Evidence Level
Saw palmetto is one of the most extensively studied herbal supplements for men's health. The 2012 Cochrane review by Tacklind et al. analyzed 32 randomized controlled trials involving 5,666 men and concluded that Serenoa repens was well-tolerated but produced only mild improvements in urinary symptoms compared to placebo, though some individual trials showed more robust benefits. Barry et al. (2011) published a large NIH-funded trial (CAMUS study) in JAMA showing that saw palmetto at doses up to 960mg did not significantly improve LUTS compared to placebo, though the study was criticized for using an ethanolic extract rather than the standard liposterolic form. Conversely, Ye et al. (2019) published a meta-analysis in Medicine showing that Permixon (a specific liposterolic saw palmetto extract) significantly improved IPSS scores and was comparable to tamsulosin for BPH symptom management. The conflicting results likely reflect differences in extract quality, standardization, and study populations.