Label Review

Exsativa®

Price: $15.97 per 30 caplets, a 15-day supply when used as suggested

Comments by Jessica Welmer, PharmD, and Cydney E. McQueen, PharmD:

Green oats contain steroid materials that can mimic testosterone. Most testosterone in the body is bound to a carrier, sex hormone binding globulin (SHBG). Theoretically, with the addition of oats, the bloodstream will be flooded with the testosterone "look-alike," which will bind to SHBG and allow actual testosterone to disassociate. For both men and women, libido is related to the testosterone level; persons with abnormally low testosterone levels do have low libidos. The theory behind the promotion of this product component is the idea that the more free testosterone circulating in the blood, the higher the sex drive. However, no clinical research has evaluated efficacy of green oats in enhancing the sex drives of men with low or normal testosterone levels. Although no drug interactions, side effects, or contraindications are documented, the theoretical concerns, assuming the proposed mechanism of action is actually taking place in vivo, are the same as for any prescribed testosterone therapy: acne, epididymitis, sleeplessness, anxiety, prostatic hypertrophy, and increased risk of prostate carcinoma. Most literature states the common dosage to be 300 mg bid, but there are insufficient data to support this statement.

This product uses nettle extract from aerial parts of the plant. A root extract has been shown to have some efficacy in treating symptoms of benign prostatic hypertrophy (BPH). However, since the roots contain constituents that are not present in the rest of the plant, it is unknown if an aerial part extract will have the same effects. Root extracts do decrease the binding capacity of SHBG. The European Scientific Cooperative on Phytotherapy (ESCOP) lists a recommended dose of 770 mg of an aerial parts extract bid for rheumatic conditions, but does not recognize use of an aerial part extract for any genitourinary use other than bladder irrigation. There is no clinical evidence to support claims of increased sexual function or drive. Nettle is a good source of both vitamin K and potassium, so should be avoided in persons on anticoagulant therapy and potassium-sparing diuretics.

Although sea buckthorn contains several acids and flavonoids, it is unclear what role this herb plays in this product. It is an excellent source of vitamin C (210-1,120 mg per berry). Traditionally, sea buckthorn has been used for topical bedsores and burns, and even for arthritis, gout, and gastrointestinal ulcers. No information supports a benefit for sexual function.

Green oats extract may well increase free testosterone levels, but there are insufficient data to support claims for increased libido in males with normal testosterone levels or claims for green oats extract in general. Nettle root extract has a benefit in BPH, but much less is known regarding an aerial parts extract. If it has similar effects, it may benefit male sexual function if the causative factor involves the prostate; an adequate dose for this purpose is unknown. Sea buckthorn is unlikely to have any benefit for improving sexual function, but there are no known safety issues involved with use.

Any male experiencing diminished sexual function or drive should first be examined by a physician to rule out prostate cancer or other medical conditions with known, well-defined treatment options. If a patient with diminished function due to BPH then wishes to try a supplement, a standardized nettle root extract or saw palmetto extract might be a better choice.