Doctor Answers: Saw Palmetto vs Flomax: Which is the Best BPH Treatment?

If you’re experiencing the challenges of an enlarged prostate, you might be considering your treatment options and wondering whether Saw Palmetto or Flomax is the better choice for you. Saw Palmetto and Flomax are two of the most popular treatments for managing benign prostatic hyperplasia (BPH), a condition that affects many men as they age. 

To help you make an informed decision, we spoke with Dr. Hamad, a renowned urologist specializing in prostate health, who provided valuable insights into the benefits and drawbacks of each option. 

Dr. Hamad has provided a comprehensive collection of resources, evidence, and research for this article. You will find links to these materials throughout the content, allowing you to explore the topics more deeply.

Additionally, a medical doctor has thoroughly reviewed all content to ensure accuracy and reliability.

Q: What is Saw Palmetto and How Does It Help with Prostate Health?

Dr. Hamad answers: Saw palmetto, scientifically known as Serenoa repens, is a shrub-like palm recognized by its distinctive palmate leaves. This plant produces dark berries containing large seeds, commonly used as supplements due to their potential health benefits. Historically, saw palmetto berries have been used for centuries as an aphrodisiac and a remedy for prostate problems. It was also used as a diuretic, cough-reducing medicine, and sedative by Native Americans, who treated urinary issues with it. Even animals that consumed saw palmetto were healthier than those that didn’t.

The medicinal use of saw palmetto was first documented in the United States by Dr. J. B. Read from Savannah, Georgia, in 1879. Today, Saw Palmetto continues to be popular, particularly among men managing prostate issues. 

The berries are a natural treatment for benign prostatic hyperplasia (BPH), and they can be consumed whole or dried to make tea. They’re also available in tablet or capsule form and an oily extract.

Research supports Saw Palmetto’s therapeutic potential. The free fatty acids, such as lauric acid, effectively inhibit 5-alpha-reductase, an enzyme involved in BPH. Moreover, saw palmetto contains anti-inflammatory phytosterols, further aiding in prostate health management.

Q: What is Flomax and How Does It Treat BPH?

Dr. Hamad answers: Flomax is a brand name for tamsulosin, a medication prescribed to treat benign prostatic hyperplasia (BPH) symptoms. It is available in capsule form and belongs to a class of medications known as alpha-blockers. In some cases, doctors may also prescribe Flomax to treat kidney stones.

Alpha-blockers like Flomax and Cardura work by binding to type 1 alpha-adrenergic receptors, thereby inhibiting smooth muscle contractions. The FDA approved Flomax in April 1997, and it has since become one of the most commonly prescribed medications for older men dealing with enlarged prostate issues.

Studies have shown that Flomax can effectively improve symptoms of BPH. For instance, one review indicated that Flomax provided minor to moderate improvements in urinary flow through the urethra and other BPH symptoms compared to a placebo. Another study confirmed that a 12-week treatment with Flomax reduced lower urinary tract symptoms with minimal and insignificant side effects. However, it’s worth noting that the effectiveness of tamsulosin (Flomax) for BPH is similar to that of other alpha-blockers.

Q: What are the Major Differences Between Saw Palmetto and Flomax?

Dr. Hamad answers: Both saw palmetto and Flomax are used to manage benign prostatic hyperplasia (BPH), making it natural to compare them. Both are effective in treating an enlarged prostate. A systematic review and meta-analysis from the American Journal of Men’s Health provided valuable insights by comparing their effectiveness over a six-month treatment period.

Q: How Do the Effects of Saw Palmetto and Flomax Compare?

Dr. Hamad answers: That study found that saw palmetto had effects comparable to Flomax in treating BPH in terms of quality of life, maximum flow rate levels, postvoid residual volume, prostate-specific antigen (PSA) test results, and other BPH symptoms. The exception was prostate volume or size, where Flomax had a better impact.

Q: What Are the Tolerance and Safety Insights for Saw Palmetto and Flomax?

Dr. Hamad answers: In terms of tolerance and safety, saw palmetto was better tolerated than Flomax, particularly concerning ejaculation disorders and decreased libido. The study concluded that while both saw palmetto and Flomax are effective in treating BPH, saw palmetto has a more favorable safety profile and does not increase the risk of low libido and ejaculation problems as Flomax does.

Q: What are the Similarities Between Saw Palmetto and Flomax?

