Vitex, also called chasteberry, chaste tree, agnus castus or monk’s pepper, is the dried fruit of the shrub Vitex agnus-castus. It is sold as a herbal medicine in Europe and as a dietary supplement in the US. Its main researched use is premenstrual syndrome (PMS) in adult women, and online it is also promoted as a natural way to lower prolactin, the pituitary hormone that drives milk production.
The most important fact is how little of this applies to men. The European Medicines Agency (EMA) says a reduction of elevated prolactin by vitex has “not been conclusively proven” in humans, even though lab studies point to a dopamine-like action (EMA monograph, 2018). The controlled data in men come from about 26 healthy volunteers, and the lowest daily dose in the main study raised prolactin rather than lowering it (Merz et al., 1996). We found no study of vitex in men with high prolactin, or in people using anabolic steroids.
This page summarizes what EU regulators, clinical trials and systematic reviews report. It is for education only and is not medical advice.
| Property | Detail |
|---|---|
| Type | Herbal medicine (EU); dietary supplement (US) |
| Plant part | Whole ripe dried fruit of Vitex agnus-castus L. |
| EU well-established use | PMS in adult women: 20 mg/day of one dry extract type, for three months |
| Other EU listing | Traditional use for minor premenstrual symptoms: powder, tincture and two other dry extracts |
| Studied doses in cited trials | 20 mg/day (Ze 440 extract); 4 mg/day of extract equal to 40 mg of fruit (BNO 1095 extract); 120–480 mg/day of fruit equivalent in men |
| Proposed mechanism | Diterpenes that act on dopamine D2 receptors in lab studies; EMA states the mode of action “is not known” |
| Half-life | Not established; EMA reports no pharmacokinetic studies |
| Evidence in men | About 26 healthy volunteers; no patients with high prolactin; no steroid users |
| WADA status | Not named on the 2026 Prohibited List |
What it is
Vitex agnus-castus is a shrub or small tree native to Mediterranean Europe, central Asia and parts of India (EMA assessment report, 2018). The name “chasteberry” may reflect an old belief that it promoted chastity, and monks reportedly used it in the Middle Ages to lower sexual desire (NCCIH, 2025).
The fruit contains essential oils, iridoid glycosides such as agnuside, diterpenes such as rotundifuran and vitexilactone, and flavonoids such as casticin and apigenin (LactMed, 2024).
Extracts and standardization
The European Pharmacopoeia requires at least 0.08% casticin in the dried fruit and at least 0.10% in a dry extract (EMA assessment report). Casticin is a quality marker, not a proven active ingredient. In the receptor assay EMA describes, casticin did not affect binding at the D2 receptor, while certain diterpenes did. A product can therefore meet its marker specification without that number saying anything about its dopamine-active content.
Doses are hard to compare because “mg” can refer to extract or to the crude fruit it came from. Each extract also has a drug-extract ratio (DER), the amount of dried fruit used per unit of finished extract.
| Product in the literature | Stated dose | What it contains | Basis |
|---|---|---|---|
| Ze 440 | 20 mg/day | Dry extract, DER 6–12:1, 60% m/m ethanol; equal to 180 mg of fruit | EMA assessment report |
| BNO 1095 | 4.0 mg/day | Dry extract, 70% ethanol; equal to 40 mg of fruit | He et al., 2009 |
| Strotan | “20 mg”/day | Per German regulator data, 0.6 mg of dry extract, equal to 20 mg of fruit | EMA assessment report |
| BP1095E1 | 120, 240 or 480 mg/day | Extract from that amount of fruit | Merz et al., 1996 |
So “20 mg” can mean 180 mg of fruit in one trial and 20 mg of fruit in another, a ninefold difference.
How it works in the body
The proposed dopamine mechanism
Dopamine released from the hypothalamus restrains prolactin secretion by acting on D2 receptors in the pituitary. Vitex is proposed to act at the same receptor as drugs such as bromocriptine and cabergoline (Puglia et al., 2023). The evidence for this comes mainly from the lab:
- Rat pituitary cells. Extract lowered prolactin release but not LH or FSH release, and it contained a component that bound the D2 receptor (Jarry et al., 1994).
