix L'autre cas, c'est que l'achat d'un ou d'un autre antibiotique dans une pharmacie classique nécessite des dépenses matérielles considérables et pas toutes les personnes ne peuvent acheter des produits pharmaceutiques aussi coûteux.


Effect of Lepidium meyenii (MACA) on sexual desireand its absent relationship with serum testosteronelevels in adult healthy men G. F. Gonzales, A. Co´rdova, K. Vega, A. Chung, A. Villena, C. Go´n˜ez and S. Castillo Instituto de Investigaciones de la Altura, and Department of Biological and Physiological Sciences (Faculty of Sciences andPhilosophy), Universidad Peruana Cayetano Heredia, Lima, Peru Key words. Lepidium meyenii—men Maca—serum testosterone—sexual desire ably the most commonly recognized and treated blind placebo-controlled, randomized, parallel trial sexual dysfunction. It affects more than 30% of men in which active treatment with different doses of aged 40–70 years (Feldman et al., 1994).
Maca Gelatinizada was compared with placebo.
Successful treatment of sexual dysfunction may The study aimed to demonstrate if effect of Maca not only improve sexual relationships, but also on subjective report of sexual desire was because of overall quality of life. Alternatives for treatment of effect on mood or serum testosterone levels. Men hypoactive sexual desire are scarcer. Testosterone is aged 21–56 years received Maca in one of two used because of its property to stimulate sexual doses: 1500 mg or 3000 mg or placebo. Self- desire in hypogonadal men (Matsumoto, 1994; perception on sexual desire, score for Hamilton Arver et al., 1996). Other compounds are potent test for depression, and Hamilton test for anxiety regulators of sexual behaviour in animals but not in were measured at 4, 8 and 12 weeks of treatment.
An improvement in sexual desire was observed with Despite the broad use of oral agents for erectile Maca since 8 weeks of treatment. Serum testoster- dysfunction (Boolell et al., 1996), and the use of one and oestradiol levels were not different in men testosterone for hypoactive sexual desire (Seidman, treated with Maca and in those treated with 2000), many people in the world prefer the use of placebo (P:NS). Logistic regression analysis showed natural plants. Traditional herbs have been a that Maca has an independent effect on sexual revolutionary breakthrough in the management of desire at 8 and 12 weeks of treatment, and this erectile dysfunction and have become known world- effect is not because of changes in either Hamilton wide as treatment (Adimoelja, 2000). One example scores for depression or anxiety or serum testoster- is the broad use of ginseng because of its supposed one and oestradiol levels. In conclusion, treatment property to provoke sexuality (Kim et al., 1976).
More recently, aphrodisiac activity has been described for the root of Lepidium meyenii (Maca), aPeruvian plant (Zheng et al., 2000; Cicero et al., 2001). Additionally, a favorable effect on sperma-togenesis has been observed in adult male rats Sexual function is an important component of (Gonzales et al., 2001a) and in adult men (Gonzales human quality of life and subjective well being.
et al., 2001b). Maca (L. meyenii) is a Peruvian Sexual problems are widespread and adversely hypocotyl which belongs to the Brassicaceae family affect mood, well being, and interpersonal func- and grows exclusively between 4000 and 4500-m tioning (Laumann et al., 1999). Main sexual altitude at the central Peruvian Andes. For centur- problems are related to sexual desire and male ies, it has been recognized traditionally for its erectile dysfunction. Erectile dysfunction is prob- properties to improve sexuality and fertility (seeObregon, 1998). Activity of the plant is located in Correspondence: Gustavo F. Gonzales, Instituto de Investi- the root. Actually, Maca is a commercially available gaciones de la Altura, Universidad Peruana Cayetano Heredia, product expended as a nutrient in different forms Postal Office 1843, Lima, Peru. Fax 00 511 4821195; e-mail:[email protected] including as tablets in the drugstore. Despite the U.S. Copyright Clearance Center Code Statement: 0303-4569/2002/3406-0367 $ 15.00/0 spread use in Peru no scientific evidence exists that (score ¼ 0), did not change (score ¼ 1), increased mildly (score ¼ 3), or increased moderately to The present study aimed to assess a role of Maca for sexual desire and to determine if this effect isbecause of changes in mood or in serum testoster- one and oestradiol levels in adult healthy men.
Mood was assessed using the Hamilton DepressionRating Scale (Mykletun et al., 2001), which has 17questions.
