Benign prostatic hyperplasia, or enlarged prostate, increases the frequency and urgency of urination. It also causes a weak stream, straining and retention. Remarkably, it will affect the quality of life of more than half of all men in their lifetime and 90% of men over 85.
The available drugs have frequent side effects, including sexual dysfunction. The extract of the herb saw palmetto berry has been shown to be comparable to the drugs for improving symptoms and for reducing the size of the enlarged prostate. But, while it is at least as effective, it is much safer and does not cause sexual dysfunction: in fact, it improves erectile dysfunction. A just published review compared the herb to the drugs and put all the evidence together (Drugs & Aging 2022;39:235-43).
In a head-to-head study with the α-blocker tamsulosin, saw palmetto was just as effective at reducing International Prostate Symptom Scores. It was just as good at improving urinary flow and prostate volume. For men with severe symptoms, it was better (Eur Urol. 2002;41(5):497–506).
A second comparison study also showed saw palmetto to be as good as the drug (Prostate. 2015;75(16):1857–67). Since then, other studies have proven saw palmetto to be the equal of α-blockers and 5α reductase inhibitors (Int Urol Nephrol. 2016;48(5):645–56; Prog Urol. 2020;30(10):522–31). Studies have also continued to show that, unlike the drugs, saw palmetto actually significantly improves erectile dysfunction (Urol Androl. 2012;84(2):94–8).
In real-world studies, saw palmetto is better tolerated than α-blockers and 5α-reductase inhibitors. In one of the studies, 16% of men suffered adverse events on α-blockers and 14% suffered adverse events on 5α-reductase inhibitors while only 1% of the men on saw palmetto did (Int Urol Nephrol. 2016;48(5):645– 56).
The dose of saw palmetto berry extract used in the studies was 320mg a day that is standardized for fatty acids (often 85%-95%).
Based on results like these, the European Association of Urology guidelines now recommend saw palmetto berry as a treatment option for men who want to avoid the side effects of the drugs, especially sexual side effects.
In systematic reviews and meta-analyses, saw palmetto has been shown to improve erectile dysfunction and to cause significantly less ejaculation disorders, ejaculatory dysfunction and less loss of libido.