- Receptor binding. An ethanol extract blocked D2 binding in calf brain tissue with an IC50 (the concentration giving half-maximal inhibition) of 40–70 µg/mL. Activity sat in the fat-soluble fraction (EMA assessment report).
- Human D2 receptors in cell culture. In 2024, a functional assay identified viteagnusin I (EC50 6.6 µM), rotundifuran (12.8 µM) and the triterpene 3-epi-maslinic acid (5.1 µM) as active, while vitexilactone was not. Four authors worked for the maker of Ze 440 (Reinhardt et al., 2024).
These are cell and tissue results. Because no human pharmacokinetic studies exist, it is unknown whether these compounds reach the human pituitary at active concentrations.
Other proposed actions
- Estrogen receptors. Results conflict. Some extracts bound estrogen receptor beta preferentially, one bound both alpha and beta, and one showed no activity in a yeast system.
- Opioid receptors. Extracts bound mu and kappa receptors in vitro, and EMA mentions possible beta-endorphin-like activity.
- Liver enzymes. A hydroethanolic extract inhibited CYP1A2, CYP2C19, CYP2D6 and CYP3A4 in vitro. EMA doubts this translates into clinically significant interactions.
All three are summarized in the EMA assessment report, which concludes that the mode of action is not known.
Regulatory status
The EU herbal monograph
The EMA’s herbal committee (HMPC) adopted the current monograph on 27 March 2018. It is written for “female adults,” and use under age 18 is not recommended because of a lack of data (EMA monograph). It does not list men as a population or any male indication.
| Category | Preparation | Daily dose | Indication |
|---|---|---|---|
| Well-established use | Dry extract, DER 6–12:1, 60% m/m ethanol | 20 mg once daily | Treatment of PMS; continued use over three months recommended |
| Traditional use | Powdered fruit | 800 mg (400 mg twice daily) | Minor symptoms in the days before menstruation |
| Traditional use | Tincture 1:5, 68–70% V/V ethanol | 165 mg once daily | Same |
| Traditional use | Dry extract, DER 7–13:1, 60% m/m ethanol | 4 mg once daily | Same |
| Traditional use | Dry extract, DER 10.0–18.5:1, 50–52% m/m ethanol | 2–3 mg once daily | Same |
“Traditional use” means the listing rests on long-standing use, not on proof of efficacy. The well-established use listing rests mainly on one placebo-controlled trial, Schellenberg 2001.
In 2018 the HMPC considered other indications and did not accept them (EMA assessment report):
| Proposed use | HMPC position |
|---|---|
| Breast pain (mastodynia) | Data not accepted as proof of efficacy; a physician is needed for diagnosis |
| Luteal phase insufficiency | Rejected; the TRH test used in the key trial “appears to be questionable” |
| Menstrual bleeding disorders | Not sufficient; no controlled trials |
| Prolactinoma | Not sufficient; no controlled trials |
| Acne, breastfeeding, menopausal symptoms | Not sufficient; no controlled trials |
EMA opened a call for scientific data for a periodic review from 15 February to 15 May 2024. When checked in November 2026, its page still listed the status as an ongoing call for data, with the 2018 text as the latest adopted monograph (EMA herbal summary page).
United States
Chasteberry is marketed as a dietary supplement. Supplements are not approved by the FDA before sale, and manufacturers are responsible for their safety (NCCIH, 2025).