Anxiety was scored with the Hamilton Anxiety Rating Scale (Lobo et al., 2002) which assesses somatic and cognitive-affective aspects.
The study was a 12-week double-blind placebo-controlled, randomized, parallel trial in which two doses of Maca Gelatinizada were orally adminis-tered and compared with the placebo.
Serum testosterone and oestradiol were determined The Institutional Review Board of the Scientific by radioimmunoassay (RIA) using an I125-testoster- Research Office from the Universidad Peruana one and I125-oestradiol, respectively, as radioactive Cayetano Heredia approved the study.
marker. The assays have been performed usingcommercial kits (Diagnostic Products Co., LosAngeles, CA). All samples were run in a same assay period. The within assay variation was 6.42% Fifty-seven subjects (21–56 years) were included in for oestradiol, and 5.5% for testosterone. Sensitivity the study. All subjects were in apparently good of testosterone assay was 4.0 pg ml)1 and that health. Men were randomly placed in one of three for oestradiol assay was 8.0 pg ml)1.
Two groups received active treatment whereas the other group received placebo. For 12 weeks,one group (n ¼ 30) received three tablets of 500 mg Data were analysed using the statistical package each of gelatinized Maca (Maca Gelatinizada La stata (version 7.0) for personal computer (Stata Molina, Lima) per day (Maca 1.5 g). The second Corporation, College Station, TX, USA).
group (n ¼ 15) received six daily tablets of gelatin- Data are presented as frequencies. Data of serum ized Maca (3000 mg) and it was defined as Maca hormones were transformed to percentage. Data 3.0 g. The third group received tablets of placebo were also analysed comparing Maca-treated groups daily for the 12-week span in the same schedule as with respect to placebo group. The differences the Maca group. During the study, all men between frequencies before and during treatment maintained their usual eating regimen.
were assessed by the chi-squared test. Logistic Most of the subjects did not smoke or use drugs regression analysis was performed to assess the for at least 3 months before study, nor did they use independent effect of Maca on sexual desire after controlling for scores of Hamilton Depression and Laboratorios Hersil (Lima, Peru) provided the Hamilton Anxiety test. For this analysis, sexual tablets of gelatinized Maca (Maca Gelatinizada La desire was the dependent variable, and it was Molina). Each tablet contains 500 mg of dehydra- dichotomized as follows: Values 0 and 1 were recoded as 0 (no effect), and values 2 and 3 were Venous blood samples were drawn after a 12-h recoded as 1 (improvement in sexual desire). A overnight fasting at 4, 8 and 12 weeks of treatment.
P < 0.05 was considered statistically significant.
Blood was centrifuged at 1000 g, and serum wascollected after centrifugation and kept frozen untilassayed for hormone measurements.
After 4 weeks of treatment, two men of the placebo group reported that treatment increased sexual Sexual desire was assessed using a subjective (self- desire (16.6%), whereas at 8 and 12 weeks of report) response about the effect of treatment on treatment none of men from this group had sexual desire at 4, 8 and 12 weeks of treatment. The basal value (before treatment) was considered as 1.
In the Maca treated group, at 4 weeks, 24.4% of Each subject was asked if treatment diminished men manifested that treatment increased sexual treated with Maca increased significantly the scorefor sexual desire at 4, 8 and 12 weeks of treatment(P < 0.01). However, when data in the Maca groupwere compared with placebo, the differences wereobserved at 8 and 12 weeks.
Multivariate analyses are shown in Tables 2–4.
Table 2 shows data observed at 4 weeks oftreatment. Treatment is assessed as dummy vari-able comparing the effect of Maca in relation toplacebo. Logistic regression analysis showed thatMaca had no effect on sexual desire. Scores ofdepression and anxiety tests and serum testosteroneand oestradiol levels were not related to sexualdesire in men. Tables 3 and 4 show data observedat 8 and 12 weeks of treatment with Maca (1.5 or3.0 g) or placebo. Treatment with Maca 1.5 g and Prevalence of men whose treatment with placebo or Maca 3.0 g are independent variables associated to gelatinized Maca increased sexual desire. 4 weeks of treatment: P: NS sexual desire at 8 and 12 weeks of treatment. No (v2 ¼ 0.32); 8 weeks of treatment: P < 0.008 (v2 ¼ 7.01); 12 weeks oftreatment: P < 0.006 (v2 independent effect on sexual desire was observed with score of neither depression and anxiety testsnor serum testosterone and oestradiol levels.
