Pygeum (Prunus africana)

Table of Contents

1. What Pygeum Is
2. One Tree, Several Names
3. Traditional Uses
4. The Condition It Is Used For
5. What Is in the Bark
6. What the Clinical Evidence Shows
7. Where the Reviews Disagree
8. Hair Loss, Prostate Cancer and Other Claims
9. Doses Used in the Trials
10. Safety: What the Trials Recorded
11. The Tree Behind the Bottle
12. Where the Evidence Stands
13. Key Research Papers
14. Connections
15. Featured Videos

What Pygeum Is

Prunus africana belongs to the rose family (Rosaceae), the same family as cherries, plums and almonds, which is why it is called the African cherry, African prune or African plum in the research literature. It is a large forest tree. The medicine comes from its bark, not from the fruit or leaves.

The tree grows in highland forest. Ecological surveys in Ethiopia, for example, recorded it as one of the defining species of mid-altitude riparian forest along the Walga River at roughly 2,360 to 2,680 metres above sea level, and as the second most dominant woody species (by an importance index that combines abundance, frequency and trunk size) in the Seqela dry Afromontane forest. A 2003 review named Cameroon, Madagascar, Equatorial Guinea and Kenya as the major exporters of bark.

"Pygeum" on a supplement label nearly always means an extract of the dried bark, not the bark itself. As the chemistry section below shows, that difference turns out to matter.

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One Tree, Several Names

The tree was first described scientifically under the name Pygeum africanum, and that older name survives in most medical papers and on product labels. Botanists later moved it into the cherry genus as Prunus africana, which is the accepted name today. The two names refer to the same species. In medical databases, searching only one name misses part of the literature: the Cochrane review and most clinical trials say Pygeum africanum, while conservation and trade studies say Prunus africana.

• Prunus africana — the current botanical name.
• Pygeum africanum — the older name, still used for the extract.
• African cherry, African prune, African plum — common English names.
• Pygeum — the shorthand used in supplements and in many reviews.

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Traditional Uses

In its home range, the tree is part of local medicine. An ethnobotanical survey of 414 informants in the Sheka Zone of south-western Ethiopia ranked Prunus africana among the highest-ranking medicinal plants used against gastrointestinal problems. A 2019–2020 survey of 158 traditional medical practitioners in four regions of Uganda found it was the plant most frequently cited for family planning and reproductive health care. These are records of what people use, gathered by interview; they are not tests of whether the uses work, and the Ugandan authors describe the plant as a candidate for further investigation.

The European prostate use is much more recent. A 2003 review dated it to about the late 1960s ("for the last 35 years"), and a 1994 French laboratory paper described the extract as having been used for more than 20 years in France in men with BPH. By 2000, phytotherapy products made up about one-third of all BPH treatment sales in parts of Europe, and in France they were the most widely used BPH drugs, according to a review of the period.

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The Condition It Is Used For

The prostate is a walnut-sized gland below the bladder that wraps around the urethra, the tube urine leaves through. With age it often enlarges. When the enlargement is not cancer it is called benign prostatic hyperplasia. Because the gland surrounds the urethra, growth can narrow the outflow and irritate the bladder, producing lower urinary tract symptoms (LUTS): a weak stream, hesitancy, a feeling of incomplete emptying, urgency, frequent urination and getting up at night to urinate (nocturia).

• A 2023 evidence review in a family-medicine journal reported that lower urinary tract symptoms from BPH affect about 25% of US men, and nearly half of those have at least moderate symptoms.
• A 2011 systematic review reported that such symptoms may affect up to 30% of men in their early seventies, and that acute urinary retention (suddenly being unable to urinate) occurs in about 1% to 2% of men with BPH per year.
• The same 2023 review identified the International Prostate Symptom Score (IPSS), a seven-question score from 0 to 35, as the best way to track symptoms.

Urinary symptoms are not specific to BPH; infection, bladder problems, medications and prostate cancer can produce similar complaints. The 2023 review noted that a PSA blood test is not recommended in the routine evaluation of urinary symptoms and that prostate-cancer screening decisions are a matter of shared decision-making with a clinician. More background is on the site's Benign Prostatic Hyperplasia page.

