A Root Cause Approach to Men’s Hormone Health Using Specific Maca Phenotypes: A Narrative Review

Emily C. Hernandez, MS, CNS; Corey B. Schuler, PhD, FNP-C, APHN-BC, CNS; Marc B. Sklar, DACM, LAc, FABORM; Kim Ross, DCN, MS, MBA, CNS, LDN, IFMCP; James Edward Barnes Frame, BS; Deanna Marie Minich, MS, PhD, CNS, FACN, IFMCP

Emily C. Hernandez, MS, CNS, Independent Contractor, Emily Hernandez Nutrition, Ventura, California, USA. Corey B. Schuler, PhD, FNP-C, APHN-BC, CNS, Clinical Faculty / Family Nurse Practitioner, Augsburg University / Synergy Family Physicians, White Bear Lake, MN, USA. Marc B. Sklar, DACM, LAc, FABORM, Clinical Director, Reproductive Wellness, San Diego, CA, USA. Kim Ross, DCN, MS, MBA, CNS, LDN, IFMCP, Associate Professor and Director of Nutrition Programs, Sonoran University of Health Sciences, Tempe, AZ, USA. James Edward Barnes Frame, BS, Sydney, NSW, Australia. Deanna Marie Minich, MS, PhD, CNS, FACN, IFMCP, Chief Science Officer, Food & Spirit, LLC, Port Orchard, Washington, USA.

Corresponding author: Emily C. Hernandez, MS, CNS  

E-mail: emily@emilyhernandez.co

Keywords: Maca, Andropause, Testosterone, Prostate, Late-Onset Hypogonadism

Introduction

Male testosterone levels decline with age, often reflecting disruption of the hypothalamus-pituitary-adrenal-testes (HPAT) axis driven by endocrine aging and lifestyle factors.¹ Concurrently, prostate changes are common, with 30-40% of men over 40 years having benign prostatic hyperplasia (BPH).² Together, these changes negatively impact mood, fertility, sexual function, body composition, bone density, cognition, and urinary function.^1-3

Non-modifiable antecedents exist, including genetic predisposition to prostate growth.⁴ However, several modifiable mediators are clinically relevant. For example, improper diet–such as one characterized by ultra-processed foods, trans fats, and excess sugar and calories—contributes to chronic inflammation and metabolic dysfunction, and chronic stress dysregulates the HPAT axis, all of which may contribute to decreased testosterone levels and impaired sperm parameters.^5-8 Testicular heat stress, such as from tight clothing or prolonged sitting, may induce local oxidative stress.⁹

A root cause approach to men’s health goes beyond symptom management, addressing modifiable antecedents, triggers, and mediators, in addition to interconnected functional medicine matrix nodes, including HPAT axis support as a key regulator of endocrine function. Botanicals, such as specific maca (Lepidium peruvianum) phenotypes and saw palmetto (Serenoa repens), show potential as adjunctive therapies to strengthen and complement lifestyle interventions.^10,11

Towards this end, this narrative review aims to explore how specific maca phenotypes support men’s hormone health within a comprehensive diet and lifestyle framework.

Main Narrative

Literature Search

An electronic search was conducted in the PubMed database. Examples of search terms used include: maca and testosterone, maca and prostate, saw palmetto, and benign prostatic hyperplasia. Studies were restricted to human cell studies and human male subjects.

Results and Discussion

Despite traditional use, differences in maca and saw palmetto growing conditions and postharvest processing can contribute to inconsistent clinical performance, emphasizing the necessity for precise botanical selection for men’s health.^12,13 Maca’s physiological effects can vary by phenotype, which are distinguishable by color, DNA, and analytical profiles.¹² Physiological effects are further influenced by the elevation at which maca is grown, exposure to extreme temperatures and wind, soil composition, microorganisms, hypocotyl size, harvest methods, drying processes, and manufacturing methods.¹²

Clinical case reports for men experiencing infertility and low testosterone demonstrate the effects of a comprehensive protocol, in which the primary intervention is a proprietary combination of specific maca phenotypes concentrated and gelatinized, as water, pressure, and heat treatments enhance the potential bioavailability of the desired targeted phytochemicals for this indication.^10,12 Maca offers adaptogenic support to modulate HPAT axis hyper- or hypoactivity, in addition to anti-inflammatory and antioxidant effects.¹²

In a case report for a 38-year-old Indian male with low testosterone and sperm motility, the intervention also involved an antimicrobial protocol to address gastrointestinal concerns, acupuncture every 1-2 weeks for stress and digestion support, and scrotal cooling to address heat stress.^10,14-17 The subject was already following a vegetarian diet, and was further instructed to adopt a Paleo-style vegetarian food plan. Results showed an increase in total testosterone by 57%, free testosterone by 10%, sperm concentration by 48%, sperm motility by 7900%, total motile sperm by 3456%, and sperm morphology by 75%, and improved libido.¹⁰