desire, whereas at 8 and 12 weeks of treatment, theprevalence of men manifesting increase of sexualdesire was 40.0 and 42.2%, respectively. Significant differences between Maca-treated and placebo-treated During the last decade an increase in the use of (v2 ¼ 7.01; P < 0.008) and 12 weeks (v2 ¼ 7.6; plants in metropolitan areas of developed countries P < 0.006) of treatment (Fig. 1).
has been observed. A recent study in a metropolitan Table 1 shows the scores for sexual desire area of Minnesota demonstrates that herbs are used measured as a subjective self report for the question frequently to promote general health/well-being if treatment had an effect on sexual desire. The group treated with placebo did not change the score Sexual difficulties are extremely prevalent among for sexual desire (P:NS), whereas the overall group both men and women (Leiblum, 1999). Plants are Effect of different doses of Maca or placebo on self-report about effect of treatment on sexual desire in apparently healthy men Data are mean ± standard error of mean (SEM).aP:NS; bP < 0.001 with respect to placebo. *P < 0.01 with respect to basal values (0 weeks).
Logistic regression analysis for the probablity that Maca, anxiety Hamilton score, depression Hamilton score, serum testosterone and oestradiol levels affect self perception of improvement in sexual desire after 4 weeks of treatment CI, confidence interval. Maca (1.5 or 3.0 g) were analysed as variable dummy with respect to placebo.
Logistic Regression v2(6) ¼ 4.58; P > v2 ¼ 0.5984; Pseudo r2 ¼ 0.0755.
Logistic regression analysis for the probablity that Maca, anxiety Hamilton score, depression Hamilton score, serum testosterone and oestradiol levels affect self perception of improvement in sexual desire after 8 weeks of treatment Maca (1.5 or 3.0 g) were analysed as variable dummy with respect to placebo.
Logistic Regression v2(6) ¼ 13.25; P > v2 ¼ 0.0393; Pseudo r2 ¼ 0.2382.
Logistic regression analysis for the probablity that Maca, anxiety Hamilton score, depression Hamilton score, serum testosterone and oestradiol levels affect self perception of improvement in sexual desire after 12 weeks of treatment Maca (1.5 or 3.0 g) were analysed as variable dummy with respect to placebo.
Logistic Rregression v2(6) ¼ 16.12; P > v2 ¼ 0.0131; Pseudo r2 ¼ 0.2898.
extensively used to relieve sexual dysfunction, as it Dharmasiri, 2000). Improvement of depression by happens with ginseng, an essential constituent in selective serotonin reuptake inhibitors in depressed traditional Chinese medicine. At least six million patients has been associated with improvement in Americans use the root of this slow-growing sexual functioning (Ekselitus & von Knorring, 2001; Michelson et al., 2001). In this case, improvement in The results of the present study demonstrate that sexual desire was related to reversion of depression another root, Maca (L. meyenii) which grows in the rather than an effect of the increased serotonergic central Andes of Peru in altitudes between 4000 activity, as serotonin stimulation inhibits sexual and 4500 m may also improve sexual desire. In fact, Maca (1.5 or 3.0 g day)1) administered orally Maca is prescribed because of its supposed in tablets during 12 weeks has a beneficial effect on properties to decrease anxiety, depression, and subjective sexual desire in adult healthy men. These stress. However, the present study has demonstra- data confirm results obtained in mice and rats ted that the effect of Maca on sexual desire is (Zheng et al., 2000; Cicero et al., 2001). Our results independent of an effect on anxiety and/or depres- demonstrate that effect of Maca in healthy men is sion. Furthermore, improvement in sexual desire by noticeable since 60 days of treatment. Certainly, Maca was not related to any increase in serum data at 30 days of treatment did not show differ- testosterone or oestradiol levels. In fact, multivari- ences between Maca treated men and placebo ate analysis has demonstrated an effect of Maca on sexual desire but this effect is independent of We have not demonstrated a higher effect with changes in scores for depression test, scores for 3.0 g compared to 1.5 g of Maca. We have not a anxiety text, serum testosterone levels, and serum clear explanation for this. Further studies will be necessary to clarify a dose-response effect.