Dr. Hamad answers: Saw palmetto and Flomax share several similarities in their potential to treat enlarged prostate conditions, which is the most common issue affecting the prostate gland. Both can help alleviate inflammation in the prostate tissue and reduce the intensity and severity of lower urinary tract symptoms associated with BPH.

As mentioned earlier, the study also indicated that while Flomax is more effective in reducing prostate volume, saw palmetto is also believed to have a similar effect. However, it’s important to note that neither saw palmetto nor Flomax is primarily intended to reduce prostate size; their primary purpose is to manage the urinary symptoms caused by prostate enlargement.

The main difference lies in their mechanisms of action and safety profiles, with saw palmetto often considered one of the best natural alternatives to Flomax.

Q: Can Saw Palmetto Be More Beneficial Compared to Flomax?

Dr. Hamad answers: Saw palmetto offers several advantages over Flomax, making it a more beneficial option for some individuals. One of the primary benefits of Flomax is its ability to relax the muscles in the prostate and bladder, which helps reduce urinary symptoms of BPH. However, saw palmetto is more versatile in terms of the range of benefits it provides.

Q: How Is Saw Palmetto More Versatile Compared to Flomax?

Dr. Hamad answers: Saw palmetto is an over-the-counter alternative to Flomax that improves prostate health and urinary function and aids in managing nighttime urination and other BPH symptoms. It also exhibits other health effects, making it a more comprehensive option.

Q: What Are the Benefits of Saw Palmetto Beyond Prostate Health?

Dr. Hamad answers: Beyond its benefits for prostate health, saw palmetto has other advantages, such as reducing male pattern baldness, improving testosterone levels, and protecting libido. More studies are needed to explore its benefits further, particularly in managing conditions like prostatitis or chronic pelvic pain syndrome.

Q: Can Saw Palmetto Lower Blood Pressure?

Dr. Hamad answers: Many people wonder if Saw Palmetto can lower blood pressure. It may be helpful for individuals with hypertension, and importantly, there are no known interactions between saw palmetto and blood pressure medications, making it a safe option to consider.  Studies show that saw palmetto may cause minor reductions in blood pressure when you lie down. However, the change is not significant and does not have clinical effect.

Q: What are the Possible Side Effects of Consuming Flomax?

Dr. Hamad answers: Flomax can cause many adverse reactions, though most are mild and tend to diminish as the body adjusts to the medication. The most common side effects of Flomax are:

• Dizziness
• Headache
• Nausea
• Tiredness and loss of energy or muscle strength
• Runny nose, sore throat, and cough
• Diarrhea
• Reduced semen
• Chest or back pain

These side effects usually resolve within a few days or weeks. However, if they persist, it’s important to consult your doctor.

Serious adverse reactions, while rare, are possible. Those are blurred vision, abnormal ejaculation, allergic reactions, low blood pressure, priapism (a long, painful erection). If you experience any of these, seek emergency medical assistance immediately.

To minimize the risk of allergic reactions, you should read the ingredients of Flomax or inform your doctor about any allergies you may have before starting the medication. You should stop taking Flomax and contact your healthcare provider if serious adverse reactions occur.

Additionally, stopping Flomax abruptly can lead to withdrawal symptoms such as reduced urination. Therefore, you should always consult your doctor before discontinuing the medication. That’s why many men prefer natural alternatives to Flomax. Saw palmetto fits perfectly into that box as a natural alpha-blocker you can quickly obtain. While saw palmetto’s safety profile requires further research, it is considered safe for regular consumption. Some side effects may occur, though. 

These include fatigue, diarrhea or constipation, headache, nausea or vomiting, decreased libido, and vertigo. These side effects tend to be mild and reversible. Saw palmetto is highly unlikely to cause severe adverse reactions.  Even though the dietary supplement is a natural product, you must adhere to dosage instructions and avoid taking it in excess. 

Q: How Do Saw Palmetto and Flomax Compare as Natural vs. Prescription Solutions?

Dr. Hamad answers: Saw palmetto and Flomax are two different approaches to treating prostate problems. Saw palmetto is a natural remedy available over the counter, while Flomax is a prescription medication.

Both saw palmetto and Flomax have comparable effectiveness in managing BPH symptoms. However, saw palmetto may be safer due to its natural origin and generally has fewer interactions with other medications. Unlike Flomax, which can interact with several types of drugs, saw palmetto can often be combined with different compounds without significant risk of adverse interactions.