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What Is in the Bark

A 1981 paper in Planta Medica was among the first to report on the constituents of the bark. A 2019 analytical study measured the compounds most often cited as active and compared four bark samples with seven commercial pygeum products:

• Beta-sitosterol and its esters — plant sterols with a structure similar to cholesterol. In bark the total was fairly constant at about 680 micrograms per gram; in some products it was above 10,000 micrograms per gram. About one-third was "free" sterol in bark, compared with nearly all of it in the products.
• Ferulic acid and its esters — more than 90% bound as esters in both bark and products, but total ferulic acid was on average about four times higher in bark (about 450 micrograms per gram) than in the products.
• Atranorin and atraric acid — present at low microgram-per-gram levels in both bark and products. Atraric acid was isolated in a 2006 study as a compound that blocked the androgen (male hormone) receptor in a cell-based test.
• N-butylbenzene sulfonamide — listed in older literature, but not found in any of the bark or product samples in the 2019 study.

In other words, the products studied did not simply concentrate the bark; their chemical profile was different. The full story is in Bark Chemistry and Prostate Mechanisms.

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What the Clinical Evidence Shows

The central document is the Cochrane systematic review by Wilt, Ishani and colleagues (2002), also published as a meta-analysis in The American Journal of Medicine in 2000. It found:

• 18 randomised controlled trials involving 1,562 men; 17 were double-blinded, but only one reported how treatment allocation was concealed.
• Studies lasted on average 64 days (range 30 to 122 days).
• Compared with placebo, pygeum produced a "moderately large" improvement in a combined measure of symptoms and urine flow (effect size −0.8 standard deviations, 95% confidence interval −1.4 to −0.3, from 6 studies).
• Men taking pygeum were more than twice as likely to report an improvement in overall symptoms (risk ratio 2.1, 95% CI 1.4 to 3.1).
• Nocturia fell by 19%, leftover urine in the bladder after urinating (residual urine volume) by 24%, and peak urine flow rose by 23%.
• Adverse effects were mild and comparable to placebo; dropout rates were 13% with pygeum, 11% with placebo and 8% with other controls.
• No trial compared pygeum with standard drugs such as alpha-blockers or 5-alpha-reductase inhibitors.

Two individual trials illustrate the raw material. A 1990 multicentre trial in Germany, France and Austria gave 263 men 50 mg of extract twice daily or placebo for 60 days; overall, urination improved in 66% of the extract group and 31% of the placebo group. A 1999 French trial compared 50 mg twice daily with 100 mg once daily for two months and found the two schedules equally effective; in a 10-month open-label extension without a placebo group, the average IPSS fell from 16 to 9.

The reviewers' own conclusion was guarded: a standardised preparation "may be a useful treatment option", but the studies were small, short, used varied doses and preparations, and rarely reported standardised validated outcomes. Details are in Enlarged Prostate (BPH) Evidence.

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Where the Reviews Disagree

Reviews written after the Cochrane analysis divide into two camps.

More favourable

• A 2023 family-medicine evidence review stated that saw palmetto is not effective but that pygeum and beta-sitosterol "may be effective".
• A 2019 Italian review described pygeum, nettle and pumpkin seed as possible add-ons to standard therapy, supported by studies showing improvements in symptoms and flow.
• A 2020 Spanish review concluded that pygeum "seems to be an option" in urology, while rating its own evidence base as level IV, meaning expert opinion.

More sceptical

• Two reviews by Keehn and Lowe (2015, 2016) concluded that early small trials of herbal BPH treatments gave mixed results, while larger, more soundly built studies found no significant benefit over placebo for phytotherapy, although the agents were largely safe.
• A 2013 Spanish systematic review found the BPH evidence inconsistent because of small numbers, lack of placebo control and short follow-up, and concluded that it did not support phytotherapy for BPH.
• A 2013 French review of urinary drugs reported that alpha-blockers and 5-alpha-reductase inhibitors have clearer efficacy than plant extracts.
• A German urologist's reviews (2000, 2002) pointed out that by strict evidence-based criteria the data were inconclusive, and that the 4th International Consultation on BPH and German guidelines of the time had not recommended phytotherapy.

