Plant compounds relax blood vessels and act weakly like estrogen in bone. Evidence is strongest for bone: preserved bone density and reduced back pain in women past menopause. Sexual function, the reason most people buy it, has no controlled human study. Liver injury, disturbed heart rhythm and muscle damage rest on scattered reports; products have repeatedly contained undeclared prescription drugs. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Alanine and aspartate aminotransferase | 10–26 U/L (women); 10–30 U/L (men) | Detects the idiosyncratic liver injury reported with Epimedium preparations |
| Total bilirubin | 0.3–1.0 mg/dL | Separates a harmless enzyme rise from genuine liver dysfunction |
| Creatine kinase | 40–200 U/L | Picks up the muscle injury described in the 2025 case report |
| Creatinine and estimated glomerular filtration rate | Creatinine 0.6–1.0 mg/dL (women), 0.8–1.2 mg/dL (men); eGFR above 90 mL/min/1.73 m² | Muscle breakdown and kidney strain track together |
| 25-hydroxyvitamin D | 40–60 ng/mL | Any bone effect depends on adequate vitamin D and calcium substrate |
| C-terminal telopeptide and procollagen type 1 N-terminal propeptide | CTX in the lower half of the premenopausal reference range; P1NP mid-range | Shows within 3–6 months whether bone breakdown is actually slowing |
| Bone mineral density by bone scan | T-score above −1.0, and change from the individual's own baseline | This is the outcome the one controlled human trial actually measured |
| Resting blood pressure | 110–125 / 70–80 mmHg | The vessel-relaxing action can add to blood-pressure-lowering treatment |
| Total and free testosterone (men) | Total 500–800 ng/dL; free 15–25 ng/dL | Tests the unproven androgen claim against the individual's own starting point |
| Estradiol (women) | No established target for this use; track change from the individual's own baseline | The flavonoids act at estrogen receptors, so a shift would be the signal of concern |
Cadence: Liver enzymes and creatine kinase at 6–8 weeks, then at 6 months, then every 6–12 months while use continues; blood pressure twice weekly for the first fortnight only; bone turnover markers at 3–6 months; density scan no sooner than 12–24 months.