{"id":5641,"date":"2023-01-24T13:18:48","date_gmt":"2023-01-24T06:18:48","guid":{"rendered":"https:\/\/drsoaraweeurology.com\/?p=5641"},"modified":"2026-08-25T02:26:57","modified_gmt":"2026-08-24T19:26:57","slug":"bph-%e1%80%a1%e1%80%90%e1%80%bd%e1%80%80%e1%80%ba-palmetto-%e1%80%80%e1%80%ad%e1%80%af%e1%80%90%e1%80%bd%e1%80%b1%e1%80%b7%e1%80%9e%e1%80%8a%e1%80%ba%e1%81%8b","status":"publish","type":"post","link":"https:\/\/drsoaraweeurology.com\/my\/2023\/01\/24\/saw-palmetto-for-bph\/","title":{"rendered":"Saw Palmetto for an Enlarged Prostate: What the Trials Actually Found"},"content":{"rendered":"\n<div class=\"wp-block-columns coblocks-author-columns has-background is-layout-flex wp-container-core-columns-is-layout-52275889 wp-block-columns-is-layout-flex\" style=\"background-color:#8C8C971A;padding-top:2.5rem;padding-right:2.5rem;padding-bottom:2.5rem;padding-left:2.5rem\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" 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It is among the most frequent questions in a prostate clinic, and the reasons behind it are reasonable ones \u2014 men who could not tolerate the side effects of prostate medication, and men whose symptoms are mild who would rather start with something they can buy themselves.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The answer has changed since this article was first written, and the title has changed with it. The previous version was headed <em>a good supplement for benign prostatic hyperplasia<\/em> while its own text said that most studies show it does not work. That contradiction has been resolved in favour of the evidence.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urology center Bangkok hospital Thailand\u00a0<a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\" target=\"_blank\" rel=\"noreferrer noopener\">Booking online<\/a>\u00a0<a href=\"tel:02-310-3009\">02-310-3009<\/a>\u00a0<a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a><\/li>\n\n\n\n<li>Samitivej Sriracha hospital Chonburi&nbsp;<a href=\"tel:088-022-1445\">088-022-1445<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">What saw palmetto is<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Saw palmetto (<em>Serenoa repens<\/em>) is an American dwarf palm. An extract of its berries, containing fatty acids and phytosterols, has been sold for prostate symptoms for decades and is proposed to act through anti-androgenic, anti-inflammatory and pro-apoptotic effects on prostate tissue. Those mechanisms are plausible in the laboratory. The question is whether they translate into a man passing urine better, and that is answered by trials rather than by mechanism.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"5649\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2023\/01\/24\/saw-palmetto-for-bph\/indoor-shot-of-puzzled-mature-man-with-thick-grey-stubble-wears-spectacles-dressed-in-elegant-shirt-with-black-bowtie-gestures-in-hesitation-poses-over-rosy-background-doubtful-grandfather\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;7.1&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;Canon EOS 5DS R&quot;,&quot;caption&quot;:&quot;Indoor shot of puzzled mature man with thick grey stubble, wears spectacles, dressed in elegant shirt with black bowtie, gestures in hesitation, poses over rosy background. Doubtful grandfather&quot;,&quot;created_timestamp&quot;:&quot;1549221717&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;70&quot;,&quot;iso&quot;:&quot;100&quot;,&quot;shutter_speed&quot;:&quot;0.00625&quot;,&quot;title&quot;:&quot;Indoor shot of puzzled mature man with thick grey stubble, wears spectacles, dressed in elegant shirt with black bowtie, gestures in hesitation, poses over rosy background. Doubtful grandfather&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Lots of patients try to avoid oral medications due to various reasons\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Lots of patients try to avoid oral medications due to various reasons&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Man looking uncertain, illustrating the common question of whether to try a prostate supplement instead of prescribed medication\" class=\"wp-image-5649\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?resize=18%2C12&amp;ssl=1 18w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Question-face.jpg?resize=750%2C500&amp;ssl=1 750w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Wanting to avoid the side effects of prostate medication is a reasonable motive \u2014 but it is worth knowing what the alternative has and has not been shown to do.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">What the two largest trials found<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This has been tested properly, twice, in large randomised placebo-controlled trials in the United States.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The <strong>STEP trial<\/strong> gave men a standardised saw palmetto extract for a year and found <strong>no difference from placebo<\/strong> in urinary symptom scores or urine flow.<\/li>\n\n\n\n<li>The <strong>CAMUS trial<\/strong> then tested the obvious objection \u2014 that the dose had been too low \u2014 by escalating up to <strong>three times the usual daily amount<\/strong> over eighteen months, using a well-characterised extract. It found <strong>no benefit over placebo at any dose.<\/strong><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">A correction to the explanation given here previously<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The earlier version of this article accepted that the trials were negative, but attributed that to poor product quality \u2014 extracts varying between manufacturers, active ingredients lost in processing \u2014 and concluded that the right preparation at the right daily amount, with a fatty acid content above a stated percentage, would work. <strong>That reasoning does not survive the CAMUS result<\/strong>, which used a characterised extract at escalating doses and still found nothing. The specific daily amount and the fatty acid specification have therefore been removed from this article: publishing them steered readers towards buying a particular grade of an unregulated product on the strength of an argument the evidence does not support.