Bark extract from an African evergreen, used for the urinary problems of prostate enlargement with age. Pooled trials point favourably: fewer, less bothersome symptoms, better flow and emptying. The evidence is thin — short, old, mostly industry-produced. Stomach upset is the only consistent complaint. Whether relief changes the disease over years, and whether bottled product matches what was studied, remain unknown. (Full Review)
| Marker | Target | Why |
|---|---|---|
| International Prostate Symptom Score | 0–7 (mild); a fall of ≥4 points is the target | Quantifies symptom burden and the response to treatment |
| Prostate-specific antigen | <1.0 ng/mL before age 60; <2.5 ng/mL thereafter; annual rise <0.35 ng/mL | Detects malignancy that pygeum would not treat and that symptom relief could mask |
| Peak urinary flow rate | >15 mL/s | Objective measure of outlet obstruction, independent of symptom perception |
| Post-void residual urine volume | <50 mL | Detects incomplete emptying and the retention risk that symptom relief can hide |
| Serum creatinine and estimated glomerular filtration rate | Creatinine 0.8–1.1 mg/dL; filtration rate >90 mL/min/1.73 m² | Obstruction and the rat toxicity findings both implicate the kidney |
| Lactate dehydrogenase | 140–220 U/L | Follows the one enzyme flagged in animal toxicity work on pygeum |
| Total and free testosterone | Total 600–900 ng/dL; free 15–25 pg/mL | Baseline against which any antiandrogenic effect of bark constituents could be detected |
| Estradiol | 20–30 pg/mL | Oestrogen rises relative to testosterone with age and is implicated in prostate enlargement |
| High-sensitivity C-reactive protein | <1.0 mg/L | Tracks the systemic inflammatory tone that pygeum is proposed to act on |
Cadence: Baseline before starting; symptoms and quality of life re-scored at 8 weeks, then at 6 months, then every 6 to 12 months; prostate-specific antigen, kidney function, and lactate dehydrogenase annually; flow measurements whenever symptoms worsen