Many dietary supplements now include saw palmetto in combination with other plants, herbs, vitamins, and minerals, enhancing its versatility.

Q: How Do Saw Palmetto and Flomax Work to Alleviate Prostate Symptoms?

Dr. Hamad answers: Flomax relaxes the bladder and prostate muscles and improves urine flow. In contrast, saw palmetto inhibits 5-alpha-reductase, an enzyme that converts testosterone to dihydrotestosterone (DHT) in the prostate. DHT plays an essential role in prostate development and the progression of BPH.

When combined with selenium and lycopene, saw palmetto functions through selenoproteins to promote an optimal balance between antioxidants and oxidants, exhibiting beneficial effects on an enlarged prostate.

Q: What are the Recommended Dosages for Flomax and Saw Palmetto?

Dr. Hamad answers: The standard dose of Flomax for BPH is 0.4 mg once a day, typically taken about half an hour after a meal, such as breakfast. If patients do not respond to the initial dosage within the first two weeks, a healthcare professional may increase the dosage to 0.8 mg once a day.

For saw palmetto, there is no specific dosage that fits everyone, as it is a dietary supplement. However, it is most effective in a dosage of 320 mg daily, which can be divided into two doses of 160 mg to avoid gastrointestinal complaints. It’s important to follow the dosage instructions provided by your doctor or the product label.

Get Your FREE PSA Lowering Diet Plan!

• Naturally lower PSA levels
• Reduce nighttime trips to the bathroom
• Enjoy better bladder control and urine flow

Thank You! You're All Set! Please Check Your Email for Further Instruction. Please allow 10-15 minutes for your eBook to arrive.

By clicking “Download Now”, I agree to Ben's Natural Health Terms and Conditions and Privacy Policy.

Q: When is the Best Time to Take Flomax and Saw Palmetto?

Dr. Hamad answers: The best time to take Flomax is in the morning after breakfast or the first meal of the day to ensure the highest levels of the medication are present when you’re most likely to urinate. Ideally, you should take Flomax at the same time every day.

 If you miss a dose and remember it within six hours, you should take it immediately. If it’s been longer than six hours, skip the missed dose and take the next dose as scheduled. Avoid doubling the dose to make up for a missed one. Many believe that taking Flomax at night is more effective. However, evidence confirms that night-time dosing isn’t necessary to improve the effectiveness and tolerability of Flomax. 

There’s no specific optimal time for taking Saw Palmetto. However, taking it with food is advisable to minimize potential digestive side effects and enhance absorption. Whether you take it after breakfast, lunch, or dinner depends on your personal schedule and preference. The important thing is to take Saw Palmetto consistently at the same times each day to maintain steady levels in your system.

Q: What Should You Consider When Taking Saw Palmetto and Flomax Together?

Dr. Hamad answers: There are no known interactions between Flomax and saw palmetto, making it safe to take them together. In fact, a study published in Urologia Internationalis found that a combination of saw palmetto and Flomax was more effective in treating BPH symptoms than using Flomax alone.

However, both saw palmetto and Flomax can cause dizziness, especially at the beginning of the treatment, until your body adapts. Therefore, while using them together is safe, it’s always advisable to consult your doctor before combining these treatments to ensure they are appropriate for your specific situation.

Key Patient Concerns about Saw Palmetto and Flomax for BPH

When it comes to managing BPH, patients often have specific concerns about the safety and effectiveness of treatments like Saw Palmetto and Flomax, especially in unique health situations. 

To address these questions, Dr. Hamad provides expert answers to some of the most common and critical patient-reported concerns regarding the safety, efficacy, and appropriate use of these treatments in various situations.

Q: Is Saw Palmetto Safe for BPH Patients with a History of Prostate Cancer?

Dr. Hamad answers: Saw palmetto is one of the most commonly used herbal supplements to treat BPH symptoms, such as frequent urination and incomplete bladder emptying. Its safety among patients with a history of prostate cancer who have BPH is not well established.

Research has shown that saw palmetto can reduce the size of the prostate gland and also improve the symptoms of urination in patients with BPH. It is believed to act through the inhibition of testosterone conversion to dihydrotestosterone (DHT), a hormone known to be associated with prostate enlargement. However, studies on the effect it has on prostate cancer have been inconclusive. 

One large cohort study involving men aged 50-76 years showed no significant association of saw palmetto use with the risk of developing prostate cancer. It suggested that the herb neither increases nor decreases the chance of developing the disease.

