Benefits
Male sexual function questionnaire scores
In a triple-blind placebo-controlled trial in 448 men reporting erection difficulties, one 500 mg SA3X capsule a day for 30 days raised Male Sexual Health Questionnaire scores more than placebo, its primary outcome, with unusually large erection score and duration differences. It is the single trial with this primary outcome; a testosterone trial by the same group reported higher scores as a secondary outcome. The maker supplied the capsules.
Serum testosterone levels in men
In a double-blind trial in 215 men aged 35 to 70 with erection difficulties and low testosterone, one SA3X capsule a day for three months raised serum testosterone, the stated primary outcome, by about 22 ng/dL versus about 2 ng/dL on a multivitamin placebo, still higher three months after stopping. A muscle trial and an uncontrolled study also reported rises; all come from one research group. Testosterone is a blood marker.
Muscle size and strength during resistance training
In a placebo-controlled trial in 546 healthy men, three months of SA3X with structured weight training was followed by larger increases than placebo in arm, chest and thigh measurements and in bench-press and squat results. The reported figures are very large for an herbal extract, the maker is listed as funder, and no other group has repeated them.
Blood cholesterol and triglyceride markers
In 279 men with raised blood lipids, SA3X capsules for three months lowered total cholesterol, triglycerides and LDL cholesterol versus placebo, but HDL cholesterol fell as well. The reported 53% total cholesterol drop with exercise is very large and hard to interpret. Lipids are blood markers only.
Mechanism of action
Spilanthol acts on sensory nerves in the mouth
Spilanthol produces tingling, pungency and numbing in the mouth. The related compound sanshool does this by blocking two-pore-domain potassium leak channels on trigeminal sensory neurons, and in mouse taste bud cells spilanthol heightened the response to sodium. This may help explain the altered taste reported in the SA3X trials.
Absorbed from the gut in animal studies
Spilanthol crossed a layer of human gut cells in the laboratory, was absorbed from the intestine after oral dosing in rats, and entered the brain quickly in mice after intravenous injection. This supports oral capsules, but how much spilanthol reaches tissues in people at 17.5 mg a day has not been measured.
Proposed hormonal action not mapped in people
The distributor proposes that SA3X raises testosterone by stimulating luteinizing hormone. The SA3X trials measured testosterone, and the muscle trial also estradiol and SHBG, but the published abstracts do not report luteinizing hormone, so the pathway behind the reported testosterone rise is unproven.
Clinical trials
Randomized, triple-blind, placebo-controlled parallel-group trial at two Apollo Hospitals centers in Hyderabad and Secunderabad, India (May to December 2021), with a non-randomized observational cohort; one SA3X capsule (500 mg Spilanthes acmella extract) nightly after dinner for 30 days, follow-up one month after stopping; primary outcome the between-group change in total Male Sexual Health Questionnaire (MSHQ) score at day 30; capsules supplied by the maker, Stiriti Ayur Therapies; no maker employees among the hospital-based authors, who declared no competing interests; registered CTRI/2021/05/033694, the same number the group's testosterone and lipid trials in different populations also report (Patnaik et al. 2022, Cureus)
448 men aged 18 to 45 with self-reported erection difficulties in the intention-to-treat analysis (152 SA3X, 146 placebo, 150 observational cohort); current users of PDE-5 inhibitors or testosterone supplements were excluded.
Primary outcome met: total MSHQ rose 17.24 points on SA3X versus 4.72 on placebo at day 30 (between-group difference 12.51, P<0.001) and stayed higher one month after stopping. The erectile function index (between-group difference 15.48 points) and self-reported erection duration (7.39 minutes, from a baseline under 2 minutes) also rose more than placebo (P<0.001); these changes are unusually large. Dysgeusia affected 3.94% on SA3X and none on placebo; no serious adverse events.
