Tongkat Ali Side Effects: What Research and Regulators Say

Short answer: At conventional doses, side effects of tongkat ali (Eurycoma longifolia) appear to be uncommon and mild, most often nausea, stomach discomfort, diarrhea, headache or rash. The US LiverTox database rates it as a possible but rare cause of liver injury, based mainly on one case report. In 2021 the European Food Safety Authority concluded that the safety of one tongkat ali root extract had not been established for use as a novel food. Long-term safety in humans has not been well studied.

Key Takeaways

• Reported side effects at normal doses are uncommon and usually mild: nausea, abdominal discomfort, diarrhea, headache and rash.
• LiverTox, run by the US National Institutes of Health, gives tongkat ali a likelihood score of D: a possible rare cause of clinically apparent liver injury.
• That rating rests largely on one case report in a man using a bodybuilding product, where other causes could not be ruled out.
• EFSA, the European food safety regulator, concluded in 2021 that the safety of a specific tongkat ali root extract had not been established as a novel food.
• Product quality varies widely, and there is no universal standard for purity or concentration.

What Is Tongkat Ali?

Tongkat ali is the root of Eurycoma longifolia, a shrub native to Malaysia, Indonesia, Thailand and Vietnam. It is also sold as longjack or Malaysian ginseng. In Southeast Asian traditional practice, the bitter root was boiled into a tonic for men’s vigor and energy. Today it is one of the most popular botanicals in men’s supplements.

Its main studied compounds are quassinoids such as eurycomanone, along with peptides and alkaloids. Standardized extracts are often labeled by their eurycomanone or “bioactive peptide” content.

Tongkat Ali Side Effects: What Has Been Reported

Common and mild side effects

According to LiverTox, side effects at conventional doses are uncommon and may include: ^[1]

• Nausea
• Abdominal discomfort
• Diarrhea
• Headache
• Rash

Short clinical studies at conventional doses did not find changes in standard liver blood tests. ^[1]

Liver injury

LiverTox describes a single case of a 47-year-old man who developed jaundice about a week after starting a bodybuilding supplement that contained tongkat ali. He improved after stopping the product. LiverTox notes that hidden anabolic steroid use is a possible explanation in bodybuilders, which weakens the link to tongkat ali itself. Based on this limited evidence, it rates tongkat ali as a possible rare cause of liver injury. ^[1]

The practical message: stop any supplement and see a doctor if you notice yellowing of the skin or eyes, dark urine or unusual fatigue.

The European regulator’s 2021 opinion

In 2021, EFSA’s expert panel reviewed an application to sell a tongkat ali root extract as a novel food in the European Union. The panel reported evidence of DNA damage in testing of that extract and concluded that its safety had not been established under the proposed conditions of use. ^[2] This opinion applies to that specific extract and application, but it is an important reason to choose carefully made products and to avoid very high doses.

Sleep, mood and hormones

Tongkat ali is often taken by men hoping to support testosterone. A 2022 systematic review and meta-analysis of clinical trials concluded that it improved total testosterone in men. ^[3] Because it can influence hormones, men with hormone-sensitive conditions, including prostate concerns, should speak to a doctor before using it. Some users anecdotally report restlessness or trouble sleeping, especially at high doses or when taken late in the day.

Product quality and contamination

LiverTox points out that there is no standardization of purity and concentration for tongkat ali extracts. ^[1] Quality problems with imported herbal products, including heavy metals and undeclared ingredients, are a known issue in the wider supplement market. Choose brands that disclose the exact amount per serving and test their products.

How Much Tongkat Ali Is Too Much?

For a full guide to amounts, see our article on tongkat ali dosage.

Who Should Avoid Tongkat Ali?

• Anyone with liver disease or a history of liver problems
• Men with hormone-sensitive conditions, including prostate concerns
• Anyone taking prescription medication, without first asking a healthcare provider
• Women who are pregnant or breastfeeding
• Anyone under 18

How to Lower Your Risk

• Stay within traditional amounts and avoid mega-dose bodybuilding products.
• Choose products that list the exact amount of tongkat ali per serving, with no proprietary blend.
• Avoid combining several products that each contain tongkat ali.
• Take it earlier in the day if it affects your sleep.
• Stop and see a doctor if you notice yellow skin or eyes, dark urine or unusual tiredness.

Tongkat Ali in Ultra Bann

Ultra Bann contains 85 mg of tongkat ali per serving, below the low end of the traditional 100 mg to 400 mg daily range, and you take one capsule every 2 days. It is combined with Thai Butea superba, Panax ginseng, Cynomorium, black ginger, epimedium and reishi, and every amount is printed on the label. See the full list on the Ultra Bann Ingredients page.

If you have a liver condition, take prescription medication or have any health concern, talk to your doctor before using Ultra Bann or any supplement that contains tongkat ali.

Frequently Asked Questions

Is tongkat ali safe to take every day?

Short studies at conventional doses have not found liver test changes, and reported side effects are uncommon. Long-term daily use has not been well studied in humans, so stay within traditional amounts and check with your provider.

Does tongkat ali cause hair loss?

There is no good clinical evidence that tongkat ali causes hair loss. Because it may influence testosterone, some men prone to hair loss choose to discuss it with their doctor first.

Does tongkat ali raise blood pressure?

Raised blood pressure is not listed among the reported side effects in LiverTox. If you have high blood pressure or take blood pressure medication, ask your provider before using it.

Is tongkat ali bad for the liver?

LiverTox rates it as a possible rare cause of liver injury, mostly based on one case report with possible other causes. Men with existing liver disease should avoid it unless a doctor approves.

Can women take tongkat ali?

Some studies have included women, but it should be avoided during pregnancy and breastfeeding. Women should talk to a healthcare provider before using it.

References

1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Tongkat Ali. National Institute of Diabetes and Digestive and Kidney Diseases. Updated October 18, 2024. NBK609015
2. EFSA Panel on Nutrition, Novel Foods and Food Allergens. Safety of Eurycoma longifolia (Tongkat Ali) root extract as a novel food pursuant to Regulation (EU) 2015/2283. EFSA Journal. 2021;19(12):6937. efsa.europa.eu
3. Leisegang K, et al. Eurycoma longifolia (Jack) Improves Serum Total Testosterone in Men: A Systematic Review and Meta-Analysis of Clinical Trials. Medicina. 2022. PMC9415500

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. This article is for information only and is not medical advice.