Do supplements help an enlarged prostate?
Not much, going by the best trials. Saw palmetto, the most tested, did no better than a dummy pill. Yet men on the dummy pill got better too. That’s why one can seem to work.
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Which supplements help an enlarged prostate?
None has strong proof. Saw palmetto is the most tested. A 2023 Cochrane review pulled together 27 trials in 4,656 men.
It found saw palmetto alone gives little to no benefit for peeing problems caused by an enlarged prostate.
Two older reviews look kinder to beta-sitosterol, a plant compound, and pygeum, from the African prune tree. But their trials were small and short.
| Supplement | What trials found | How strong |
|---|---|---|
| Saw palmetto | Little to no change in symptoms, at 3 to 6 months or after a year. | Strong. 2023 review. |
| Saw palmetto mixed with other herbs | May make little to no difference. | Weak. 4 trials, 460 men. |
| Beta-sitosterol | Seemed to ease symptoms and flow. Did not shrink the prostate. | Weak. 4 trials of up to 26 weeks, from 2000. |
| Pygeum | Men were more than twice as likely to say symptoms improved. | Weak. 18 small trials, about 2 months long, from 2002. |
Sources: Cochrane 2023; Cochrane 2000; Cochrane 2002
For beta-sitosterol, the reviewers say long-term benefit and safety are not known. Zinc, lycopene and pumpkin seed weren’t tested in any of these reviews.
NICE, which guides NHS doctors, says do not offer herbal remedies for these symptoms.
Already taking one? Tell your GP. NICE asks doctors to check herbal and shop-bought medicines that may be adding to the problem.
Does saw palmetto work?
In one trial, 225 men over 49 with moderate to severe symptoms took 160 mg twice a day for a year.
They did no better than a dummy pill on symptoms, flow, prostate size or PSA (a prostate blood test).
Dose too low? A second trial, in 369 men aged 45 or older, went up to 3 times the usual dose over 72 weeks.
Source: Barry 2011, JAMA
The score covers 7 peeing questions. Lower is milder.
That dummy-pill fall is why a supplement can seem to work. Feeling better doesn’t show the pill did it.
Is it safe? A US government health body says it is well tolerated, with mild, uncommon side effects such as stomach upsets, dizziness and headache.
It doesn’t seem to change PSA results, even at higher doses.
Want to try it anyway? Tell your GP.
Can you shrink an enlarged prostate naturally?
No supplement has been shown to. Trials that measured size found saw palmetto and beta-sitosterol didn’t shrink it.
Medicines such as finasteride can help stop the prostate growing by lowering hormone levels. The NHS may offer them if you’re at high risk of getting worse.
NICE says to offer them if your prostate is likely larger than 30 g (grams) or your PSA is above 1.4 ng/ml. You must also be at high risk, such as being an older man.
How the NHS usually treats an enlarged prostate
- 1
Lifestyle first
If your symptoms aren’t causing many problems.
- 2
Medicines
May be offered for moderate or severe symptoms. Some help you pee. Some stop growth.
- 3
Surgery
If medicines haven’t helped, or symptoms are severe.
Source: NHS
Never stop or change a prescribed medicine without your prescriber. Not sure how bad yours are? Score them in enlarged prostate symptoms.
Does exercise or lifestyle help an enlarged prostate?
It may. A review of 11 studies in over 43,000 men looked at activity levels.
Men who did moderate or heavy exercise were less likely to have an enlarged prostate (BPH) or its symptoms than men who did very little.
Those studies watched men. They didn’t test exercise on them. So it’s a link, not proof.
Two kinds of training have NHS backing for symptoms: pelvic floor and bladder training.
Six things to try first
- Cut down on alcohol and caffeine, as they can make you pee more.
- Drink less before bed or going out, but drink enough the rest of the day.
- Keep to a healthy weight, as being overweight can make symptoms worse.
- Train your bladder: when you need to pee, hold on for a short time, and build up over a few weeks.
- Do pelvic floor exercises to strengthen the muscles that help control your bladder.
- Tell your GP about any supplements or herbal remedies you take.
Need to go often or in a rush? NICE says to offer supervised bladder training. Learn the moves in pelvic floor exercises for men.
When to speak to a GP
Peeing problems can sometimes come from more serious conditions, such as prostate cancer. So it’s important to get them checked by a GP.
- See a GP if you find it hard to pee or need to pee more often.
- Get an urgent GP appointment or call 111 if you have blood in your pee (it may look pink, red or brown), pain when peeing, or you cannot pee at all.
- If you suddenly and painfully can’t pee at all, call your doctor or nurse, or go to A&E. It needs treating straight away.
- If peeing problems come with urine infections that keep coming back or won’t clear, NICE advises a specialist check.
Your GP may test your pee and offer a PSA blood test. Got a result back? See high PSA levels.