--- topic: "Ashwagandha" title: "Clinical Evidence and Dosing" order: 2 description: "Trial evidence for anxiety, sleep, testosterone, and thyroid plus KSM-66 vs Sensoril extract comparison and dosing guidance" question: "Does ashwagandha improve sleep, anxiety and testosterone, and what dose works?" answer: "Ashwagandha root extract likely improves sleep, anxiety and testosterone, based on small trials using 300–600 mg a day for 8 or more weeks." actions: - "For stress and sleep, trials used 300–600 mg a day of root extract for 6–8+ weeks, ideally in the evening for sleep [1][5]." - "Give it 4–8 weeks before judging whether it works." - "For testosterone or strength, trials paired 300 mg twice daily with resistance training for 8+ weeks [2]." cautions: - "It changes thyroid hormone levels: people with thyroid disease or on thyroid medication should use it only under medical supervision [4]." - "It is not a replacement for medical treatment of diagnosed conditions." confidence: 3 confidenceNote: "Five placebo-controlled RCTs, the longest 16 weeks; each outcome (sleep, testosterone, thyroid) rests on one or two small trials." evidenceSummary: rctCount: 5 observationalCount: 0 metaAnalysisCount: 0 replicated: true newestStudyYear: 2020 references: - id: "1" pmid: "31728244" title: "Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study" authors: "Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar D" year: 2019 journal: "Cureus" - id: "2" pmid: "26609282" title: "Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial" authors: "Wankhede S, Langade D, Joshi K, Sinha SR, Bhattacharyya S" year: 2015 journal: "Journal of the International Society of Sports Nutrition" - id: "3" pmid: "30854916" title: "A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha (Withania somnifera) in Aging, Overweight Males" authors: "Lopresti AL, Drummond PD, Smith SJ" year: 2019 journal: "American Journal of Men's Health" - id: "4" pmid: "28829155" title: "Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial" authors: "Sharma AK, Basu I, Singh S" year: 2018 journal: "Journal of Alternative and Complementary Medicine" - id: "5" pmid: "32226684" title: "Efficacy and Tolerability of Ashwagandha Root Extract in the Elderly for Improvement of General Well-being and Sleep: A Prospective, Double-Blind, Randomized, Placebo-Controlled Study" authors: "Kelgane SB, Salve J, Sampara P, Debnath K" year: 2020 journal: "Cureus" --- Clinical trials show that ashwagandha can help with anxiety, sleep, and stress. There is also emerging evidence for benefits in testosterone levels, muscle strength, and thyroid function. Two main extracts dominate the market: KSM-66 (root-only extract) and Sensoril (root and leaf extract). Typical effective doses range from 300 to 600 mg per day [1][2]. Results usually take 4 to 8 weeks to become noticeable. The herb is not a replacement for medical treatment of diagnosed conditions. ### Anxiety and Sleep Langade et al. (2019) conducted a 10-week RCT comparing 300 mg twice daily of ashwagandha root extract to placebo in adults with insomnia. The treatment group saw significant improvements in sleep onset latency, sleep efficiency, and total sleep time as measured by actigraphy. Those with comorbid anxiety also showed meaningful reductions on the Hamilton Anxiety Rating Scale [1]. ### Testosterone and Physical Performance Wankhede et al. (2015) studied KSM-66 at 300 mg twice daily in young men undergoing resistance training over 8 weeks. The ashwagandha group had significantly greater increases in muscle strength (bench press and leg extension) and testosterone levels, with a concurrent reduction in exercise-induced muscle damage as measured by serum creatine kinase [2]. Lopresti et al. (2019) found that 21 mg of withanolide glycosides per day (Shoden extract) in overweight men aged 40-70 increased DHEA-S by 18% and testosterone by approximately 15% compared to placebo over 16 weeks [3]. ### Thyroid Function Sharma et al. (2018) demonstrated that 600 mg/day of ashwagandha root extract normalized TSH, T3, and T4 levels in patients with subclinical hypothyroidism over 8 weeks, compared to placebo [4]. This is a meaningful finding but also a caution: people on thyroid medication should consult their doctor before using ashwagandha. ### KSM-66 vs Sensoril: Extract Comparison The two most clinically studied ashwagandha extracts differ in source material, standardization, and withanolide concentration: | Property | KSM-66 | Sensoril | |---|---|---| | Plant part | Root only | Root and leaf | | Withanolide content | ~5% withanolides | ~10% withanolide glycosides | | Typical dose | 300-600 mg/day | 125-250 mg/day | | Primary studied outcomes | Stress, testosterone, strength | Stress, cortisol, cognitive | KSM-66 is extracted using a milk-based process (consistent with traditional Ayurvedic preparation) and is standardized to at least 5% withanolides by HPLC. Most of the testosterone [2] and exercise performance literature uses KSM-66. Sensoril, which includes leaf material, achieves higher withanolide glycoside concentrations per milligram, meaning effective doses tend to be lower. Both extracts have demonstrated cortisol reduction and anxiolytic effects in RCTs, but head-to-head comparisons are lacking. Extract choice should be guided by the specific outcome of interest and dose tolerance. ### Detailed Evidence by Outcome **Sleep**: Langade et al. (2019) reported that sleep onset latency improved by 17 minutes versus 4 minutes in placebo (p < 0.05), and sleep efficiency rose from 75.6% to 83.5% in the treatment group [1]. A separate trial in elderly subjects using 600 mg/day confirmed improvements in sleep quality (PSQI) and mental alertness upon waking [5]. **Testosterone and androgens**: The Wankhede (2015) trial showed testosterone increases from baseline of 96.2 ng/dL to 120.5 ng/dL in the ashwagandha group, compared to a slight decline in the placebo group [2]. Lopresti et al. (2019) measured a 14.7% increase in testosterone versus 2.8% in placebo (p < 0.05) using a different extract at a lower withanolide dose, suggesting the effect is not exclusive to KSM-66 [3]. **Thyroid**: The Sharma et al. (2018) study of 50 subclinical hypothyroid patients showed significant normalization across all thyroid markers after 8 weeks at 600 mg/day. Serum TSH decreased from 5.46 to 4.19 mIU/L (p < 0.001) in the treatment group, while T3 and T4 levels increased toward normal ranges [4]. This finding carries a strong clinical implication: ashwagandha may interfere with thyroid medication dosing and should not be used without medical supervision in patients with thyroid disease. ### Dosing Summary - **General stress and anxiety**: 300-600 mg/day of root extract (KSM-66) or 125-250 mg/day (Sensoril), taken for at least 6-8 weeks. - **Sleep**: 300 mg twice daily (KSM-66) or 600 mg/day root extract, ideally taken in the evening [1][5]. - **Testosterone and exercise**: 300 mg twice daily KSM-66, combined with a resistance training program, for 8+ weeks [2]. - **Thyroid support**: Only under medical supervision. Studied at 600 mg/day for 8 weeks [4]. Cycling (e.g., 8 weeks on, 2-4 weeks off) is commonly recommended in practice, though no studies have directly evaluated cycling protocols.