The bark of the African plum tree (Pygeum africanum), a traditional African remedy for a variety of conditions, is nowadays widely used for prostate enlargement and other urinary diseases. Read on to learn more about this herbal supplement, its health benefits, and potential side effects.

What Is Pygeum?

Pygeum africanum (or Prunus africana), commonly known as the African plum tree or pygeum, is an evergreen tree native to the mountainous regions of Sub-Saharan Africa, the Madagascar and Comoros islands, and the Gulf of Guinea [R].

In Africa, pygeum bark has traditionally been chewed or crushed into powder and drunk as a tea to help with conditions such as [R, R]:

  • Prostate problems
  • Urinary problems
  • Bladder discomfort
  • Kidney disease
  • Chest pain
  • Stomach ache
  • Malaria
  • Fever symptoms
  • “Madness”

Pygeum bark is widely sold as an extract in Europe (especially in France) and the US to treat and/or prevent urinary disorders, prostate enlargement, and prostate cancer [R, R].

The extract is mainly marketed under the brand names [R, R, R]:

  • Tadenan
  • Pygenil
  • Prosta-FX

Components of Pygeum

Pygeum bark is rich in phytosterols, fatty acids, pentacyclic triterpenes, and esters of ferulic acid. Phytosterols are compounds found in plants that are structurally similar to cholesterol. The variety of fatty acids found in pygeum include saturated fatty acids and unsaturated omega fatty acids. There are some promising data on the pentacyclic triterpenes and ferulic acid found in pygeum bark as anti-cancer compounds and other pygeum compounds (atraric acid and n-butylbenzenesulfonamide) as hormone blockers [R, R, R, R, R, R].

Pygeum bark is very rich in phytosterols such as [R, R, R]:

  • Beta-sitosterol (also found in pygeum leaves)
  • Beta-sitosterol glucoside (also found in pygeum leaves)
  • Beta-sitostenone
  • Campesterol
  • Daucosterol

The main fatty acids present in the bark include [R, R, R]:

  • Palmitic
  • Abietic
  • Linoleic
  • Oleic
  • Myristic
  • Lauric

The most abundant pentacyclic triterpenes are [R, R]:

It also contains esters of ferulic acid with the following fatty alcohols [R]:

  • n-Docosanol
  • n-Tetracosanol

Other active compounds present in pygeum bark include:

  • N-Butylbenzenesulfonamide (NBBS) [R]
  • Atraric acid [R]

Mechanisms of Action

1) Blocking of Connective Tissue Cell Growth

Prostate enlargement is caused by the excessive growth of its connective tissue cells, the structural framework of animal tissues. This growth is triggered by the following proteins (growth factors) [R, R]:

  • Basic fibroblast growth factor (bFGF)
  • Epidermal growth factor (EGF)
  • Transforming growth factor-beta1 (TGF-beta 1)
  • Insulin growth factor (IGF)

These proteins activate an enzyme (protein kinase C) that promotes cell division [R].

Pygeum extract reduced prostate connective tissue cell growth in patients with prostate enlargement by decreasing the production of growth factors and blocking their function [R, R].

Blood extracted from a patient with prostate enlargement that had been treated with pygeum extract reduced the growth of several types of healthy human prostate cells (cell study) [R].

Pygeum extract also blocked growth in rat prostate connective tissue cells treated with growth factors [R, R].

Although the active compound responsible for blocking the growth of connective tissue cells has not been identified yet, another plant containing n-docosanol (Myoschilos oblongum) also blocks prostate cell growth, making n-docosanol a probable candidate [R].

2) Blocking of Cancer Cell Growth

Several compounds present in pygeum extract kill cancer cells and block their growth. Among them, the most important ones are:

  • Ursolic acid: it increases cancer cell death by reducing the production of a protein normally involved in cell death (B-cell leukemia/lymphoma 2 protein) [R, R].
  • Oleanolic acid: it causes cancer cell death and blocks proteins that promote cancer growth [R, R].
  • Ferulic acid: it prevents the growth of new blood vessels from older ones, as well as the growth and spread of prostate cancer cells [R].
  • Atraric acid: it prevents the growth of prostate cancer cells by blocking the transport and activation of the male sex hormone receptor [R].
  • N-butylbenzenesulfonamide: like atraric acid, it prevents the growth of prostate cancer cells by blocking the transport and activation of the male sex hormone receptor but its effect is weaker [R].
  • Beta-sitosterol: it negatively affects the function and membrane structure of prostate cancer cells, reduces their spread, and induces their death [R, R, R].
  • Lauric acid: it prevents the formation of the strong male sex hormone dihydrotestosterone (DHT) and reduces the growth of prostate cancer cells [R, R].

