Saw Palmetto and Improved Lower Urinary Tract Symptoms

Research synthesisLow evidenceModerate effect4 studies · 3 beneficial · 1 neutral · 0 harmful

Across 4 studies, 3 reported beneficial effects (moderate in 2 studies, small in 1) and 1 reported neutral effects for saw palmetto on improved lower urinary tract symptoms. The most-studied dose is 320 mg/day based on a 365-day randomized controlled trial in treatment-naïve men with moderate-to-severe LUTS and prostate volume >30 cc. Effect sizes were predominantly moderate.

Effective dose range: 320 mg/day
Studied populations: Men with benign prostatic hyperplasia (BPH) and moderate-to-severe lower urinary tract symptoms

Caveats: The only high-quality randomized controlled trial tested saw palmetto in combination with alfuzosin, not as monotherapy, so the effect may not generalize to saw palmetto alone. Three of the four included papers are literature reviews, which provide secondary evidence. The evidence base is small (4 studies), and conclusions should be considered preliminary.

Generated May 14, 2026

Doses used in studies

mg/day: 320 (median 320, IQR 320–320) — 1 study

Time to effect

Median: 12.2 months · IQR 12.2 months–12.2 months · Range 12.2 months–12.2 months — Reported in 1 of 4 studies

Safety in these studies

Overall tolerabilityReported
Generally, though, all treatments were tolerated well with minimal side effects.
from: Role of Phytotherapy in the Management of BPH: A Summary of the Literature.

4 of 4 papersPopulation:

Efficacy of Serenoa repens Extract Combined With Alfuzosin Versus Alfuzosin Alone in Men With Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Multicenter Randomized Study.
- 2025-10-16
- RCT
- The Prostate 86(2)
- - Giulio Bevilacqua
  - Dalila Carino
  - Stefano Salciccia
  - Alessandro Gentilucci
  - Flavio Forte
  - Massimiliano Di Marco
  - Antonio Pastore
  - Marco Martini
  - Stefano Signore
  - Alessandro Calarco
  - Martino Recchia
  - Olivia Voglino
  - Valenzi Fabio Maria
  - Pietro Viscuso
  - Fabrizio Presicce
  - Ervin Shehu
  - Marco Frisenda
  - Alessandro Sciarra
- PubMed: 41098072
- DOI: 10.1002/pros.70071
3 Insights on
- Improved Lower Urinary Tract Symptoms
- High evidence
- Clinical
The combination of HESr and alfuzosin was significantly more effective than alfuzosin monotherapy in relieving LUTS, with greater benefits from Month 3 onward.
Effect
Beneficial
Effect size
Moderate
Significant
Yes
Dose
320 mg/day
Role of Phytotherapy in the Management of BPH: A Summary of the Literature.
- 2023-02-28
- Review
- Journal of clinical medicine 12(5)
- - Vaki Antoniou
  - Vineet Gauhar
  - Sachin Modi
  - Bhaskar Kumar Somani
- PubMed: 36902686
- DOI: 10.3390/jcm12051899
1 Insight on
- Improved Lower Urinary Tract Symptoms
- Low evidence
For most of the reviewed substances, only modest effectiveness was reported.
Effect
Neutral
Effect size
Small
Significant
No
Dose
not stated
Nutraceutical treatment and prevention of benign prostatic hyperplasia and prostate cancer.
- 2019-10-02
- Review
- Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 91(3)
- - Arrigo F G Cicero
  - Olta Allkanjari
  - Gian Maria Busetto
  - Tommaso Cai
  - Gaetano Larganà
  - Vittorio Magri
  - Gianpaolo Perletti
  - Francesco Saverio Robustelli Della Cuna
  - Giorgio Ivan Russo
  - Kostantinos Stamatiou
  - Alberto Trinchieri
  - Annabella Vitalone
- PubMed: 31577095
- DOI: 10.4081/aiua.2019.3.139
11 Insights on
- Improved Lower Urinary Tract Symptoms
- Low evidence
Recent meta-analyses found the effectiveness of Serenoa repens similar or inferior of that of finasteride and tamsulosin but clearly higher than that of placebo in the treatment of mild and moderate low urinary tract symptoms (LUTS), nocturia and discomfort.
Effect
Beneficial
Effect size
Small
Significant
Yes
Phytotherapy of benign prostatic hyperplasia. A minireview.
- 2014-07-01
- Review
- Phytotherapy research : PTR 28(7)
- - Ester Pagano
  - Massimiliano Laudato
  - Michele Griffo
  - Raffaele Capasso
- PubMed: 25165780
- DOI: 10.1002/ptr.5084
1 Insight on
- Improved Lower Urinary Tract Symptoms
- Low evidence
This articles review the mode of action, the efficacy, and the safety, including herb-drug interactions of the most common botanicals (Serenoa repens, Pygeum africanum, Urtica dioica, and Cucurbita pepo) and nutraceuticals (isoflavones, lycopene, selenium, and β-Sitosterol) in controlling the lower urinary tract symptoms associated to BPH.
Effect
Beneficial
Effect size
Moderate
Significant
Yes

Saw Palmetto and Improved Lower Urinary Tract Symptoms

Efficacy of Serenoa repens Extract Combined With Alfuzosin Versus Alfuzosin Alone in Men With Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Multicenter Randomized Study.

Role of Phytotherapy in the Management of BPH: A Summary of the Literature.

Nutraceutical treatment and prevention of benign prostatic hyperplasia and prostate cancer.

Phytotherapy of benign prostatic hyperplasia. A minireview.