What the research shows
Prolactin in humans
Almost all clinical prolactin data come from women. The results are mixed, and the two best-known positive studies have design limits.
| Study | Who | Dose and comparison | Prolactin result | Main limit |
|---|---|---|---|---|
| Milewicz et al., 1993 | 52 women with “latent” high prolactin; 37 analyzed (17 vs 20) | “20 mg”/day vs placebo, 3 months | Prolactin release after TRH injection fell | EMA considers the TRH test unreliable; 15 not analyzed |
| Kilicdag et al., 2004 | 40 women with mild high prolactin | 40 mg/day vs bromocriptine 2.5 mg twice daily, 3 months | 945.66 to 529.19 mIU/L with vitex; 885.04 to 472.68 mIU/L with bromocriptine; no difference between groups | No placebo; brief report |
| Wuttke et al., 1997 (per Puglia et al., 2023) | 101 women with cyclic breast pain | Solution or tablets vs placebo, 3 months | Basal prolactin lower than placebo | Read through a review only |
| Ma et al., 2010 (per Puglia et al., 2023) | 67 women with PMS | BNO 1095 vs placebo, 3 cycles | No significant fall in serum prolactin | Prolactin was not the primary outcome |
| Shahnazi et al., 2016 (per Puglia et al., 2023) | 70 women with PCOS | Vitex vs low-dose oral contraceptive, 3 months | No significant change | Read through a review only |
The Kilicdag numbers are from the table in the Puglia review, because the brief report has no abstract. The summaries we could read do not make clear whether “40 mg” means extract or crude fruit.
The 2023 review in Frontiers in Endocrinology found no large randomized trials and concluded that “it is not possible to reach any solid conclusions” on vitex in high prolactin. Its authors think it might be a reasonable option for selected patients with mild elevation who want herbal treatment, while saying the established dopamine agonists should be offered first (Puglia et al., 2023).
Two case reports involve pituitary tumors. In one, prolactin fell from 2207 to 1766 mU/L (reference 50–600) and the microadenoma was unchanged on MRI. In the other, prolactin fell from 2166 to 1588 IU/L (reference 80–600) and periods returned while a 2 mm microadenoma was still present (EMA assessment report; Puglia et al., 2023). In both, prolactin stayed well above the reference range. The second case was published as a prolactinoma masked by the remedy, and the EMA monograph carries a matching warning.
Dose dependence
Low and high doses may push prolactin in opposite directions. LactMed summarizes this as low doses increasing serum prolactin and high doses decreasing it (LactMed, 2024). EMA says the effect “seems to be dependent on the dose administered and the initial level of prolactin concentration.”
The clearest controlled human demonstration is the study in men described below, and the pattern does not line up neatly across studies. Milewicz reported lower stimulated prolactin in women at a dose equal to 20 mg of fruit, while Merz reported higher prolactin in men at 120 mg of fruit. Sex, baseline prolactin, the extract and the test all differed, so no threshold can be read across studies. The authors of the male study suggested that the extract may contain both dopamine-blocking and dopamine-activating components, but this remains a hypothesis.
Data in men
We found only these human data in men, all from healthy volunteers. The 20 men in the third study may overlap with those in the first, since doses and duration match.
| Study | Who | Dose | Prolactin | Testosterone, LH, FSH |
|---|---|---|---|---|
| Merz et al., 1996 | 20 healthy men | Extract from 120, 240 or 480 mg of fruit daily vs placebo, 14 days each | 120 mg: 24-hour profile and TRH-stimulated prolactin rose. Higher doses: slight fall in 24-hour profile. 480 mg: TRH-stimulated prolactin fell | No influence on testosterone, LH or FSH reported (EMA assessment report) |
| Vogel 2001, a thesis summarized by EMA | 6 healthy men | Single doses of 1.5, 15, 30 or 60 mg of extract vs bromocriptine 2.5 mg and placebo | No effect at any vitex dose; bromocriptine lowered prolactin in all men | No effect on LH, testosterone or estradiol at any vitex dose; FSH was measured but its result is not stated |
| Dericks-Tan et al., 2003, summarized by EMA | 20 healthy men | 70% ethanol extract, 120–480 mg/day, 14 days | Not the focus; melatonin secretion rose with dose | Not reported in the summary |
For rough scale, the EU’s 20 mg extract dose equals about 180 mg of fruit, which falls between the 120 mg dose that raised prolactin and the 240 mg dose that lowered it slightly. The extracts differ, so this comparison is only a rough guide. Fourteen days in healthy men also says nothing about longer use.