Given the widespread use in countries like Germany and Italy for the management of BPH, saw palmetto is effective for urinary symptoms. Still, as research shows, it must not be considered a replacement for evidence-based treatments of prostate cancer.

From my perspective as an MD, patients with a history of prostate cancer should exercise caution and consult a healthcare provider before using saw palmetto, as its interaction with cancer treatments remains unclear. Further research is needed to confirm its safety profile in this specific patient group.

Q: Can Saw Palmetto Help Reduce Prostate Inflammation in Men with BPH?

Dr. Hamad answers: Saw palmetto is a popular herbal remedy often used for symptomatic treatment in cases of benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate gland. The primary symptoms usually include discomfort in starting or maintaining urination and waking up several times during the night to urinate. 

Due to variability in test results, and despite its popularity in the prevention and treatment of BPH in Europe and the U.S., the body of evidence shows inconclusive results in terms of its effectiveness in reducing prostate inflammation.

Some studies suggest that saw palmetto has anti-inflammatory action and decreases the size of the prostate, thus possibly improving symptoms of BPH. Its free fatty acids, such as lauric acid, and phytosterols, such as β-sitosterol, reportedly have actions on the inhibition of 5-alpha reductase and a reduction of inflammation of the prostate. However, the clinical evidence is mixed. 

Other studies also reported that saw palmetto is as effective as finasteride, or Proscar, in alleviating these symptoms-particularly nighttime urination – with no associated side effects on libido, commonly associated with finasteride.

In my view, saw palmetto may help some individuals due to its anti-androgenic and anti-inflammatory properties. However, it should not be considered a first-line treatment for BPH until more reliable clinical evidence is available. For BPH patients seeking complementary options, consult with a healthcare professional to weigh the benefits and risks prior to starting any herbal supplement.

Q: How Does Flomax Affect Urinary Urgency in BPH Patients?

Dr. Hamad answers: Flomax (tamsulosin) is an alpha-blocker, specifically designed to relieve urinary symptoms associated with benign prostatic hyperplasia (BPH). Recent studies show that Flomax acts on the smooth muscle tissue of the prostate and the bladder neck, making it easier for urine to pass. This is achieved by smooth muscle relaxation, which lessens the feeling of urgency.

From a clinical perspective, Flomax can indeed improve urine flow and alleviate symptoms like urgency of urination; it does not decrease the size of the prostate. As the study showed the primary mechanism of this drug is to decrease the muscle tone to allow better bladder emptying. Based on the research, patients often notice an improvement within days of starting the medication, particularly in terms of decreased urinary urgency and nighttime urination frequency.

While Flomax can significantly relieve symptoms of BPH, it is important to remember that these medications actually do nothing to shrink the size of the prostate. In fact, in most cases, the prostate will continue to grow bigger over time, and surgery may well be required if symptoms get worse.

As an MD, I find tamsulosin to be effective for a lot of patients, especially in improving quality of life by reducing the frequency and urgency of urination. However, the expectations of the patient must be managed as this medication improves symptoms but is not a cure for BPH.

Q: Does Flomax Interfere with Blood Thinners in BPH Treatment?

Dr. Hamad answers: Flomax (tamsulosin) may have potential interactions with blood thinners like warfarin, though the evidence is not fully clear. Findings from the study show that some blood thinners, like warfarin (Coumadin), are used to prevent blood clots, while others, such as clopidogrel (Plavix), an antiplatelet drug used to prevent platelets from clumping together. The research showed that no interaction was found between Plavix and tamsulosin.

There is limited data on the exact nature of the interaction between tamsulosin and warfarin. Some studies suggest that tamsulosin may slightly affect warfarin levels, although the clinical relevance is not well understood. 

Common side effects of Flomax include dizziness or fainting due to the blood pressure lowering, increasing the risk of falls and bleeding, particularly when combined with anticoagulation. Adverse effects may be heightened in cases involving polypharmacy, especially in elderly patients or those with impaired renal or hepatic function.

Because of this, doctors may want to take precautions to monitor the patients more closely if these medications are taken together. This is done particularly by regularly checking INR (International Normalized Ratio) levels to ensure that blood clotting is within a safe range.

In my professional opinion, while Flomax does not directly interfere with most blood thinners, carefulness must be taken, and regular monitoring should be done. This is very important, especially for patients at risk of bleeding or presenting conditions such as hypotension.