3) Anti-Inflammatory Activity

Inflammation commonly occurs in patients with enlarged prostates. Their prostate cells have increased levels of the following white blood cell types [R, R]:

  • CD3+ T-cells: cells that recognize and kill infected or cancer cells
  • CD11c+ macrophages: cells that capture and “eat” foreign and harmful cells, organisms, and substances
  • CD20+ B-cells: cells that produce antibodies

During inflammatory processes, a fatty acid called arachidonic acid is released from cell membranes. In white blood cells, arachidonic acid is broken down into leukotrienes or prostaglandins. Both leukotrienes and prostaglandins trigger several inflammatory responses [R, R, R].

In men with prostate enlargement, beta-sitosterol and beta-sitostenone decrease prostaglandin production in this organ [R].

In human cells, the addition of pygeum extract blocked the breakdown of arachidonic acid and thus reduced the production of leukotrienes [R].

4) Anti-Sex Hormone Activity

The human prostate contains an enzyme (5 alpha-reductase) that converts the male sex hormone testosterone into its more powerful variant dihydrotestosterone (DHT). Because dihydrotestosterone is increased in patients with prostate enlargement, it is believed to trigger this condition [R].

Alternatively, aromatase is the enzyme that converts male sex hormones into female sex hormones. Excessive female sex hormone build-up also triggers prostate enlargement [R].

A commercial pygeum extract blocked both 5 alpha-reductase and aromatase in rat prostate tissues. The effect was stronger in combination with a stinging nettle extract. Among the compounds present in pygeum extract, lauric acid is known to block 5 alpha-reductase [R, R].

Testosterone and dihydrotestosterone (DHT) bind to the male sex hormone receptor, which switches on target genes that can trigger prostate enlargement and cancer [R].

Two components capable of blocking the male sex hormone receptor and preventing its activation in the nucleus have been isolated in pygeum bark: atraric acid and n-butylbenzenesulfonamide (NBBS) [R, R].

Health Benefits of Pygeum

1) Pygeum Helps With Prostate Enlargement

Prostate enlargement is a disease that affects 50% of men in their 60s and 85% of men over 80 years old. Its main symptoms include [R]:

  • Increased urinary frequency
  • Difficulty in delaying urination
  • Certain effort required to start urination
  • Weak urinary flow
  • Sensation of incomplete emptying of the bladder

Although surgery is often required in severe cases, drugs can be used in the early stages or when the symptoms are mild [R].

In a literature review of 13 open-label studies (both the patients and the researchers knew which treatment was being used) on 849 patients and 12 DB-RCT studies on 717 patients conducted between 1970 and 1995, intake of pygeum extract showed overall positive effects on prostate enlargement symptoms over placebo [R].

Another meta-analysis demonstrated intake of pygeum extract caused a moderate improvement of prostate enlargement symptoms compared to placebo (analysis of 18 DB-RCT involving 1562 patients and DB-RCT of 263 patients) [R, R].

In an uncontrolled, open-label, study on 85 patients, intake of pygeum extract resolved symptoms and improved quality of life in patients with prostate enlargement but did not reduce prostate size [R].

The daily intake of a preparation combining the extracts of pygeum (15 g dry stem), saw palmetto (660 mg dry leaf), and hoary willowherb (500 mg dry herb), as well as different plant oils, reduced urination frequency for 3 months (DB-RCT of 57 patients with prostate enlargement) [R].

However, in a trial (DB-RCT) with 20 patients, pygeum extract did not relieve prostate enlargement symptoms. Similarly, the daily intake of a combined pygeum (25 mg) and stinging nettle (300 mg) extract did not show any improvements on prostate enlargement symptoms and quality of life in another study (DB-RCT on 49 patients) [R, R].

2) Pygeum Helps With Long-Term Prostate Inflammation

In an open-label trial (both the patients and the researchers knew which treatment was being used) on 47 patients with long-term prostate inflammation, 42 were healed after taking pygeum extract (100 mg/day) for 5-7 weeks [R].