In male mice, 30 days of injected extract into the abdominal cavity lowered LH and testosterone, as bromocriptine did (Nasri et al., 2007). The route and doses (165–365 mg/kg) do not resemble human oral use, and the 14-day human data did not show this effect. Long-term effects on testosterone in men have not been studied.
We found no controlled human trial in men measuring sexual desire, sperm or fertility, muscle, or breast tissue. The medieval idea that vitex lowers male desire has not been tested in trials, and neither has the reverse idea, mentioned without data in the 2023 review, that it may increase male libido. The EU monograph states that no fertility data are available.
Why this does not transfer to men or to steroid-related prolactin
Evidence gap. No published trial has tested vitex in men with high prolactin, in men with breast symptoms, or in anyone taking anabolic steroids. Statements that vitex manages “prolactin side effects” of steroids such as nandrolone or trenbolone are extrapolations, not findings.
The extrapolation fails at several points:
- Different condition. The positive female studies involve premenstrual symptoms, cyclic breast pain and “latent” high prolactin, which reviewers tie to the menstrual cycle (Puglia et al., 2023). Men do not have this cycle, so these results cannot be carried over.
- Different baseline. EMA says the effect depends on starting prolactin. The men studied were healthy, not men with raised levels.
- Unknown direction at low doses. In the main male study, the lowest dose raised prolactin. Supplement content varies widely (see Quality below), so the dose a product actually delivers relative to these study doses is often unknown.
- Unknown hormonal setting. The effect of vitex on prolactin during high androgen or estrogen exposure has not been studied. EMA also considers estrogen-like effects possible and unresolved.
The human data on prolactin in steroid users are themselves thin; see cabergoline. For high prolactin, the drugs with regulatory approval and controlled trial data are dopamine agonists such as cabergoline and bromocriptine. Pramipexole is a dopamine agonist approved for other conditions. The small head-to-head data do not make vitex interchangeable with these drugs: bromocriptine lowered prolactin in the male experiment where vitex did nothing. Mucuna pruriens and P5P are other supplements with prolactin claims, each with its own limited evidence.
Premenstrual syndrome (women only)
This is the best-studied use.
| Study | Design and who | Preparation | Result |
|---|---|---|---|
| Schellenberg, BMJ 2001 | Double-blind RCT; 170 women evaluated (86 vs 84), three cycles | Ze 440, 20 mg/day | Main symptom score improved more than with placebo (P under 0.001); responders (50% symptom reduction) 52% vs 24%; manufacturer-sponsored |
| Schellenberg et al., 2012 | Double-blind dose-finding RCT; 162 women aged 18–45, three cycles | Ze 440, 8, 20 or 30 mg/day vs placebo | 20 mg beat placebo and 8 mg; 30 mg was not significantly better than 20 mg |
| He et al., 2009 | Double-blind RCT; 217 Chinese women with moderate to severe PMS, three cycles | BNO 1095, 4.0 mg extract (40 mg of fruit) | Diary score 29.23 to 6.41 vs 28.14 to 12.64 with placebo (P under 0.0001); authors report a 50% placebo effect |
Pooled analyses agree on direction but disagree on confidence:
- Verkaik et al., 2017 found 17 RCTs, of which 14 entered quantitative analysis. In the placebo-controlled trials the pooled effect was large (Hedges g −1.21; 95% CI −1.53 to −0.88), but heterogeneity was extreme (I² 91%), most trials had a high risk of bias and there were signs of publication bias. The authors call the result “merely explorative” and likely an overestimate.
- Csupor et al., 2019 kept only trials of properly characterized products. Of 21 trials, 3 qualified (520 women). Women on vitex were 2.57 times as likely to have symptom remission as those on placebo (95% CI 1.52–4.35).
- van Die et al., 2013 reviewed 12 RCTs. For premenstrual dysphoric disorder (PMDD, a severe form), one trial found vitex equivalent to fluoxetine and fluoxetine outperformed vitex in the other.