In another case report, a 44-year-old Caucasian male experienced low testosterone, depression, and an inability to gain muscle mass. The subject was already consuming a high-protein diet, with strength training three to four days per week, and reported adequate sleep.¹⁰ He was advised to consume the same proprietary combination of specific maca phenotypes and more fibrous vegetables. After 12 weeks of use, he experienced a 31.5% and 259.9% increase in total and free testosterone, respectively, with improved lean body mass, depression, and generalized inflammation.¹⁰

Maca’s effects on men’s health are also demonstrated in clinical research. In a clinical trial involving men (>40 years of age) with symptoms of late-onset hypogonadism, black maca demonstrated statistically significant improvements in symptoms compared to placebo.¹⁸

Though limited, available evidence suggests that phenotype-specific maca may support male hormone and fertility concerns. Clinically, maca may be considered a supportive adjunct within a comprehensive diet and lifestyle framework.

Similar to maca, the phytochemical profile and fatty acid content of saw palmetto depend on processing methods, thereby influencing its clinical effects.¹³ This variability may explain its inconsistent effects on treating lower urinary tract symptoms in men.^19,20 A clinical trial in men (aged 40 to 65) with mild-to-moderate BPH symptoms found that higher β-sitosterol content in supercritical CO₂-extracted saw palmetto was a key factor in improving BPH symptoms and low testosterone levels compared to conventional saw palmetto oil and placebo.²¹

Specific maca phenotypes may support inflammatory modulation for prostate health, and cell study data suggest potential combined effects of saw palmetto and specific maca phenotypes.¹¹ In a human prostate cell study, raw maca was used to preserve the desired targeted bioactive compounds for prostate health that may be degraded by gelatinization. Results showed significant antioxidant potential of red maca extracts from small and large hypocotyls.¹¹ Red large maca independently inhibited COX-2, an enzyme implicated in prostate growth, by 48.5%.¹¹ Further, a combination of red large maca with black small maca and saw palmetto powder inhibited COX-2 by 87.9% (Figure 1).¹¹ Maca extracts exhibited cytotoxic effects against two prostate cancer cell lines, LNCaP (androgen-sensitive human prostate adenocarcinoma cells derived from the lymph node metastasis) and DU145 (primary prostate adenocarcinoma derived from a central nervous system metastasis).¹¹ The LNCaP cell line was most sensitive to treatment with maca extract, with black maca exhibiting significant effects independently and in combination with CO₂-extracted saw palmetto (Figure 2 ).¹¹

Figure 1. COX-2 Inhibition By Combine Maca & Saw Palmetto Samples

Figure 2. Cytotoxic Activity of Combined Maca and Saw Palmetto Samples

Human-based evidence suggests CO₂-extracted saw palmetto may support prostate health, while preliminary cell data indicate maca may contribute mechanistically and independently.^10,11,18,21 Hence, human clinical trials are needed to investigate efficacy.

Maca is generally well-tolerated, without any well-established contraindications. However, caution is advised in patients with hormone-sensitive conditions.

Conclusion

Diet and lifestyle play a foundational role in men’s health through various mechanisms, including mitigating oxidative stress and supporting HPAT axis function. Select botanicals may strengthen and complement these efforts. Notably, the case studies use a minimalist approach grounded in a comprehensive assessment of each patient’s health concerns and lifestyle. The interventions prioritize reinforcing existing supportive behaviors, introducing small but meaningful diet or lifestyle changes, and using specific maca phenotypes to strengthen support.

Although emerging research on maca suggests potential benefits for men’s health, studies using unspecified maca phenotypes restrict clinical applicability. Future research reporting specific maca phenotypes would improve clinical interpretability.

Disclosures

E.H., M.S, and D.M. are independent contractors for Symphony Natural Health. C.S. is on the Medical Team and lectures for Symphony Natural Health. K.R. is on the Medical Team for Symphony Natural Health. J.F. is the CEO of Symphony Natural Health and Director of Natural Health International (NHI-USA).

The manufacturer (NHI-USA) of the commercial maca and saw palmetto products, who donated part of the samples used in the cell study, had no role in the experimental design, analysis, interpretation of data, or in the decision to publish the results.

Funding

This manuscript was financially supported by Symphony Natural Health, manufacturer of the dietary supplement, Maca-OG™, used in the referenced case studies.

