The researchers suggested that findings from the 12-week pilot study provide preliminary evidence for the use of the extract to support men’s urinary health.
Red sage acts through distinct pathways compared with conventional drug treatments and widely established herbal remedies such as saw palmetto, according to the report. It may also avoid adverse effects such as erectile dysfunction that may occur with other treatments.
“Collectively, the findings from this study indicate that SAGX is well tolerated and was associated with fewer reported adverse events, which may translate into more substantial supportive benefits for prostate health than saw palmetto extract,” they wrote in the journal Nutrients.
Impact and treatments for lower urinary tract symptoms
Up to 40% of men older than 50 have lower urinary tract symptoms (LUTS), which can include urinary frequency and weak stream, incomplete bladder emptying, and waking during the night to urinate.
These symptoms can affect quality of life and confidence, and the medications used to treat them can have adverse effects on blood pressure, sexual function, or hormone levels.
As interest in alternative therapies to treat the condition rose, saw palmetto became a widely used plant-based remedy for benign prostatic hyperplasia and lower urinary tract symptoms.
However, a 2023 Cochrane review suggested that the supplement has little to no effect on symptoms and quality of life, and inconsistencies in product standards have also been reported.
Saw palmetto targets androgen signaling pathways, but increasing evidence suggests that inflammation, oxidative stress, and pelvic microvascular dysfunction are key contributors to LUTS. Therefore, plant-based compounds that support these additional mechanisms could be a potential complementary or alternative approach.
Salvia miltiorrhiza—also known as red sage, Chinese sage, or danshen- is a plant used in traditional Chinese medicine primarily to promote blood circulation, protect the heart, and reduce inflammation. Compounds called tanshinones in the plant exert antioxidant, anti-inflammatory, and vasodilatory effects.
The current study noted that tanshinones activate the Nrf2/HO-1 signaling pathway. “Activation of this pathway may reduce prostatic inflammation and mitigate oxidative stress within the bladder, mechanisms that plausibly contribute to the observed improvements in storage-related symptoms, most notably urinary frequency,” the researchers wrote.
They also highlighted the positive results on erectile function (ED), in contrast to 5-α-reductase inhibitors, which patients are commonly prescribed for LUTS and can exacerbate ED.
Study details
The study involved 30 men aged 40–80 years with a clinical diagnosis of mild to moderate LUTS. They were randomly assigned to receive either 400 mg of a proprietary extract of S. miltiorrhiza (SAGX) standardized to contain a minimum of 10% cryptotanshinone or 320 mg of saw palmetto extract once daily for 12 weeks.
The researchers assessed changes in the International Prostate Symptom Score (IPSS), the LUTS-related quality-of-life (QoL) score, and the International Index of Erectile Function (IIEF).
The results showed a significantly greater reduction in total IPSS score in the SAGX group compared with the saw palmetto group at 12 weeks. The SAGX group also demonstrated great improvements in urinary frequency, storage, and quality of life.
There were also greater improvements for the SAGX group for erectile function, sexual desire, and intercourse satisfaction.
As far as safety was concerned, there were fewer adverse effects in the SAGX group, and these were classed as mild in intensity and included dizziness and itching.
“In the context of LUTS management, the minimum clinically important difference (MCID) is generally defined as a reduction of 3 points in the IPSS,” the researchers wrote.
“The mean reduction of 4.6 points observed in the SAGX group exceeded this threshold, indicating a clinically meaningful therapeutic effect.”
In comparison, saw palmetto “exhibited only a 0.6-point reduction, a magnitude that falls below the MCID and is considered clinically negligible,” they added.
They recommended a definitive three-arm confirmatory trial to validate their preliminary findings.
Source: Nutrients 2026, 18(11), 1752; https://doi.org/10.3390/nu18111752 “Efficacy and Safety of Salvia miltiorrhiza Extract (SAGX) Compared with Saw Palmetto in Men with Lower Urinary Tract Symptoms: A 12-Week, Randomized, Double-Blind, Parallel-Group Pilot Study.” Authors: Kim, E. Y. et al.