Ashwagandha & Hormones: What the Evidence Really Shows

Abstract Summary

Objective

Evaluate how ashwagandha may affect key hormonal axes—HPA (cortisol/stress), HPT (thyroid), and HPG (sex hormones)—and summarize safety.

Context

Chronic stress elevates cortisol and can disrupt thyroid and reproductive hormones. Adaptogens like ashwagandha are marketed for “hormonal balance,” but effects depend on baseline physiology, dose, and extract standardization.

Methods Used

Approach

Prioritize lifestyle (sleep, nutrition, training load) and screen for medical contributors. If considering ashwagandha, use a standardized root extract, start low, monitor symptoms and labs as indicated, and stop with adverse effects. Coordinate with a clinician for thyroid disease, pregnancy/breastfeeding, liver disease, or medication use.

Data Collection

Meta-analysis of 15 RCTs found reductions in anxiety, stress scores, and cortisol at ~8 weeks. An RCT in subclinical hypothyroidism showed increased T3/T4 and decreased TSH with 300 mg BID root extract for 8 weeks. Trials in men report mixed but sometimes favorable changes in DHEA-S/testosterone after 8–16 weeks.

Researchers’ Summary of Findings

Impact on Health

Reduced cortisol and stress may support sleep, mood, and training adaptation. Selected patients with subclinical hypothyroidism may see lab improvements; any sex-hormone benefits are modest and uncertain in healthy men.

Health Implications

Consider for adults with high stress after lifestyle steps. Avoid during pregnancy/breastfeeding; use caution with thyroid disease, liver disease, and interacting drugs. Limit to short-term (≤3 months) pending long-term data.

Sustainability

Favor third-party-verified brands (USP, NSF) and root-only extracts; choose minimal-packaging formats and evidence-based dosing to reduce waste.

DOI: 10.1192/bjo.2025.10136