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Product variability between brands is real. It is simply not the reason the trials were negative.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-large\"><img data-recalc-dims=\"1\" decoding=\"async\" width=\"800\" height=\"533\" data-attachment-id=\"5651\" data-permalink=\"https:\/\/drsoaraweeurology.com\/my\/2023\/01\/24\/saw-palmetto-for-bph\/close-up-biotin-capsules-and-bottle-on-clay-brown-plate-on-burlap-background-dietary-supplements-for-healthy-skin-hair-nail-vitamins-and-minerals-for-vegans-and-vegetarians-superfood\/\" data-orig-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?fit=1200%2C800&amp;ssl=1\" data-orig-size=\"1200,800\" data-comments-opened=\"1\" data-image-meta=\"{&quot;aperture&quot;:&quot;4&quot;,&quot;credit&quot;:&quot;&quot;,&quot;camera&quot;:&quot;NIKON D3300&quot;,&quot;caption&quot;:&quot;Close up biotin capsules and bottle on clay brown plate on burlap background. Dietary supplements for healthy  skin, hair, nail. Vitamins and minerals for vegans and vegetarians. Superfood&quot;,&quot;created_timestamp&quot;:&quot;1518186535&quot;,&quot;copyright&quot;:&quot;&quot;,&quot;focal_length&quot;:&quot;27&quot;,&quot;iso&quot;:&quot;200&quot;,&quot;shutter_speed&quot;:&quot;0.025&quot;,&quot;title&quot;:&quot;Close up biotin capsules and bottle on clay brown plate on burlap background. Dietary supplements for healthy  skin, hair, nail. Vitamins and minerals for vegans and vegetarians. Superfood&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"Saw palmetto supplement can possibly improve your prostate health\" data-image-description=\"\" data-image-caption=\"&lt;p&gt;Saw palmetto supplement can possibly improve your prostate health&lt;\/p&gt;\n\" data-large-file=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?fit=800%2C534&amp;ssl=1\" src=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?resize=800%2C533&#038;ssl=1\" alt=\"Supplement capsules, illustrating that herbal prostate products are unregulated and vary between manufacturers\" class=\"wp-image-5651\" srcset=\"https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?w=1200&amp;ssl=1 1200w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?resize=300%2C200&amp;ssl=1 300w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?resize=1024%2C683&amp;ssl=1 1024w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?resize=768%2C512&amp;ssl=1 768w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?resize=18%2C12&amp;ssl=1 18w, https:\/\/i0.wp.com\/drsoaraweeurology.com\/wp-content\/uploads\/2023\/01\/Tablet.jpg?resize=750%2C500&amp;ssl=1 750w\" sizes=\"(max-width: 800px) 100vw, 800px\" \/><figcaption class=\"wp-element-caption\">Herbal products are not regulated as medicines, so content varies between brands \u2014 though that is not why the trials found no benefit.<\/figcaption><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">The real risk is not the supplement itself<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Saw palmetto is generally well tolerated. Mild digestive upset is the usual complaint, and bleeding has been reported often enough that it is worth mentioning to your doctor if you take an anticoagulant or antiplatelet drug, or before any surgery.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The greater risk is what happens while a man is taking it. <strong>The symptoms attributed to an enlarged prostate \u2014 a weak stream, getting up at night, urgency, incomplete emptying \u2014 are not exclusive to benign enlargement.<\/strong> Prostate cancer, bladder cancer, bladder stones, a urethral stricture, diabetes and neurological disease all present the same way. A man who buys a supplement, feels no worse, and does not attend for two years has not treated his prostate; he has postponed finding out what the problem is.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There is a related practical point about blood tests. Prescription 5-alpha reductase inhibitors roughly halve the PSA reading, and anyone interpreting a PSA must know the patient is taking one. Reported effects of saw palmetto on PSA have been inconsistent, but the principle is the same: <strong>tell whoever orders your PSA about every prostate supplement you take<\/strong>, so the number is read correctly. See <a href=\"https:\/\/drsoaraweeurology.com\/2020\/05\/21\/psa-screening-test\/\">should I have a PSA test<\/a>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What does work, if the symptoms are bothering you<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Nothing at all<\/strong>, for genuinely mild symptoms. Watchful waiting with simple measures \u2014 timing of fluids, reducing evening alcohol and caffeine, reviewing diuretics and antihistamines \u2014 is a legitimate and evidence-based choice, and it is the honest alternative to a supplement for men who want to avoid medication.<\/li>\n\n\n\n<li><strong>Alpha blockers<\/strong> work within days. The commonest reasons for stopping them are dizziness on standing and a change in ejaculation, both reversible.<\/li>\n\n\n\n<li><strong>5-alpha reductase inhibitors<\/strong> shrink a large prostate over months and reduce the risk of retention and surgery, at the cost of possible sexual side effects.<\/li>\n\n\n\n<li><strong>Procedures<\/strong> where medication fails or is not wanted, including <a href=\"https:\/\/drsoaraweeurology.com\/2022\/09\/29\/water-vapor-therapy-bph\/\">water vapour therapy<\/a> and prostate resection, both available at Bangkok Hospital Headquarters.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">If, knowing all of the above, you still wish to try saw palmetto, that is a defensible choice for mild symptoms \u2014 it is inexpensive and unlikely to harm you. It should be a decision made with the information in front of you rather than on the strength of a search result, it should not replace assessment, and it should not be continued indefinitely if nothing changes.