Written by Tahir Maqbool Mir, PhD, Toxicologist. Evidence shows that saw palmetto is well-tolerated and safe for majority of individuals in helping to support men’s sexual health.

What the Science Says About Saw Palmetto’s Promise for Older Men’s Sexual Health

As men get older, they may have sexual and urinary health problems that are connected in some way. Researchers are considering saw palmetto more and more as a possible treatment for urinary and sexual health. Saw palmetto extract obtained from the Serenoa repens plant that grows in the southeastern United States is believed to have multiple benefits, including the ability to maintain both sexual and urinary health at the same time, while regular medications typically help with either problem, but not both. This dual mode of action makes it different from standard drug treatments; and because of this, healthcare professionals are becoming more interested in plant-based medicines instead of, or in conjunction with, medical options. The plant’s potential shows how more and more people are using modern clinical frameworks to learn about traditional plant knowledge^{1, 2}.

The Issue: When Prostate Health Impairs Sexual Health

Benign prostatic hyperplasia, also known as BPH or prostate enlargement, is a common old age health problem, affecting most men by the time they reach their seventies. Frequent urination is one of the several unpleasant symptoms of BPH that affects both sleep and overall quality of life. Men with this condition have trouble completely emptying their bladders and often feel the constant need to go to bathroom. These symptoms are linked and make daily routine activities difficult and can even disturb sleep. This is a big problem that goes beyond just needing to go to the bathroom. The overall effect on quality of life shows why finding effective treatments for older men is still a top priority in medicine³.

Moreover, medical research has demonstrated a well-known link between BPH and sexual health, indicating that the men with lower urinary tract symptoms caused by BPH are 3.7 times more likely to develop erectile dysfunction than men who do not have these urinary problems. In certain individuals, the severity of urinary symptoms could get worse, leading to erectile and ejaculatory dysfunctions^{4, 5}.

Some clinical challenges for both patients and healthcare providers providing conventional treatments for BPH or enlarged prostate, primarily alpha-blockers and 5-alpha-reductase inhibitors such as finasteride and dutasteride, are that these medications help with urinary symptoms by shrinking the prostate tissue, but they worsen the sexual problems that men with the condition already have. It has been observed that men who get standard drug treatments for BPH, often lack interest in sexual activities, because of concomitant side effects such as erectile and ejaculatory dysfunctions associated with these conventional treatments.  This paradox causes men to have to deal with one health problem while making another worse, which shows that current treatment methods are not working. The side effects have made healthcare professionals more interested in other ways to treat prostate symptoms that don’t have sexual side-effects⁶.

Saw Palmetto: A Plant-Based Option with Two Benefits

Researchers are looking into saw palmetto again because the usual BPH drugs don’t work well. Saw palmetto is a natural remedy with a history of traditional and medicinal use that works on the mechanisms involved in an enlarged prostate, while preserving or even improving sexual function, making it different than conventional drugs⁷. 

Saw palmetto interacts with the enzyme 5-alpha-reductase, which is involved in the conversion of testosterone into dihydrotestosterone (DHT), a stronger form of androgen. DHT has potentially more affinity to prostate cells than testosterone does and may cause the abnormal growth of prostate tissue. Saw palmetto has chemical constituents including plant sterols that have the potential to inhibit this enzyme from working, thereby leading to the reduction of DHT production only in prostate tissue, while leaving testosterone levels unaffected⁸.

This targeted approach has a big benefit: saw palmetto lowers DHT without lowering testosterone levels, which means it doesn’t cause the sexual problems that come with other treatments⁹. Men can maintain normal testosterone levels for sexual function while alleviating urinary symptoms, thereby addressing the essential therapeutic gap that conventional medications fail to close¹⁰.

Clinical Evidence: An Impressive Research History

In the past twenty years, researchers have conducted more than thirty controlled trials to see how well saw palmetto works for men with enlarged prostates who have urinary symptoms and sexual health problems. Most studies used the same amount of berry extract (320 mg per day); therefore, study results can be easily compared between different research centers ¹⁰.

Phytotherapy Research published a large clinical trial that followed eighty-two men who took 320 mg of saw palmetto every day for two months. The results showed that all the measured outcomes had significant improvements. The validated International Prostate Symptom Scale showed that urinary symptom scores dropped by about half, from 14.4 to 6.9 points. The scores for sexual function tests significantly increased, from 22.4 to 31.4 points, and the scores for quality-of-life tests elevated from 137.3 to 195.0 points. All improvements were statistically significant, meaning that these changes were not likely to have happened by chance¹¹.

