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Open Source Apothecary At Home / Urinary and reproductive
Saw palmetto is the most studied and the largest trials found no better than placebo. That is the finding.
remedyBenign prostatic hyperplasia is a non-cancerous enlargement of the prostate causing lower urinary tract symptoms: frequency, nocturia, weak stream, hesitancy. It is common with age and it is important to distinguish it from prostate cancer, which is why a man with new urinary symptoms needs assessment rather than a supplement.
Saw palmetto is the important honest entry. It is the most-used herb for BPH and the most-studied. In the largest and best-designed randomised trials — including the STEP trial and the CAMUS trial, both of which used higher doses and longer follow-up than the earlier positive studies — saw palmetto was not better than placebo for urinary symptoms. The earlier positive trials were smaller and shorter. This is the classic pattern of a herb whose effect dissolved under better testing, and a handbook that reported only the earlier trials would be misleading.
Nettle root has small trials showing modest symptom improvement, often in combination. Pygeum africanum has small trials and a signal, of low quality. Beta-sitosterol (a plant sterol) has small trials showing improvement.
What actually works. For mild symptoms: reducing evening fluid intake, reducing caffeine and alcohol, and treating constipation. Alpha-blockers (tamsulosin and others) work quickly and are effective. 5-alpha-reductase inhibitors (finasteride) shrink the prostate and reduce the risk of retention and surgery, with sexual side effects. Combination therapy. Surgery for severe or refractory cases. And an assessment to exclude prostate cancer and to check kidney function — a man with a rising creatinine from obstruction needs treatment, not a supplement.
The overactive bladder point. Frequent urination can be BPH, or overactive bladder, or diabetes, or a diuretic, or a urinary infection. The distinction matters because the treatments differ and because the causes that need looking for are not prostate supplements.
Electrical parameters may impact effectiveness (in favour of 10 Hz, motor threshold).PubMed 40711757 ↗
In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL.PubMed 39106788 ↗
For safety, most anticholinergic drugs were more likely to cause dry mouth and constipation, lower doses were better tolerated.PubMed 37506033 ↗
There is evidence of significant improvement in OAB symptoms using PTNS which is comparable to the effect of antimuscarinics but with a better side effect profile.PubMed 22581511 ↗
Some, like Serenoa repens and Roystonea regia, are the sources of drugs that have been approved for medicinal uses.PubMed 20034398 ↗
Randomized studies of Serenoa repens, alone or in combination with other plant extracts, have provided the strongest evidence for efficacy and tolerability in treatment of BPH in comparison with other phytotherapies.PubMed 11276294 ↗
Saw palmetto
Nettle root
Pygeum africanum and beta-sitosterol
The measures that cost nothing
The treatments that work
The assessment that comes first