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Symptoms that need attention rather than a supplement<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Get medical attention for any of the following. In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Complete inability to pass urine<\/strong> with a painful full bladder \u2014 this is acute retention and needs same-day treatment.<\/li>\n\n\n\n<li>Visible blood in the urine, with or without clots.<\/li>\n\n\n\n<li>Fever with pain low in the abdomen or on passing urine.<\/li>\n\n\n\n<li>Symptoms that came on suddenly rather than gradually over years.<\/li>\n\n\n\n<li>New bone pain, unexplained weight loss, or leaking urine continuously without warning.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions About Saw Palmetto for BPH<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Does saw palmetto actually work for an enlarged prostate?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The two largest randomised placebo-controlled trials found no benefit over placebo in urinary symptoms or flow rate \u2014 including one that tested up to three times the usual daily amount using a characterised extract. On the best available evidence, it does not meaningfully improve BPH symptoms.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What dose should I take, and which brand is best?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">This article previously gave a specific daily amount and a fatty acid specification for choosing a brand. Both have been removed. The argument behind them \u2014 that the trials failed because the extracts were inadequate \u2014 does not hold, since a dose-escalation trial with a characterised extract also found nothing.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Is it harmful?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Not usually. Mild digestive upset is the commonest complaint, and it is worth telling your doctor you take it if you are on blood-thinning medication or about to have surgery. The greater risk is delay \u2014 treating prostate symptoms without establishing what is causing them.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Will it affect my PSA test?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Reported effects have been inconsistent, unlike prescription 5-alpha reductase inhibitors, which roughly halve the reading. Either way, tell whoever orders and interprets your PSA about any prostate supplement you take.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">I cannot tolerate prostate medication. What are my options?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Side effects differ between drugs and between individuals, so a different agent within the same class is often worth trying before abandoning medication altogether. For mild symptoms, watchful waiting with fluid timing and a review of other medicines is a legitimate plan. Where medication is unsuitable or unwanted, procedural options including water vapour therapy exist and are discussed at consultation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Arranging a consultation<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If prostate symptoms are affecting your sleep or daily life, Dr. Soarawee Weerasopone sees patients at <a href=\"https:\/\/www.bangkokhospital.com\/en\/bangkok\/doctor\/dr-soarawee-weerasopone-2\">Bangkok Hospital Headquarters<\/a> and at Samitivej Sriracha Hospital in Chonburi on <a href=\"tel:0880221445\">088-022-1445<\/a>. Bring a list of every supplement and medicine you take, including the ones bought without a prescription.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Bangkok Hospital Telemedicine is available for patients who cannot attend in person, including international patients \u2014 arrange it in advance by email to the Urology department at <a href=\"mailto:bhquro@bdms.co.th\">bhquro@bdms.co.th<\/a>. Samitivej Sriracha is in-person only. Enquiries about cost are answered by the hospital, not by this website.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Disclaimer:<\/strong> This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters, and is intended for education only. It is not medical advice, diagnosis or a prescription for any individual, and no advice, diagnosis or prescription is given through personal messaging channels or social media. Dr. Soarawee operates no public social media account; any account offering private consultation in his name is fraudulent. In an emergency in Thailand, call <strong>1669<\/strong>.<\/p>\n\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@graph\": [\n    {\n      \"@type\": \"MedicalWebPage\",\n      \"@id\": \"https:\/\/drsoaraweeurology.com\/2023\/01\/24\/saw-palmetto-for-bph\/#webpage\",\n      \"url\": \"https:\/\/drsoaraweeurology.com\/2023\/01\/24\/saw-palmetto-for-bph\/\",\n      \"name\": \"Saw Palmetto for an Enlarged Prostate: What the Trials Actually Found\",\n      \"description\": \"The two largest randomised placebo-controlled trials of saw palmetto found no benefit over placebo for BPH symptoms, including at triple dose with a characterised extract.\",\n      \"inLanguage\": \"en\",\n      \"datePublished\": \"2023-01-24\",\n      \"dateModified\": \"2026-08-24\",\n      \"isPartOf\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#website\" },\n      \"author\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"reviewedBy\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"publisher\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/#physician\" },\n      \"about\": { \"@id\": \"https:\/\/drsoaraweeurology.com\/2023\/01\/24\/saw-palmetto-for-bph\/#saw-palmetto\" },\n      \"audience\": { \"@type\": \"MedicalAudience\", \"audienceType\": \"Patient\" },\n      \"disambiguatingDescription\": \"This article was previously titled a good supplement for benign prostatic hyperplasia while its own text stated that most studies show no benefit. 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