References

1. Cheng H, Zhang X, Li Y, et al. Age-related testosterone decline: mechanisms and intervention strategies. Reprod Biol Endocrinol. 2024;22(1):144. doi:10.1186/s12958-024-01316-5
2. Madersbacher S, Sampson N, Culig Z. Pathophysiology of Benign Prostatic Hyperplasia and Benign Prostatic Enlargement: A Mini-Review. Gerontology. 2019;65(5):458-464. doi:10.1159/000496289
3. Ma H, Sun J, Wu X, Mao J, Han Q. Percent body fat was negatively correlated with Testosterone levels in male. PLoS One. 2024;19(1):e0294567. doi:10.1371/journal.pone.0294567
4. Liu B, Wang X, Yang Z, et al. A genetic study to identify pathogenic mechanisms and drug targets for benign prostatic hyperplasia: a multi-omics Mendelian randomization study. Sci Rep. 2024;14(1):23120. doi:10.1038/s41598-024-73466-w
5. Whittaker J. Dietary trends and the decline in male reproductive health. Hormones (Athens). 2023;22(2):165-197. doi:10.1007/s42000-023-00431-z
6. Liu X, Li X, Cai D, Sun J, Bai W. Dietary patterns and testosterone balance: a review of clinical data and perspectives. J Adv Res. 2025;S2090-1232(25)00911-7. doi:10.1016/j.jare.2025.11.016
7. Mbiydzenyuy NE, Qulu LA. Stress, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-gonadal axis, and aggression. Metab Brain Dis. 2024;39(8):1613-1636. doi:10.1007/s11011-024-01393-w
8. Ma Y, Yu X, Liu YF, Song B, Sun Z, Zhao S. Immunoregulation and male reproductive function: impacts and mechanistic insights into inflammation. Andrology. 2025;13(6):1302-1321. doi:10.1111/andr.13772
9. Gao Y, Wang C, Wang K, He C, Hu K, Liang M. The effects and molecular mechanism of heat stress on spermatogenesis and the mitigation measures. Syst Biol Reprod Med. 2022;68(5-6):331-347. doi:10.1080/19396368.2022.2074325
10. Ross K, Schuler C, Sklar M. Optimizing Testosterone Levels and Fertility Outcomes: A Case Series on the Impact of Lepidium peruvianum(Maca-OGTM) in Andropause and Sperm Dysfunction. Am J Mens Health. 2024;18(6):15579883241304570. doi:10.1177/15579883241304570
11. Gaweł-Bęben K, Kukula-Koch W, Szwajgier D, et al. Synergism of Specific Maca Phenotypes (Lepidium peruvianum) in Combination with Saw Palmetto (Serenoa repens) Extract for Chemoprevention of Prostate Cancer as Determined in In Vitro Cytotoxicity Assays on Human Epithelial and Prostate Cancer Cells. Molecules. 2024;29(23):5632. doi:10.3390/molecules29235632
12. Minich DM, Ross K, Frame J, Fahoum M, Warner W, Meissner HO. Not All Maca Is Created Equal: A Review of Colors, Nutrition, Phytochemicals, and Clinical Uses. Nutrients. 2024;16(4):530. doi:10.3390/nu16040530
13. Penugonda K, Lindshield BL. Fatty acid and phytosterol content of commercial saw palmetto supplements. Nutrients. 2013;5(9):3617-3633. doi:10.3390/nu5093617
14. Feng J, He H, Wang Y, et al. The efficacy and mechanism of acupuncture in the treatment of male infertility: A literature review. Front Endocrinol (Lausanne). 2022;13:1009537. doi:10.3389/fendo.2022.1009537
15. Li X, Liu S, Liu H, Zhu JJ. Acupuncture for gastrointestinal diseases. Anat Rec (Hoboken). 2023;306(12):2997-3005. doi:10.1002/ar.24871
16. Wild B, Brenner J, Joos S, Samstag Y, Buckert M, Valentini J. Acupuncture in persons with an increased stress level-Results from a randomized-controlled pilot trial. PLoS One. 2020;15(7):e0236004. doi:10.1371/journal.pone.0236004
17. Benidir T, Remondini T, Lau S, Jarvi KA. Evaluation of patient compliance with the use of scrotal cooling devices. F S Rep. 2021;2(3):289-295. doi:10.1016/j.xfre.2021.06.007
18. Shin D, Jeon SH, Piao J, et al. Efficacy and Safety of Maca (Lepidium meyenii) in Patients with Symptoms of Late-Onset Hypogonadism: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. World J Mens Health. 2023;41(3):692-700. doi:10.5534/wjmh.220112
19. Kwon Y. Use of saw palmetto (Serenoa repens) extract for benign prostatic hyperplasia. Food Sci Biotechnol. 2019;28(6):1599-1606. doi:10.1007/s10068-019-00605-9
20. Franco JV, Trivisonno L, Sgarbossa NJ, et al. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database Syst Rev. 2023;6(6):CD001423. doi:10.1002/14651858.CD001423.pub4
21. Sudeep HV, Thomas JV, Shyamprasad K. A double blind, placebo-controlled randomized comparative study on the efficacy of phytosterol-enriched and conventional saw palmetto oil in mitigating benign prostate hyperplasia and androgen deficiency. BMC Urol. 2020;20(1):86. doi:10.1186/s12894-020-00648-9