Part of the disagreement is about what counts as "pygeum". The 2002 review argued that each manufacturer's extract has to be evaluated on its own, because extraction methods differ, and that meta-analyses mixing different products can mislead.

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Hair Loss, Prostate Cancer and Other Claims

Hair loss

Pygeum appears in hair-loss reviews alongside saw palmetto, nettle and pumpkin seed. The only randomised trial in the pack is a 2025 study of 80 men and women with chronic telogen effluvium (diffuse shedding) or androgenetic alopecia (pattern hair loss). They took a capsule containing l-cystine, saw palmetto, pumpkin seed, pygeum, vitamins and minerals, or placebo, for six months. Hair density rose by 12.3 hairs per square centimetre at six months in the supplement group, a statistically significant difference from placebo. Because the capsule held many ingredients, the trial cannot say what, if anything, pygeum contributed. Several authors were employees of the company that made the product.

Prostate cancer

Pygeum extract slowed the growth of two human prostate cancer cell lines in culture and, in a 2007 study, mice genetically engineered to develop prostate cancer that were fed pygeum had a lower cancer incidence (35%) than mice fed a casein control diet (62.5%). That is laboratory and animal work only. There are no human trials of pygeum for preventing or treating prostate cancer, and a 2013 systematic review found no evidence for phytotherapy in treating prostate cancer.

Chronic prostatitis

Pygeum is often listed among plant treatments for prostatitis, and a 2019 review discussed plant extracts for prostatitis and chronic pelvic pain. No trial in the evidence pack for this page tested pygeum alone for prostatitis, so this page makes no claim either way. See Prostatitis.

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Doses Used in the Trials

The site does not give dosing advice; this section reports what researchers used.

• The 1990 placebo-controlled multicentre trial used capsules of 50 mg extract, one in the morning and one in the evening, for 60 days.
• The 1999 trial compared 50 mg twice daily with 100 mg once daily and found them equally effective and equally tolerated at two months; the open extension continued 100 mg once daily for another 10 months.
• The Cochrane review noted that the trials as a group "used varied doses and preparations", and that many did not report results in a way that allowed them to be combined.

The trials tested standardised extracts, not powdered bark or teas. The 2019 chemical comparison found that the beta-sitosterol content of products generally followed their labelled phytosterol values but varied widely from product to product, so milligram amounts on different labels may not describe the same thing.

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Safety: What the Trials Recorded

• In the Cochrane review, adverse effects were mild and comparable to placebo, and dropout rates were similar across groups.
• In the 1990 trial of 263 men, gastrointestinal side effects occurred in 5 patients, and treatment was stopped in 3 of them.
• In the 1999 trial, the safety profile was similar between the once-daily and twice-daily groups and across the 12 months.
• Reviews of herbal BPH treatments describe them as "largely safe for ingestion", with mild and infrequent adverse events.

What is not known

• Safety beyond about 12 months of continuous use has not been studied in a controlled trial.
• There is no good data on interactions with prescription drugs, including the alpha-blockers and 5-alpha-reductase inhibitors used for BPH.
• The trials enrolled men with BPH; there is no safety data for women, children, or use during pregnancy or breastfeeding.
• A 2015 review stated that, in its authors' view, complementary treatments were an option only for men with mild symptoms who understood their limitations, and not for men with moderate or severe BPH. Decisions about any treatment belong with a clinician.

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The Tree Behind the Bottle

Almost all pygeum bark was wild-harvested. A 2003 review estimated world exports of dried bark at 1,350 to 1,525 tonnes a year in 2000, down from a peak of 3,225 tonnes in 1997, and concluded that wild collection was no longer sustainable where harvesting raised tree death rates. Prunus africana has been listed in Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) since 1995, which means its international trade requires export permits. A 2016 study described CITES export restrictions on Burundi, Kenya and Madagascar, a European Union import ban from 2007 lifted in 2011, and harvesters in Mount Cameroon National Park earning less than one US dollar a day. The whole story is in Overharvesting and the CITES Listing.