What made these improvements so important was that they didn’t have the sexual side effects that come with most medications. Researchers and patients alike rated the treatment as very effective, with acceptance rates of over 95% and very few side effects were reported. This is a huge difference from standard drug treatments. These results were further confirmed by research studies conducted over longer periods; for example, a study conducted on 120 men for a period of two-years explored the effect of saw palmetto on several health markers at regular intervals, such as urinary flow, prostate-specific antigen (PSA) levels, erectile function, symptom progression, and overall quality of life. The results of this study reported that saw palmetto consistently improved both sexual function and urinary symptoms, with major improvements observed in the first year of treatment. This study validated that saw palmetto’s benefits last over time, suggesting it has a real therapeutic benefit instead of just short-term placebo effects. The authors of this study conclude that saw palmetto is a good choice for men who want to maintain prostate health without having sexual side effects associated with conventional treatments, because it provides significant symptom relief and is well tolerated by majority of individuals with very mild or rare side effects¹².

A six-month study at multiple sites looked at sexual outcomes and found significant improvements. The number of men who said they wanted sex less went down by half, from 26.5% to 13.2%. Researchers also observed steady improvements in erectile function, but they need to do more studies to be sure of these result¹³. These results indicate that saw palmetto actively improves sexual health rather than simply mitigating pharmaceutical side effects, establishing it as a fundamentally different therapeutic strategy compared to traditional medications.

Advantages Relative to Conventional Treatments

Direct clinical trials show that saw palmetto works just as well as finasteride and dutasteride to relieve prostate symptoms. However, it works much better than both medications for sexual function. Users say they have fewer problems with low libido and erectile dysfunction than when they take conventional drugs. This shows that saw palmetto is a better all-around treatment choice.

How to Improve Sexual Health

Saw palmetto’s benefits for sexual health work through a number of biological pathways that are linked to one another. Laboratory studies indicate that it has direct effects on erectile tissue, in addition to easing urinary symptoms, which in turn lowers sexual anxiety and improves quality of life. Studies reported that saw palmetto relaxes smooth muscle in the corpus cavernosum, which is the erectile tissue of the penis. This makes the penis more responsive to stimulation. Mechanistically, these improvements have been attributed to the elevated levels of nitric oxide synthase and diminished phosphodiesterase-5 enzyme activity in smooth muscle cells, which are the same biological pathways on which conventional drugs such as sildenafil and tadalafil, two well-known drugs for erectile dysfunction, work. This suggests that saw palmetto works on the basic mechanisms of sexual function instead of just treating urinary side effects¹⁴.

This multi-pathway approach also shows that saw palmetto directly improves the biology of erectile tissue, not just as a side effect of making symptoms better. So, the herb gives older men a better way to keep their sexual health.

Timeline and What Patients Should Expect

People who are thinking about taking saw palmetto should know that they will need to take it every day for a while before they see results. Clinical research indicates that therapeutic effects generally manifest within three to four weeks of continuous supplementation, with the majority of patients observing significant improvement by the fourth week. Some people see benefits in as little as three weeks. For traditional treatments, this is relatively quick onset, which makes saw palmetto a good choice for men for maintaining urinary and sexual function.

Things to Think About; Safety and Tolerability

One of the best things about saw palmetto is that it is safe to use. Clinical studies show that the herb is very well tolerated. In more than 95% of cases, both patients and doctors rate its safety as good or excellent. Although side effects do happen, they are mild and not very common. This is very different from the sexual dysfunction, lower ejaculate volume, and other problems that come with pharmaceutical treatments. Long-term safety data makes it even more reliable. Studies have shown that individuals taking saw palmetto on daily basis for up to six months show that they can proceed, because its long-term use is unlikely to cause any major problems. Further studies have indicated that saw palmetto is well tolerated in patients taking saw palmetto at a dose of 320 mg daily for long periods.

Saw palmetto is a good choice for men who want to feel better and stay healthy because it is well tolerated and works better than other options.

The Current Status of Research and Prospective Directions

While there is a lot of evidence that supports saw palmetto maintains prostate health, scientists agree that there is a need of more research on how saw palmetto mechanistically affects sexual function. A comprehensive analysis conducted on saw palmetto and published in several systemic reviews indicated that saw palmetto alleviates BPH symptoms; however, individual responses vary significantly^{10, 15, 16}. Researchers stressed the need for more high-quality controlled trials to validate their findings. Future studies should employ more sophisticated measurement techniques.

Researchers say that instead of just asking yes or no questions, we should use proven tools like the International Index of Erectile Function to learn more about how erectile function is getting better and what the best dosing patterns are¹⁷.

There are always some questions to be answered and some things that need to be studied more, but the existing evidence shows that saw palmetto is well-tolerated and safe for majority of individuals and can help with symptoms. This makes saw palmetto a good treatment option; however, it is important to remember that results may vary from person to person.

Consequences for Patient Care

For patients dealing with both prostate enlargement and sexual dysfunction, saw palmetto has a unique benefit: it can help both problems at the same time without the sexual side effects that come with most other medications. Standard medications make it hard to choose between relieving urinary problems and keeping your sex life intact but saw palmetto may help with both.

The recommended clinical dose of 320 milligrams per day of lipophilic berry extract is well-supported by research, and most men see benefits within three to five weeks. It has a great safety record and very few and mild side effects, which have been documented over decades of clinical use. This makes it a good choice for people who want natural alternatives to drugs.

Posted January 8, 2026.

References:

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