(294) Effects of Tribulus Terrestris and Brief Sexual Counseling on Desire and Sexual Function in Reproductive-Aged Women with Hypoactive Sexual Desire Disorder

Introduction Hypoactive Sexual Desire Disorder (HSDD) is the most prevalent female sexual dysfunction during the reproductive phase, affecting overall well-being and intimate relationships. Tribulus terrestris (TT), a phytotherapeutic compound rich in protodioscin, has been described as a modulator of steroidogenesis and a potential agent for improving sexual desire. Structured psychosocial interventions, such as brief sexual counseling based on the PLISSIT model, may act synergistically. This study evaluated the hormonal and functional effects of TT, administered alone or in combination with PLISSIT-based counseling, in reproductive-aged women diagnosed with HSDD. Objective To analyze the effects of Tribulus terrestris on the Female Sexual Function Index (FSFI) domains and on serum levels of total, free, and bioavailable testosterone in reproductive-aged women with HSDD, comparing the isolated pharmacologic effect with the combined psychosexual approach. Methods This retrospective observational study (2016–2024), interrupted between 2020 and 2022 due to the COVID-19 pandemic, included 194 reproductive-aged women (22–53 years) clinically diagnosed with HSDD. Participants were allocated into three groups: (1) TT (equivalent to 112 mg of protodioscin) combined with brief sexual counseling following the PLISSIT model (6 biweekly sessions); (2) TT administered alone; (3) brief sexual counseling only (PLISSIT model). The FSFI and hormonal parameters were assessed before and after 90 days of treatment. Paired t-tests and one-way ANOVA were applied, with significance set at p < 0.05 and effect size calculated using Cohen’s d and η2. Results Both TT groups showed significant increases in total FSFI scores (Group 1: 18.8 → 25.7; d = 1.14 / Group 2: 19.8 → 25.5; d = 1.64; p < 0.001) and marked improvements in the Desire (d = 1.69) and Orgasm (d = 1.68) domains. TT also produced significant elevations in total testosterone (14.7 → 18.1 ng/dL; p < 0.001; d = 0.62), free testosterone (0.28 → 0.38 ng/dL; p < 0.001; d = 0.87), and bioavailable testosterone (1.72 → 2.11 ng/dL; p < 0.001; d = 0.77). Brief sexual counseling alone yielded moderate improvements in the satisfaction and desire domains, without relevant hormonal changes. When comparing interventions, stronger and more consistent effects were observed in TT-treated groups, regardless of the addition of counseling. These findings are detailed in Table 1, which presents the Female Sexual Function Index (FSFI) baseline and post-treatment scores in reproductive-aged women with HSDD (n = 194), and in Table 2, which summarizes the Serum Testosterone Levels (Mean ± SD) before and after treatment. Conclusions Tribulus terrestris (equivalent to 112 mg of protodioscin) proved effective in improving sexual function and enhancing androgen levels in reproductive-aged women with HSDD. Brief sexual counseling based on the PLISSIT model amplified subjective outcomes, reinforcing the importance of an integrated pharmacological and psychosocial approach. The study contributes to validating TT as a safe and effective alternative for the management of female HSDD. Disclosure No