In another open-label study on 18 patients suffering from long-term prostate inflammation, intake of pygeum extract (200 mg/day) with or without antibiotics for 60 days improved all the urinary parameters measured [R].

Because these studies were not blinded to the participants or researchers, the effects might be due to a placebo effect.

3) Pygeum Improves Bladder Function

Prostate enlargement is normally accompanied by bladder blockage and bladder muscle damage due to low blood supply [R, R].

In rabbits with bladder blockage, pygeum extract improved the mobility of the bladder muscles in response to stimulation and protected them from damage. The improved mobility in response to pygeum was due to the restored production of the normal forms of a muscle protein (myosin), while the antioxidant activity of the myristic acid contained in the pygeum extract protected muscle tissues from damage [R, R, R, R, R].

Diabetes can lead to a bladder condition (diabetic cystopathy) with similar symptoms to prostate enlargement. In diabetic rats, pygeum extract reduced damage in the bladder and increased the production of two protective growth factors (nerve growth factor and substance P) [R, R, R].

4) Pygeum Has Anti-Cancer Cell Effects

In a study in mice, pygeum extract reduced the growth of two cancer cell lines and decreased the incidence of prostate cancer [R].

The blood of a man who had taken pygeum extract activated a set of genes that reduced the growth of two human cancer cell lines [R].

In a cell study (human prostate cancer cells), a compound isolated from pygeum bark (atraric acid) bound to their male sex hormone receptor and prevented its activation. As a result, the cells could neither grow nor invade other tissues [R].

Similarly, in another cell study, another compound isolated from pygeum bark (n-butylbenzenesulfonamide) bound to this receptor and reduced the growth of human prostate cancer cells [R].

A dietary supplement (ProstaCaid) containing pygeum bark among many other compounds reduced the growth and spread of a prostate cancer cell line [R].

Epstein-Barr virus is known to cause several cancers such as lymphatic, throat, and stomach cancer. In a study in human cells, pygeum and other plant extracts decreased the activation of this virus [R, R].

5) Pygeum and Hair Loss

Dihydrotestosterone produced by 5 alpha-reductase type 2 reduces hair growth in people with male pattern baldness [R].

Because pygeum extract decreases dihydrotestosterone production by blocking 5 alpha-reductase, it may prevent hair loss caused by this sex male hormone [R].

Since a direct causal link has not been established or studied, the effect of pygeum on hair loss is only speculative.

6) Pygeum and Acne

During puberty, male sex hormones can stimulate oil glands in the skin. The glands increase their size and oil secretion, which causes acne [R].

By blocking the production of dihydrotestosterone and the interaction of male sex hormones with their receptor, pygeum extract may reduce the incidence of acne [R, R, R].

Since a direct causal link has not been established or studied, the effect of pygeum on acne is only speculative.

Side Effects

Adverse side effects have been observed in some patients. Among them, the most common ones are those affecting the digestive system, such as [R, R]:

Other effects reported include [R, R]:

  • Muscle and joint pain
  • Headache
  • Dizziness
  • Visual disturbances
  • Restlessness
  • Insomnia/difficulty falling asleep
  • Hernia (protrusion of intestines through a canal in the groin: inguinal hernia)

The most serious adverse effects are those related to the urinary system [R]:

  • Lack of urination
  • Urine retention

Because the effects of pygeum during pregnancy and breastfeeding have not been studied, its use should be avoided in these cases [R].

Limitations and Caveats

Prostate Enlargement Studies

Many of the studies were open-label (both the patients and the researchers knew which treatment was being used) or had a low number of patients [R, R].

A meta-analysis concluded the prostate enlargement studies were limited by the study duration, variability in the design, dosage, composition of extract preparations, and parameters measured in the studies [R].

Pygeum extract failed to show better performance over placebo in some clinical trials [R, R].

Prostate Inflammation Studies

The clinical trials were conducted on few patients were not placebo controlled [R, R].

Bladder Studies

The effects of pygeum extract on bladder function have only been tested on animals. Additionally, a very high pygeum concentration (100 mg/kg body weight) was required compared to the effective dose used against prostate enlargement [R, R, R].

Cancer Studies

No clinical trials have been carried out to investigate the role of pygeum extract on prostate cancer prevention. The results are based on studies on cells and mice only [R, R, R, R, R, R].