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Where the Evidence Stands

• Reasonably established: in older, small, short randomised trials, standardised pygeum extract improved urinary symptoms and flow measures more than placebo, with placebo-like side effects (Cochrane review, 18 trials, 1,562 men).
• Uncertain: whether the effect holds in long, large, modern trials using standard symptom scores; whether it matches standard drugs (never compared directly); and whether one product's results apply to another.
• Laboratory only: anti-androgen activity of atraric acid, anti-inflammatory effects on white blood cells, and effects on prostate cancer cells and mice.
• Not supported by human trials: any prostate-cancer prevention or treatment use; any effect of pygeum alone on hair loss.
• Well documented: the tree was overharvested, and its trade is regulated under CITES.

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Key Research Papers

1. Wilt T, Ishani A, Mac Donald R, et al. Pygeum africanum for benign prostatic hyperplasia. The Cochrane database of systematic reviews. 2002;1998(1):CD001044. PubMed PMID: 11869585
2. Ishani A, MacDonald R, Nelson D, et al. Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis. The American journal of medicine. 2000;109(8):654-64. PubMed PMID: 11099686
3. Wilt TJ, Ishani A, Rutks I, et al. Phytotherapy for benign prostatic hyperplasia. Public health nutrition. 2000;3(4A):459-72. PubMed PMID: 11276294
4. Barlet A, Albrecht J, Aubert A, et al. [Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: evaluation of objective and subjective parameters. A placebo-controlled double-blind multicenter study]. Wiener klinische Wochenschrift. 1990;102(22):667-73. PubMed PMID: 1702916
5. Chatelain C, Autet W, Brackman F. Comparison of once and twice daily dosage forms of Pygeum africanum extract in patients with benign prostatic hyperplasia: a randomized, double-blind study, with long-term open label extension. Urology. 1999;54(3):473-8. PubMed PMID: 10475357
6. Arnold MJ, Gaillardetz A, Ohiokpehai J. Benign Prostatic Hyperplasia: Rapid Evidence Review. American family physician. 2023;107(6):613-622. PubMed PMID: 37327163
7. McNicholas T, Kirby R. Benign prostatic hyperplasia and male lower urinary tract symptoms (LUTS). BMJ clinical evidence. 2011;2011. PubMed PMID: 21871136
8. Keehn A, Taylor J, Lowe FC. Phytotherapy for Benign Prostatic Hyperplasia. Current urology reports. 2016;17(7):53. PubMed PMID: 27180172
9. Keehn A, Lowe FC. Complementary and alternative medications for benign prostatic hyperplasia. The Canadian journal of urology. 2015;22 Suppl 1:18-23. PubMed PMID: 26497340
10. Morán E, Budía A, Broseta E, et al. [Phytotherapy in urology. Current scientific evidence of its application in benign prostatic hyperplasia and prostate adenocarcinoma]. Actas urologicas espanolas. 2013;37(2):114-9. PubMed PMID: 23058996
11. Dreikorn K. The role of phytotherapy in treating lower urinary tract symptoms and benign prostatic hyperplasia. World journal of urology. 2002;19(6):426-35. PubMed PMID: 12022711
12. Cicero AFG, Allkanjari O, Busetto GM, et al. Nutraceutical treatment and prevention of benign prostatic hyperplasia and prostate cancer. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2019;91(3). PubMed PMID: 31577095
13. Salinas-Casado J, Esteban-Fuertes M, Carballido-Rodríguez J, et al. Review of the experience and evidence of Pygeum africanum in urological practice. Actas urologicas espanolas. 2020;44(1):9-13. PubMed PMID: 31627963
14. Thompson RQ, Katz D, Sheehan B. Chemical comparison of Prunus africana bark and pygeum products marketed for prostate health. Journal of pharmaceutical and biomedical analysis. 2019;163:162-169. PubMed PMID: 30316061
15. Schleich S, Papaioannou M, Baniahmad A, et al. Activity-guided isolation of an antiandrogenic compound of Pygeum africanum. Planta medica. 2006;72(6):547-51. PubMed PMID: 16773539