Randomized, double-blind, placebo-controlled parallel-group trial at Apollo Hospitals, Hyderabad, India (September 2021 to July 2022); one SA3X capsule (described as 500 mg Spilanthes acmella extract standardized to 3.5% spilanthol) or a multivitamin placebo daily for three months, follow-up at month 6, three months after stopping; primary outcome the change in serum testosterone; MSHQ, erectile function index and erection duration were secondary; subgroup analyses were not pre-specified; capsules provided by the maker, Stiriti Ayur Therapies; no financial support or conflicts declared; registered CTRI/2021/05/033694, the same number the group's sexual function and lipid trials report; PubMed indexes the paper as an editorial although the full text reports a trial (Patnaik et al. 2022, Maedica (Bucur))
215 men aged 35 to 70 with erection difficulties (MSHQ score 25 or less), serum total testosterone under 300 ng/dL and a sexual partner in the intention-to-treat analysis (105 SA3X, 110 placebo); testosterone supplement users were excluded and PDE-5 inhibitor users stopped one month before enrolling.
Primary outcome met: serum testosterone rose 21.85 ng/dL on SA3X versus 1.89 ng/dL on placebo at month 3 (P<0.001), from baselines of about 230 to 240 ng/dL, and 18.69 versus 1.79 ng/dL at month 6 after stopping (P<0.001). MSHQ, erectile function index and erection duration rose more than placebo from month 1 (treatment differences 14.53 points, 14.85 points and 6.01 minutes), unusually large changes. The testosterone effect differed by body-mass index, other health conditions and prior PDE-5 inhibitor use. Dysgeusia (7.61%) was the main side effect; three men on SA3X reported decreased semen volume; no serious adverse events.
Randomized, placebo-controlled parallel-group trial in Hyderabad, India; daily SA3X or placebo for three months, each with or without structured exercise; outcomes muscle circumference, bench-press and squat strength, total and free testosterone, estradiol and SHBG; primary outcome and dose not specified in the abstract; Europe PMC lists funding from the maker, Stiriti Ayur Therapies (grant STI1901IN); hospital and medical college authors (Mishra et al. 2025, J Complement Integr Med)
546 healthy men randomized to SA3X or placebo, with or without a structured exercise program.
In the exercise arms, SA3X beat placebo for mid-arm muscle circumference (10.54 vs 7.21 cm), chest circumference (15.23 vs 10.82), thigh measurement (12.84 vs 9.01), bench press (85.01 vs 65.09 kg) and squat (155.04 vs 95.06 kg), all p<0.05; the abstract reports these as increases, which would be implausibly large for three months of training. SA3X without exercise also increased muscle size more than placebo. Total and free testosterone rose more than placebo; estradiol did not. No significant adverse effects.
Randomized, placebo-controlled parallel-group trial; after a one-month control period, SA3X capsules (titled as 500 mg spilanthol, the same 500 mg product used in the other trials) or placebo for three months, each with or without standardized weight lifting four times a week; reported registration CTRI/2021/05/033694, the same number given for the sexual function and testosterone trials; funding not stated in the abstract (Mishra et al. 2024, J Complement Integr Med)
279 men with dyslipidemia randomized to four groups.
Both SA3X groups had larger falls than placebo in total cholesterol, triglycerides and LDL cholesterol, but HDL cholesterol also fell. By day 90 total cholesterol was 16.78% lower without exercise and 52.87% lower with exercise compared with placebo, a very large change. Triglycerides and LDL differed at days 60 and 90 (p=0.01 and p=0.03). C-reactive protein, creatine kinase and serum creatinine fell. Adverse events, mainly taste disturbance, were mild.
Uncontrolled longitudinal study in Hyderabad, India (November 2021 to May 2022); SA3X capsules (500 mg extract, 17.5 mg spilanthol) for three months with serum testosterone measured during treatment and at six months; capsules provided by Stiriti Ayur Therapies; authors declared no competing interests (Patnaik et al. 2022, Cureus)
326 sexually active men aged 25 to 60 with erection difficulties.
Mean serum testosterone rose from 309.84 ng/dL at baseline to 323.91 ng/dL at month 2 (p=0.03) and 332.27 ng/dL at month 3 (p<0.01), an adjusted change of 22.43 ng/dL. The rise was smaller in men with diabetes, high cholesterol or a history of substance use, and larger in men taking PDE-5 inhibitors. With no placebo group, the authors state causality cannot be established.