An EMA-reviewed trial (Lauritzen et al., 1997) used vitamin B6 as the comparator in 127 women: vitex (about 40 mg of fruit daily) vs pyridoxine 100 mg twice daily during part of the cycle. Scores fell by 10.1 vs 6.8 points (P = 0.0377), but the vitex group started higher (15.2 vs 11.9), and both groups ended at the same mean of 5.1. The authors concluded only that vitex was at least as effective (EMA assessment report). NCCIH rates the PMS studies as low to moderate quality (NCCIH, 2025).
Cyclic breast pain (women only)
A 2020 review included 25 studies. A conservative meta-analysis of six studies (718 women; 356 on vitex, 362 on placebo) showed a moderate benefit (SMD 0.67; 95% CI 0.5–0.85), typically at 20–40 mg/day for three months. Risk of bias was unclear in most studies (Ooi et al., 2020).
The advantage over placebo may not be stable. In a double-blind trial of a vitex solution in 97 women (48 vs 49), with pain scored on a 100 mm visual analog scale, the difference from placebo was borderline by the third cycle (Halaska et al., 1999):
| Cycle | Mean pain reduction, vitex | Mean pain reduction, placebo | P |
|---|---|---|---|
| 1 | 21.4 mm | 10.6 mm | 0.018 |
| 2 | 33.7 mm | 20.3 mm | 0.006 |
| 3 | 34.3 mm | 25.7 mm | 0.064 |
Reviewers and regulators disagree here. Ooi and colleagues call vitex safe and effective for this use, but EMA did not accept the data as proof of efficacy. None of this applies to breast pain or breast growth in men, which these trials did not study.
Menstrual disorders (women only)
A 2019 review of five studies found no significant effect on bleeding amount vs placebo in the first cycle (mean difference 3.08; 95% CI −3.11 to 9.26) or the second (0.00; 95% CI −5.75 to 5.75). The studies were of relatively low quality (Mollazadeh et al., 2019). NCCIH says there isn’t enough reliable evidence for infertility, and that one low-quality study suggested benefit for heavy bleeding related to an IUD (NCCIH, 2025).
A Swiss observational study of Ze 440 in 211 women with cycle irregularities reported remission or improvement in 79–85% at follow-up. With no control group, EMA says proof of efficacy cannot be derived from it. Its 2018 report judged the data insufficient for bleeding disorders (EMA assessment report).
Side effects and risks
General tolerability
In trials, adverse effects in women were usually mild and reversible. The most frequent are nausea, headache, digestive upset, menstrual disorders, acne, itching and rash (Daniele et al., 2005). In Schellenberg 2001, 4 women on vitex and 3 on placebo reported mild events.
EMA reports no serious adverse events in any trial, with exposure in more than 6,000 women. Severe allergic reactions with face swelling, shortness of breath and difficulty swallowing are still listed, from pharmacovigilance reports, with unknown frequency (EMA monograph). Research safety data extend to about 3 months (NCCIH, 2025).
What was reported in men
The EMA assessment report summarizes two reports of 14-day dosing in 20 healthy men, and they may describe the same experiment:
- One records 18 men with 26 adverse reactions, including dry mouth, disturbed perception, slight confusion, slight activated states and itching in the palate and nose. EMA says these reactions are expected with dopaminergic compounds.
- The other records 13 of 20 men with 27 adverse events, including slight confusion, eczema with itching, digestive complaints, headache, increased activity and fatigue, with no clear link to rising dose. Thromboplastin time (a clotting test) was 3–5% longer at the two higher doses.
EMA does not explain the difference in counts, which may reflect different reporting criteria. No reliable rate exists from so few men.
Pregnancy and breastfeeding
EMA reports no data in pregnant women, calls animal reproductive data insufficient, and does not recommend use in pregnancy. It also does not recommend use during breastfeeding, because animal data suggest an effect on lactation and it is unknown whether vitex enters human milk (EMA monograph). LactMed advises avoiding it during lactation. It notes 15 cases of itching, rash or hives among 352 nursing mothers given a tincture, and that no valid trials support its use to increase milk supply (LactMed, 2024).