Q: How Does Flomax Impact Elderly Patients with Severe BPH Symptoms?

Dr. Hamad answers: Tamsulosin is one of the drugs of choice for the treatment of severe symptoms of BPH in elderly gentlemen, which facilitates the passage of urine through the relaxation of smooth muscle in the prostate and at the bladder neck. Generally, research shows that elderly individuals can be more sensitive to certain adverse effects as a result of age-related alterations in the metabolism of pharmacologic agents and increased sensitivity to medication.

One of the common concerns is orthostatic hypotension, a sudden fall in blood pressure upon standing; this leads to dizziness. Although less common compared with other alpha-blockers, this may increase the incidence of falls. In elderly patients especially, minor falls resulting in fractures and other serious complications become a real concern.

Other side effects include headaches, nasal congestion, and fainting in elderly patients, especially in the frail and with pre-existing conditions such as low blood pressure or heart diseases, though generally well-tolerated.

There is also some discussion of a possible but unestablished connection between tamsulosin and dementia among older adults. Some studies may indicate a possible association; however, additional research is required to confirm this risk.

Given these considerations, the study shows that starting at the lowest effective dose (0.4 mg) for elderly patients is recommended, as higher doses (0.8 mg) may increase the risk of the adverse effects mentioned above. Regular follow-ups and monitoring in patients for such adverse effects as dizziness, hypotension, or a change in cognition are of paramount importance in ensuring safety.

Q: How Does Saw Palmetto Impact BPH’s Prostate-Specific Antigen (PSA) Levels?

Dr. Hamad answers: Saw palmetto, a popular supplement for treating lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH), does not significantly impact prostate-specific antigen (PSA) levels. Multiple studies involved, including the comprehensive CAMUS trial, an escalating dosage of saw palmetto as high as 960 mg administered for up to 72 weeks, without significant changes in PSA levels observed. This finding suggests that saw palmetto neither lowers nor raises PSA levels any more than a placebo.

There has been a concern, largely historical, that saw palmetto might mask prostate cancer due to artificially lowering the PSA levels, in a similar way to how finasteride works. Research has put this theory to rest, including a study of over 1,000 patients, and it also showed that saw palmetto does not interfere with PSA as finasteride does.

Therefore, it remains a generally safe option for managing BPH symptoms without complicating PSA-based prostate cancer screening. From my experience, it’s important to consider that while saw palmetto may not affect PSA, the efficacy in reducing BPH symptoms is still in debate.

Conclusion: Choosing Between Saw Palmetto and Flomax

Both saw palmetto and Flomax offer potential relief for prostate issues, with saw palmetto standing out due to its natural, prescription-free accessibility. While both are similarly effective in addressing the symptoms of an enlarged prostate, saw palmetto tends to have a more favorable safety profile.

You should consult with your doctor before choosing any treatment for lower urinary tract symptoms to ensure it’s appropriate for your health needs. Additionally, alongside medications, considering alternative therapies such as yoga, prostate massage, or trigger point release therapy can provide a holistic approach to managing prostate health. Prioritizing natural solutions like saw palmetto may help reduce the likelihood of needing surgical interventions in the future.

Our Medical Review Process

At Ben’s Natural Health, we emphasize transparency, clear communication, and scientific accuracy. All our content is created by medical professionals and undergoes review every 12 to 24 months to ensure it remains accurate, supported by credible research, and aligned with the latest scientific developments. We exclusively reference peer-reviewed studies from respected medical journals, with full citations and links provided, so you can trust the information is reliable. For more on our review process and research standards, check out our medical review process.

Our Editorial Guidelines

For over 25 years, Ben’s Natural Health has been a leader in delivering high-quality, scientifically accurate information on natural health. Our strict editorial guidelines ensure that you can rely on the accuracy and trustworthiness of our content. Each article is written by accredited experts, including doctors, dieticians, nutritionists, fitness trainers, and surgeons, and is independently reviewed for quality. We maintain transparency by linking the expert’s qualifications and full bio at the top of every article. You can read our full editorial guidelines to learn more about our approach to writing and fact-checking.

Medical Disclaimer

The content provided on this blog is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Although the content is medically reviewed and written by a licensed doctor, it is not personalized to your specific health needs. Always consult your primary care physician or another qualified healthcare provider when making decisions about your health. Never disregard professional advice or delay seeking it because of something you’ve read here. Your use of the information on this blog is entirely at your own risk.

6 Natural Alternatives To Flomax.