16. Paubert-Braquet M, Cave A, Hocquemiller R, et al. Effect of Pygeum africanum extract on A23187-stimulated production of lipoxygenase metabolites from human polymorphonuclear cells. Journal of lipid mediators and cell signalling. 1994;9(3):285-90. PubMed PMID: 7921787
17. Shenouda NS, Sakla MS, Newton LG, et al. Phytosterol Pygeum africanum regulates prostate cancer in vitro and in vivo. Endocrine. 2007;31(1):72-81. PubMed PMID: 17709901
18. Piquero-Casals J, Saceda-Corralo D, Aladren S, et al. Oral Supplementation with l-Cystine, Serenoa repens, Cucurbita pepo, and Pygeum africanum in Chronic Telogen Effluvium and Androgenetic Alopecia: A Double-Blind, Placebo-Controlled, Randomized Clinical Study. Skin appendage disorders. 2025;11(1):27-35. PubMed PMID: 39911983
19. Stewart KM. The African cherry (Prunus africana): can lessons be learned from an over-exploited medicinal tree? Journal of ethnopharmacology. 2003;89(1):3-13. PubMed PMID: 14522426
20. Cunningham A, Anoncho VF, Sunderland T. Power, policy and the Prunus africana bark trade, 1972-2015. Journal of ethnopharmacology. 2016;178:323-33. PubMed PMID: 26631758
21. Kassa Z, Asfaw Z, Demissew S. An ethnobotanical study of medicinal plants in Sheka Zone of Southern Nations Nationalities and Peoples Regional State, Ethiopia. Journal of ethnobiology and ethnomedicine. 2020;16(1):7. PubMed PMID: 32024539
22. Adia MM, Savina A, Jane N, et al. Medicinal plant species used for contraception and reproductive health care in rural Uganda. Heliyon. 2025;11(1):e41518. PubMed PMID: 39844971
23. Longo R, Tira S. Constituents of Pygeum africanum Bark. Planta medica. 1981;42(6):195-6. PubMed PMID: 17401960
24. Game X, Cornu JN, Robert G, et al. [Drug therapy of urethral diseases]. Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2013;23(15):1287-98. PubMed PMID: 24183087
25. Dreikorn K. Phytotherapeutic agents in the treatment of benign prostatic hyperplasia. Current urology reports. 2000;1(2):103-9. PubMed PMID: 12084323
26. Levin RM, Das AK. A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens. Urological research. 2000;28(3):201-9. PubMed PMID: 10929430
27. Meragiaw M, Woldu Z, Martinsen V, et al. Woody species composition and diversity of riparian vegetation along the Walga River, Southwestern Ethiopia. PloS one. 2018;13(10):e0204733. PubMed PMID: 30332486
28. Birhanu L, Moges G, Amsalu N, et al. Woody species diversity, structure and community distribution along environmental gradients of Seqela Dry Afromontane forest in Northwestern Ethiopia. PloS one. 2025;20(1):e0313020. PubMed PMID: 39823466

PubMed Topic Searches

1. PubMed: Pygeum africanum and benign prostatic hyperplasia
2. PubMed: Prunus africana bark chemistry
3. PubMed: Prunus africana conservation and trade
4. PubMed: Phytotherapy for lower urinary tract symptoms

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Connections

• All Herbs
• Pain and Men's Health Herbs — the category this herb belongs to
• Pygeum Benefits Hub — the four deep-dive articles
• Pygeum: BPH Evidence — the trials, number by number
• Pygeum: Bark Chemistry — sterols, ferulic esters and atraric acid
• Pygeum: Overharvesting and CITES — the conservation story
• Pygeum vs Saw Palmetto and Nettle — the three prostate herbs compared
• Saw Palmetto — the most-studied prostate herb
• Stinging Nettle — nettle root, the third common BPH herb
• Benign Prostatic Hyperplasia — the condition itself
• Prostate Conditions — enlargement, inflammation and cancer
• Prostatitis — inflammation of the prostate
• Prostate Cancer — where pygeum has only laboratory data
• PSA Test — the prostate blood test
• Pumpkin Seeds: Prostate and Urinary Health — another plant used for BPH
• Ferulic Acid — one of the bark's compounds
• Frequent Urination — one of the main symptoms

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