Benign prostatic hyperplasia (BPH) is an extremely common condition in the male population and represents one of the leading causes of urinary disorders after the age of 50. Its incidence progressively increases with age: more than 50% of men over 50 show clinical or histological signs of BPH (*), and this percentage may rise to 80–90% in men over 80 years of age. Not all individuals develop clinically relevant symptoms, but when present, these may significantly affect quality of life, leading to voiding difficulties, reduced urinary flow, urgency, and nocturia.

Population aging and the higher prevalence of sedentary lifestyles are contributing to an increase in diagnosed cases. For this reason, specialists recommend a urological evaluation starting at age 50, or as early as 45 in individuals with a family history or other risk factors. Early diagnosis allows clinicians to monitor disease progression and select the most appropriate therapeutic approach.

Serenoa repens: use and emerging data on adverse effects

Serenoa repens is a lipidosterolic extract obtained from the fruits of the American dwarf palm, widely used in Europe to support urinary symptoms associated with mild to moderate BPH. Its use is based on a modulatory action on 5α-reductase activity and on anti-inflammatory effects documented in preclinical studies.

A recent study published in the British Journal of Clinical Pharmacology analyzed a series of clinical cases in which sexual and psychiatric effects were reported in subjects taking Serenoa repens. The authors hypothesized the possibility of a post-Serenoa syndrome (PSS), characterized by persistent symptoms after treatment discontinuation. In the observed sample, 61% of cases developed symptoms within the first month of use, with dosages ranging between 300 and 600 mg per day.

It is essential to emphasize that this was an observational case series and therefore cannot establish a definitive causal relationship. Nevertheless, the findings highlight the need for careful monitoring of potential adverse effects, particularly in predisposed individuals.

Adverse effects: comparison with pharmacological inhibitors

The manifestations reported in the described cases mainly included reduced libido, erectile dysfunction, anxiety-depressive symptoms, and, more rarely, mild gastrointestinal disturbances. These clinical presentations resemble, in some respects, those observed with pharmacological 5α-reductase inhibitors such as finasteride and dutasteride.

In the case of finasteride, scientific literature reports persistent sexual side effects and, in a minority of cases, psychiatric symptoms even after treatment discontinuation. The so-called Post-Finasteride Syndrome remains under debate within the scientific community, but it has led regulatory authorities to recommend particular caution in individuals with a history of mood disorders.

These data reinforce the importance of carefully assessing possible psychiatric comorbidities before initiating treatments that interfere with 5α-reductase activity, whether pharmacological or phytotherapeutic in nature.

Mechanism of action and hormonal balance

5α-reductase is the enzyme responsible for converting testosterone into dihydrotestosterone (DHT), an androgen with greater affinity for the androgen receptor and involved in prostate tissue growth. Modulation of this enzyme represents one of the main therapeutic targets in BPH.

It is important to clarify that, unlike selective pharmacological inhibitors, Serenoa repens does not cause a complete blockade of DHT formation but rather a partial modulation of enzymatic activity. The reduction in DHT levels observed with Serenoa is generally lower than that achieved with finasteride. However, any intervention on the androgen axis may theoretically influence individual hormonal balance.

A significant alteration in the testosterone-to-DHT ratio may affect not only prostate function but also sexual health and, indirectly, certain neuroendocrine aspects related to mood regulation. For this reason, the use of substances active on 5α-reductase should occur under medical supervision, with appropriate symptom monitoring.

OXIBLUME and modulation of prostatic homeostasis

In this context, nutraceutical approaches aimed not at complete enzyme inhibition but at regulating androgen balance are emerging. OXIBLUME, alone or in combination with coenzyme Q10, has been developed with the goal of contributing to the modulation of 5α-reductase activity, supporting the maintenance of prostatic homeostasis.

Available analyses indicate that the mechanism of action of OXIBLUME is based on enzymatic modulation, with the aim of sustaining a physiological balance between testosterone and dihydrotestosterone, without acting as a complete pharmacological inhibitor. The association with coenzyme Q10 provides additional metabolic and antioxidant support, aspects that are relevant in prostate cellular physiology.

The management of BPH always requires individualized evaluation. An integrated approach based on solid scientific data and accurate patient information currently represents the most rational strategy for preserving long-term prostate health.

For more information about OXIBLUME click here.

* Firenzuoli F, Firenzuoli B, Mascherini V, et al. Can we identify a post-Serenoa syndrome (PSS)? A case series on sexual and psychiatric side effects of Serenoa repens. Br J Clin Pharmacol. 2026;1–10.