Pituitary tumors and hormone-sensitive cancers
- Prolactin-secreting tumors. EMA warns that vitex “can mask symptoms of the tumour” and that people with a history of a pituitary disorder should consult a doctor before use.
- Estrogen-sensitive cancer. People with current or past estrogen-sensitive cancer are told to consult a doctor first (EMA monograph). NCCIH says it may not be safe for women with hormone-sensitive conditions such as breast, uterine or ovarian cancer (NCCIH, 2025).
Liver
EMA treats signs of liver toxicity in two rat studies (4 and 26 weeks) as a signal, with effects at all doses in the longer study. It did not add a warning, because no matching findings emerged from clinical trials or case reports. Lab values were unaffected in Ze 440 trials, but EMA reports no such data from efficacy trials of other preparations (EMA assessment report). LiverTox says oral chaste tree has not been implicated in enzyme elevations or clinically apparent liver injury (LiverTox, 2023). Tests for mutagenicity and carcinogenicity have not been performed.
Interactions
No interaction has been reported in humans, but we found no dedicated interaction study with any of the drugs or supplements below. The EMA wording is that interactions “cannot be excluded.”
| Combined with | What is known | Source |
|---|---|---|
| Dopamine agonists: cabergoline, bromocriptine, pramipexole | Not studied together; interaction cannot be excluded; patients are told to consult a doctor | EMA monograph |
| Dopamine antagonists such as antipsychotics or metoclopramide | Theoretical interference; these drugs can also raise prolactin | Daniele et al., 2005; Puglia et al., 2023 |
| Mucuna pruriens (a levodopa source) | No data; not named by EMA | Our search |
| Estrogens and anti-estrogens | Not studied; interaction cannot be excluded | EMA monograph |
| Oral contraceptives | No interaction found so far, though reviewers say this needs dedicated study | Puglia et al., 2023 |
| Testosterone or anabolic steroids | No data | Our search |
Quality
Clinical results from one extract do not automatically apply to another, and this matters most outside regulated medicines. A 2014 analysis compared 7 medicinal products with 17 health foods from Japan and the US. Medicinal products had similar chemical profiles, while health foods varied widely, with relative marker amounts of 14–5054% for agnuside and 3–1272% for casticin. In about half of the health foods, the marker ratio looked closer to a related Chinese herb, Vitex negundo, than to the standard fruit, which does not prove substitution but raises the question (Fukahori et al., 2014). The lead author’s listed affiliation is a pharmaceutical company.
Together with the “mg” problem above, this means a supplement’s label often cannot be matched to a trial dose, or to either side of the prolactin dose pattern seen in men.
Legal status and use in sport
Vitex is not named on the WADA 2026 Prohibited List.
Key takeaways
- A women’s herbal medicine. The EU recognizes one 20 mg/day dry extract type for PMS in adult women, plus traditional-use preparations for minor premenstrual symptoms, and it writes its dosing only for female adults.
- PMS evidence is positive but flawed. Trials consistently favor vitex over placebo, yet the largest meta-analysis calls its own pooled effect exploratory because of bias and extreme heterogeneity.
- Prolactin lowering is unproven in humans. Lab studies support a D2 action, but EMA says a fall in elevated prolactin is not conclusively proven, and clinical results are mixed.
- Men: almost no data, and the direction varied. In 20 healthy men, the lowest dose raised prolactin and higher doses lowered it; in 6 men, single doses did nothing while bromocriptine worked.
- Nothing in steroid users. No trial has tested vitex for prolactin raised by steroid use or for gynecomastia, so female results and healthy-volunteer data do not establish any benefit there.
- Safety data are mostly in women and short term. Effects are usually mild, but use is not recommended in pregnancy or lactation, it can mask a prolactinoma, and interactions with dopamine-acting drugs and estrogen-related drugs cannot be excluded.
Sources
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- World Anti-Doping Agency. The 2026 Prohibited List. WADA 2026 Prohibited List.