Pygeum for BPH (Benign Prostatic Hyperplasia)

Pygeum africanum bark extract is one of the few phytotherapies for benign prostatic hyperplasia with a Cochrane review behind it. Across 18 trials in more than 1,500 men, 100-200 mg/day improved peak urinary flow by roughly 19% and reduced nocturia by about two episodes per week, without changing prostate volume or PSA.

Phytosterols and pentacyclic triterpenes in the lipophilic bark extract suppress prostaglandin synthesis and reduce oedema in prostatic and bladder-neck tissue. Ferulic acid esters limit local cholesterol availability for androgen synthesis, and the extract inhibits fibroblast growth factor-driven stromal proliferation. Unlike finasteride it does not inhibit 5-alpha-reductase, so testosterone, DHT and PSA remain unchanged — symptomatic relief comes from reduced inflammation and improved bladder contractility rather than gland shrinkage.

The anchor evidence is the Cochrane systematic review of 18 randomised, placebo-controlled trials (n=1,562), which found men taking pygeum were more than twice as likely to report overall symptom improvement, with a 19% increase in peak urine flow, a 24% reduction in residual volume and 19% fewer nocturia episodes. Adverse events matched placebo. The limitations are consistent and worth stating: most trials ran only 30-90 days, few used the modern IPSS instrument, sample sizes were small, and extract standardisation varied between manufacturers. No head-to-head trial establishes non-inferiority against alpha-blockers, and no trial has demonstrated effects on disease progression, acute retention or surgical need. The effect size is therefore best read as reliable symptomatic relief of a modest magnitude in mild to moderate disease.

Men with severe obstructive symptoms, large prostate volume, or symptoms driven by detrusor dysfunction rather than inflammation typically see nothing.