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Planta Med
DOI: 10.1055/a-2802-8363
Reviews

Hormonal Modulation with Withania somnifera: Systematic Review and Meta-Analysis of Randomized-controlled Trials

Authors

  • Michal Fornalik 

    1   Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland

  • Anna Malkiewicz

    1   Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland

  • Dominika Adamczak

    2   Department of Cancer Immunology, Chair of Medical Biotechnology, Poznan University of Medical Sciences, Poznan, Poland
    3   Doctoral School, Poznan University of Medical Sciences, Poznan, Poland

  • Filip Nawrocki

    1   Faculty of Medicine, Poznan University of Medical Sciences, Poznan, Poland

  • Aleksandra Zielinska

    4   Department of Pharmacology and Phytochemistry, Institute of Natural Fibres and Medicinal Plants, National Research Institute, Plewiska, Poland

  • Samim Ali Mondal

    5   Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract

Hormonal imbalances, particularly involving the hypothalamic–pituitary–adrenal and gonadal axes, contribute to chronic conditions such as stress-related disorders, infertility, and metabolic dysregulation. Ashwagandha (Withania somnifera L.) has been proposed as a potential oral modulator of endocrine function due to its adaptogenic properties. This review aims to systematically evaluate the effects of oral ashwagandha supplementation on circulating hormone levels in adults. Our literature search included MEDLINE, Embase, and ClinicalTrials.gov. The protocol was registered in PROSPERO (CRD42024611576). We included randomized, placebo-controlled trials in adults assessing oral ashwagandha versus placebo that reported changes in hormone levels. Two reviewers independently screened studies, extracted summary data, and assessed risk of bias using the Cochrane tool. Meta-analyses were conducted using a random-effects model to calculate mean differences (MD) or standardized mean differences (SMD), with heterogeneity and publication bias assessed using I² and Eggerʼs test, respectively. Twenty-three trials were included, encompassing 1706 patients. Ashwagandha significantly reduced cortisol (SMD =− 1.18, p < 0.04) and increased serotonin (MD = 31.75 ng/ml, p < 0.01). Subgroup analyses suggested possible dose-response effects based on withanolide content. No effect was found on TSH or T3, but T4 levels increased modestly (MD = 0.61 µg/dL, p = 0.02). Ashwagandha increased testosterone in men (MD = 57.43 ng/dl) but not in women (MD = 5.09 ng/dl), with a significant gender difference. This treatment did not influence E2 levels in either gender. Ashwagandha supplementation appears to modulate key hormonal pathways, particularly cortisol and sex hormones. However, heterogeneity and limited data on some endpoints warrant further standardized trials.

Keywords

ashwagandha - Withania somnifera - Solanaceae - hormone regulation - cortisol - serotonin - testosterone - estradiol

Supporting Information

    The supporting information contains extended methodological data and supplementary results. This includes the full GRADE evidence profiles, the complete search strategy, risk of bias assessments, and a comprehensive set of additional analyses. These analyses encompass sensitivity analyses (L1O, GOSH, and Baujat), meta-regressions (e.g., on dosing and composition), and full results for all secondary outcomes assessed in the systematic review.

  • Supporting Information (PDF)


Publication History

Received: 28 August 2025

Accepted after revision: 26 January 2026

Article published online:
25 February 2026

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