Hair Loss and Acne Claims

The effects of pygeum extract on hair loss and acne prevention have not been clinically tested and are speculations based on its male sex hormone blocker activity [R, R, R].

Drugs Interactions

Because pygeum extract reduces the production of dihydrotestosterone (a male sex hormone) and female sex hormones, it may interfere with hormone drugs such as birth control pills [R, R].

Pygeum may enhance the action of 5 alpha-reductase blockers (testosterone blockers) such as these medications for enlarged prostates [R]:

  • Terazosin (also a high blood pressure medication)
  • Finasteride (also treats hair loss)
  • Doxazosin (also a high blood pressure medication)

Similarly, it may increase the aromatase-blocking action (an enzyme involved in estrogen synthesis) of these breast cancer medications [R]:

  • Exemestane
  • Anastrozole
  • Letrozole
  • Testolactone

Pygeum can increase the effects of these male sex hormone blockers used to treat prostate cancer [R]:

  • Flutamide
  • Bicalutamide
  • Nilutamide
  • Abiraterone acetate
  • Enzalutamide

Pygeum extract may also enhance the blocking of 5-lipoxygenase by drugs such as zileuton (asthma medication) [R].

Because it reduces the production of the regulator protein B-cell lymphoma 2 (a protein involved in cell death), pygeum extract may decrease the activity of drugs targeting it, such as these cancer medications [R]:

  • Oblimersen
  • Venetoclax

Pygeum extract may also reduce the activity of protein kinase C activators such as ingenol mebutate (anti-tumor medication) and add to the effect of drugs blocking this protein such as Ruboxistaurin (medication for damage to the retinas from diabetes) [R].

Pygeum Supplements

The most widely used pygeum supplement is Tadenan. It is standardized to 14% steroids and 0.5% n-docosanol and sold as 50 mg or 100 mg capsules. Other supplements are Pygenil and Prosta-FX [R].

Pygeum is also available as a liquid extract or as bark that has been ground into a powder that can be mixed with foods and beverages. Extracts are more effective than the bark powder because they are standardized to a concentration of their main active compounds [R].

Pygeum in Combination With Other Supplements

Pygeum extract is often sold in preparations with saw palmetto or stinging nettle. These combinations have stronger effects than pygeum alone [R, R].

A commercial supplement for prostate health (ProstaCaid) combines pygeum extract with Curcuma root (turmeric), pumpkin seeds, dandelion herb, stinging nettle extract, saw palmetto fruits, broccoli extract, pomegranate fruit, grapefruit skin extract, tea extract, and a mushroom blend, among others [R].

Because of its effect on the production of male and female sex hormones, pygeum extract may interfere with supplements containing phytoestrogens (e.g., soybean isoflavones) [R].

Although several online anecdotes claim that the combination of pygeum extract with lecithin supplements increased sexual performance and orgasm intensity in men (the combination is commonly known as “the holy grail stack”), they are not backed by any scientific evidence.

Dosage

Both 50 mg, 2x/day (the most common dosage) and 100 mg, 1x/day for up to 12 months were effective and safe (DB-RCT on 209 patients with prostate enlargement). In most cases, the effects could be observed after 4-8 weeks [R, R, R].

Genes Linked to Pygeum

The protein kinase C PLCγ1-R707Q mutation produces a permanently active protein that increases resistance to death in cancer cells. Pygeum may be less effective in people with this mutation [R].

Male sex hormone receptor variants may have an increased or reduced affinity for atraric acid and n-butylbenzenesulfonamide (NBBS), and thus alter the effect of pygeum extract on prostate cancer [R, R].

Several 5 alpha-reductase SNPs (rs166050, rs523349, and rs612224) alter the effectiveness of prostate enlargement treatments. These mutated versions may also increase or reduce the effect of treatments with pygeum extract [R].

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User Experiences

Pygeum was almost exclusively taken to reduce prostate enlargement symptoms. Users of several commercial brands were generally happy with their effects. Particularly, they reported being able to sleep all night long without having to urinate.

In some cases, users stopped taking the extract after not noticing any effects.

A few users reported dizziness and stomach cramps as the main adverse effects caused by the extract.

Some users took pygeum extract to increase their ejaculate volume. In general, they were happy with the results.

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