Effect of Maca on sexual desire could be because of Sexual desire may be affected by behavioural any unknown chemical signal, i.e., phyto-oestrogens.
depression, stress (Kumar et al., 2001), anxiety Increase in serum testosterone levels in men with (Rowland et al., 1987) and sedation (Ratnasooriya & low desire by low serum testosterone levels resulted in resumption of sexual activity (Jannini et al., 1999).
and the Universidad Peruana Cayetano Heredia This is not the situation of our study as men were apparently healthy. Brown et al., (1978) providedevidence that differences among men in circulatingtestosterone concentration within the normal range do not account for differences in sexual activity andinterest. Ansong & Punwaney (1999) have studied Adimoelja A (2000) Phytochemicals and the breakthrough of traditional herbs in the management of sexual dysfunctions.
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sexual drive. Serum testosterone levels were not Ansong KS, Punwaney RB (1999) An assessment of the clinical relevance of serum testosterone level determination in the evaluation of men with low sexual drive. J Urol 162:719– Data from our study demonstrate that serum testosterone levels were not associated to the Arver S, Dobs AS, Meikle AW, Allen RP, Sanders SW, Mazer improvement in sexual desire by treatment with NA (1996) Improvement of sexual function in testosterone Maca. According to our data and from others, deficient men treated for 1 year with a permeation enhancedtestosterone transdermal system. J Urol 155:1604–1608.
testosterone is necessary, although not sufficient for Boolell M, Gepi-Attee S, Gingell JC, Allen MJ (1996) normal or increased levels of sexual desire. In Sildenafil, a novel effective oral therapy for male erectile addition, supra-physiological levels of testosterone dysfunction. Brit J Urol 78:257–261.
maintained for up to 2 months can promote some Brown WA, Monti PM, Corriveau DP (1978) Serum testos- aspects of sexual arousability without stimulating terone and sexual activity and interest in men. Arch SexBehav 7:97–103.
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1992). These suggest that physiological levels of improves sexual behaviour in male rats independently from plasma testosterone do not provide a maximal its action on spontaneous locomotor activity. J Ethnopharm stimulus in terms of sexual arousability. Moreover, an increase in plasma testosterone into supra- Ekselitus L, von Knorring L (2001) Effect of sexual function of long-term treatment with selective serotonin reuptake in- physiological range is not associated with any hibitors in depressed patients treated in primary care. J Clin detectable changes in sexual behaviour (Anderson et al., 1992). Therefore, all of these data suggest that Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, testosterone should not be used when sexual desire McKinlay JB (1994) Impotence and its medical and psy- is attempted to improve in men with normal serum chosocial correlates: results of the Massachusetts Male AgingStudy. J Urol 151:54–61.
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peripherally can affect sexual behavior in male rats. Life Sci oestrogens. Phyto-oestrogens may have oestrogenic Gonzales GF, Ruiz A, Gonzales C, Villegas L, Co´rdova A (2001a) Effect of Lepidium meyenii (Maca) roots on spermato- or anti-oestrogenic activities (Kuiper et al., 1998). A genesis of male rats. Asian J Androl 3:231–233.
possible role of oestrogens on both human male Gonzales GF, Co´rdova A, Gonzales C, Chung A, Vega K, fertility and sexuality has also been suggested by Villena A (2001b) Improved sperm count after administra- recent studies (Rochira et al., 2001). Male rodents tion of Lepidium meyenii (Maca) in adult men. Asian J Androl show impaired sexual behaviour and fertility as a Harnack LJ, Rydell SA, Stang J (2001) Prevalence of use of consequence of oestrogen defect (O’Donnell et al., herbal products by adults in the Minneapolis/St Paul, Minn, 2001). Therefore, it is an interesting suggestion that metropolitan area. Mayo Clin Proc 76:688–694.
oestrogenic substances should be considered also as Jannini EA, Screponi E, Carosa E, Pepe M, Lo Giudice F, Ômale hormonesÕ (O’Donnell et al., 2001).
Trimarchi F, Benvenga S (1999) Lack of sexual activity from In conclusion, treatment with tablets of Maca at erectile dysfunction with a reversible reduction in serumtestosterone. Int J Androl 22:385–392.
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BARRY H. SCHWAB, PH.D. EDUCATION Ph.D. Biostatistics, Medical College of Virginia, Richmond, Virginia, 1984 B.A. Statistics, State University of New York, College at Oneonta, 1980 Undergraduate Study Abroad, Tel Aviv University, Israel (1978 – 1979) EMPLOYMENT HISTORY 1984-present Janssen Research & Development, LLC (a J&J company) Vice President, Clinical

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