Because tongkat ali (or rather: a tongkat ali extract at a proper dosage) stimulates the Leydig cells to synthesize more testosterone, it is a natural occurrence that testicles will become larger. Likewise, bodybuilders who abuse steroids shut down their Leydig cells and therefore suffer penile and testicular atrophy (a pathological shrinking of the penis and testicles to boyhood size). Many bodybuilders therefore use tongkat ali after steroid cycles to get their penis and testicles back to an adult appearance, or they use tongkat ali together with steroids to prevent penile and testicular shrinking in the first place.

However, as with any pharmacologically active substance, one can overdose with tongkat ali. It is not, for example, advisable to use 5 gram of 1:50 tongkat ali extract per day, as this can have unwanted side effects such as extreme and painful testicular swelling. In this context, I have been asked by Ida of Sumatra Pasak Bumi to comment on a case report on side effects that has been sent to them. Here first the case report as it was received by Sumatra Pasak Bumi, and below that, my comments:

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I bought some tongkat ali 1:50 extract in October. I have also used tongkat in May / June last year in high dosages, up to 4 grams a day, without any problems except pressure in the head which is normal as I understand.

This time, after a few days moderate use , I got pain in my left testicle and started feeling sick as if I was getting a flue or a cold (no or little fever though).

The pain in my testicle, which was getting swollen, almost disappeared in a couple of days. I have been examined and a small cyst was found — nothing critical. The reason I am starting to suspect tongkat for the swelling is that I’ve tried using it a couple of times in the period since I got sick and I’ve felt really reduced the day after taking a dosage of about 1 gram. This can't be a coincidence. I was trying about a week after the infection, or what it was, to take tongkat because I was feeling better, and to my surprise I got worse again and started to feel dull pain in my testicles again. I've been a little reduced all the time up to now and still am, though I’m feeling a lot better – feels just like a weak cold now. Yesterday though, at about 7pm, I took 3 capsules of 400mg 1:50 extract and didn't feel too bad that day though I did get the weak dull pain in my testicles back. Today that pain is a little more pronounced, and I’m feeling like I have a flue coming, just like those last times. My energy levels are really low. The tongkat is working like it usually does in addition to the bad symptoms. I know it is tongkat, I have got to put it that way.

So my question is: Is it possible that there could be spores of fungus in the capsules that has broken out or maybe other things that could make me ill?

I hadn't been with a woman since April so I don't believe it could be a sexually transmitted disease. I haven't been flat out sick either. The one thing I am a 100% certain about is that taking tongkat now will make me fell ill. Nausea is also present. Isn't it so that one can get sterile of the fungus that could be on tongkat ali roots? My doctor gave me antibiotics soon after I got the testicular swelling problem. This didn't make me feel better though.

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The symptoms described cannot have anything to do with fungi or bacteria that would be present on tongkat ali extract. If there were fungi or bacteria, they would affect the gastro-intestinal tract, not the testicles.

That said, it seems that the tongkat ali has a pronounced effect on the person who’s report is presented above. Because tongkat ali stimulates testosterone production, it can cause testicular swelling. Furthermore, via increased testosterone levels, tongkat ali can also activate the neurotransmitter dopamine. This can cause nausea, apart from having other symptoms such as increased libido. An alternative use of one dopmaninergic drug, apomorphine, which is prescribed in Europe for libido problems, is as an enemic… a medication that induces nausea up to the level of vomitting. As always, the effect is determined by the dosage, and that holds for the tongkat ali, too.