Evaluation of Potential Hormonal Activities of Ashwagandha (Withania somnifera)

Ashwagandha is a widely used herb in traditional medicine systems, particularly Ayurveda. Despite its extensive tradition, growing concerns regarding its potential endocrinological effects have prompted scientific scrutiny. This review systematically evaluates the current preclinical, clinical, and case study evidence concerning AS's effects on hormonal systems, including the thyroid axis, the hypothalamic-pituitary-adrenal (HPA) axis, and the hypothalamic-pituitary-gonadal (HPG) axis. AS appears to elevate thyroid hormones in hypothyroid contexts. Multiple studies consistently show AS-mediated reductions in cortisol levels, supporting its proposed anti-stress effects via modulation of HPA-axis activity. Evidence also indicates AS may influence sex hormone regulation in both sexes, notably increasing testosterone levels in men and affecting estrogen and gonadotrophins in women. Mechanistically, these hormonal effects likely result from modulation of central regulatory pathways rather than direct receptor binding. Limitations in existing studies-such as high dosing in animal models and small sample sizes in clinical trials-underscore the need for more rigorous, dose-responsive, and mechanistically targeted research. In the meantime, careful consideration is warranted when evaluating AS as a therapeutic agent.