Saw palmetto for enlarged prostate: does it work as well as tamsulosin?

Not clearly: the biggest trials found saw palmetto no better than placebo, though some analyses matched tamsulosin and one extract eased night-time urination.

Published October 2026

Short answer

No, not clearly. The largest placebo-controlled trial and Cochrane review found no benefit over placebo, though some analyses scored it like tamsulosin and one extract cut night-time urination. Evidence grade B (Moderate). Cochrane review, GRADE meta-analysis and a 369-man trial agree on no benefit over placebo; downgraded once for inconsistency with extract-specific and tamsulosin-comparison analyses.

Key takeaways

In the 72-week CAMUS trial of 369 men, saw palmetto at up to three doses did no better than placebo, with symptom scores 0.79 points better on placebo [1].
A Cochrane review of 32 trials (5,666 men) found no better than placebo for symptoms, flow or prostate size in high-quality trials [2].
Head to head, 4 studies (1,080 men) found saw palmetto and tamsulosin gave the same symptom scores after 6 months, with fewer ejaculation problems on saw palmetto [3].
One hexanic extract reduced night-time urination by 0.64 trips versus placebo in a meta-analysis that included observational studies [4].
Side effects were mild and similar to placebo, and no drug interactions were reported [5].

The short version

No, not clearly. The biggest placebo-controlled trial and the Cochrane review found saw palmetto no better than placebo for the urinary symptoms of an enlarged prostate [1][2]. Yet some analyses found it scored about the same as tamsulosin, and one specific extract reduced night-time urination [3][4].

What the studies show

The big placebo-controlled trial. In the 72-week CAMUS trial of 369 men, symptom scores fell by 2.20 points on saw palmetto (at up to three doses) and by 2.99 points on placebo, a difference of 0.79 points in favour of placebo [1]. It was no better than placebo on any secondary measure, and no clearly attributable side effects were found [1].

Cochrane and later reviews. A Cochrane review of 32 trials (5,666 men) found that in two high-quality long-term trials (582 men) saw palmetto was not better than placebo for urinary symptoms (difference 0.25 points, 95% CI -0.58 to 1.07), and that peak urine flow and prostate size were not improved [2]. A 2021 meta-analysis of 27 trials (4,853 men) rated the evidence with GRADE and found little to no difference in urinary symptoms, quality of life or side effects compared with placebo [6]. A 2021 network meta-analysis of 22 trials (8,564 men) concluded saw palmetto showed no clinically meaningful improvement in symptoms or flow [7].

Versus tamsulosin. Four studies (1,080 men) found saw palmetto and tamsulosin gave the same symptom scores after at least 6 months (difference 0.63 points, 95% CI -0.33 to 1.59), though tamsulosin shrank the prostate more [3]. Ejaculation problems and reduced libido were less common with saw palmetto [3].

One specific extract. A 2018 meta-analysis of a hexanic extract (Permixon), including randomized and observational studies, found 0.64 fewer night-time trips to the toilet than placebo and a 2.75 mL/s higher peak urine flow, with similar symptom scores to tamsulosin [4].

The nuances

Extracts differ. The positive result was for one hexanic extract, and the network analysis found the extract type changed the results [4][7].

Why the results disagree. One possible reason is placebo response: men on placebo in the CAMUS trial also improved by 2.99 points, so scoring the same as tamsulosin does not by itself show a benefit over placebo [1][3].

Safety. A systematic review of 40 papers found side effects mild and similar to placebo, most often abdominal pain, diarrhoea, nausea, fatigue and headache, with no drug interactions reported [5]. A 2021 meta-analysis found no statistically significant negative effect on sexual function compared with placebo or tamsulosin [8].

What this means for you

Saw palmetto is unlikely to give clinically meaningful relief on average, but it is low risk, and some men may respond to specific extracts [7][5][4]. Urinary symptoms can have other causes, so a doctor should check them rather than self-treating. For more, see Saw Palmetto.

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