Effects of Serenoa repens extract on sexual function in patients with benign prostatic hyperplasia: a systematic...

Serenoa repens extract has been widely used as a phytotherapeutic option for benign prostatic hyperplasia (BPH), potentially offering a milder alternative to pharmaceutical treatments such as 5-alpha reductase inhibitors or alpha-blockers. However, its effects on sexual function remain inconsistent across randomized trials. This study aimed to evaluate the effects of S. repens extract on sexual function and quality of life in men withBPH.

Five electronic databases were searched from inception to January 21, 2026, for randomized controlled trials comparing S. repens extract with placebo in men with BPH. The primary outcome was sexual function, with analyses restricted to studies using the International Index of Erectile Function (IIEF) where possible to improve comparability. Quality of life was evaluated as a secondary outcome. Random-effects meta-analyses were performed using standardized mean differences with Hartung-Knapp-Sidik-Jonkman adjustment and restricted maximum likelihood estimation.

Six randomized controlled trials were included. The pooled analysis showed no statistically significant effect of S. repens extract on sexual function compared with placebo (Hedges' g = -0.08, 95% CI -0.93 to 0.77; I ² = 96.16%). The corresponding 95% prediction interval ranged from -2.448 to 2.286, indicating considerable between-study variability and suggesting that future studies could plausibly demonstrate effects favoring either S. repens or placebo. In the subgroup analysis restricted to studies using the IIEF, heterogeneity was substantially reduced (Hedges' g = -0.206, 95% CI -0.540 to 0.128; I ² = 28.76%), although the treatment effect remained statistically non-significant. Similarly, no significant improvement was observed in quality-of-life outcomes, and substantial heterogeneity persisted across studies.

Current evidence does not support a clinically meaningful benefit of S. repens extract over placebo for improving sexual function or quality of life in men with BPH. Because the overall pooled estimate combined conceptually different sexual function instruments and was associated with substantial heterogeneity, it should be interpreted cautiously. The IIEF-restricted analysis demonstrated markedly lower heterogeneity and may therefore provide a more clinically interpretable estimate of treatment effect, because it was based on a more homogeneous assessment of erectile and sexual function than the overall analysis combining different outcome instruments. The overall certainty of the evidence was very low, and further adequately powered randomized controlled trials using standardized and conceptually comparable sexual function measures are warranted.

This study was registered in the PROSPERO database (CRD420261293450).