BPH at Age 69 and After Castration: Saw Palmetto, Symptoms and Hormones

Question 1: Enlarged Prostate at Age 69 and Restarting Saw Palmetto

Hello Fabian,

At age 69, an enlarged prostate is common. However, I would separate your old diagnosis of BPH from your current pain and tingling symptoms.

Is BPH Common at Age 69?

Yes.

BPH becomes increasingly common with age and is the most common prostate problem in men over 50. Some men develop an enlarged prostate without significant symptoms, while others develop urinary frequency, urgency, nocturia, weak stream, hesitancy or incomplete emptying.

Prostate size and symptom severity do not always match. A large prostate can produce relatively mild symptoms, while a smaller prostate can still cause significant lower urinary tract symptoms.

Is Pain at the Tip of the Penis a Typical BPH Symptom?

Not by itself.

Intermittent discomfort at the tip of the penis—particularly during or after urination—can occur with several conditions, including:

• prostatitis or chronic pelvic pain syndrome;
• urinary tract infection;
• urethritis;
• urethral narrowing or irritation;
• urinary stones;
• bladder irritation;
• recent catheterization or instrumentation; and
• penile or foreskin inflammation.

Scrotal tingling can also occur with pelvic pain syndromes, nerve irritation, testicular or epididymal problems, or musculoskeletal conditions.

NIDDK notes that chronic prostatitis/chronic pelvic pain syndrome can cause pain in the penis or scrotum, including pain during or after urination.

What Evaluation Would Make Sense Now?

Current European male-LUTS guidance recommends a complete history, physical examination and urinalysis for men with urinary symptoms.

Depending on your current symptoms, a clinician may consider:

• urinalysis to look for infection, blood or glucose;
• urine culture if infection is suspected;
• examination of the penis, urethral opening, scrotum and testicles;
• digital rectal examination when appropriate;
• post-void residual urine measurement;
• uroflowmetry if the stream is weak;
• updated prostate imaging if prostate size would change treatment; and
• PSA after a discussion of the benefits and limitations.

See our prostate and urinary testing guide.

Can You Restart Saw Palmetto After a Year?

There is no known medical rule that stopping saw palmetto for a year prevents you from taking it again later.

Saw palmetto is not like a medicine that produces a recognized withdrawal or rebound enlargement when it is stopped.

If symptoms improved while you were taking it and later returned, that does not prove that the supplement controlled prostate growth. BPH and lower urinary tract symptoms naturally fluctuate, and placebo effects can also influence how symptoms are perceived.

Does Saw Palmetto Actually Treat BPH?

The best current evidence is not convincing.

The U.S. National Center for Complementary and Integrative Health states that enough research has been performed to conclude that saw palmetto is probably not helpful for BPH urinary symptoms.

A 2023 review of 27 studies found that saw palmetto used alone produced little or no benefit for BPH symptoms. NIH-funded trials also found no significant improvement over placebo, including at higher-than-usual doses.

Does Stopping BPH Treatment Make the Prostate Grow Back Larger Than Before?

That statement from the original answer was too broad.

Saw palmetto has not been shown to reliably shrink the prostate, so there is no established “rebound enlargement” phenomenon when it is stopped.

Prescription 5-alpha-reductase inhibitors such as finasteride and dutasteride are different. They reduce dihydrotestosterone (DHT) and can reduce prostate size by approximately 18–28% over time. If treatment is discontinued, the hormonal suppression ends and prostate growth can resume, but this is not the same as saying the gland becomes abnormally larger than it otherwise would have been.

Can an Enlarged Prostate Be Reduced in Size?

Yes. The old claim that prostate enlargement can never be reduced was incorrect.

Finasteride and dutasteride can shrink the prostate in appropriately selected men. They are generally most useful when there is demonstrable prostate enlargement and an increased risk of progression.

Alpha blockers such as tamsulosin improve urinary flow by relaxing smooth muscle but do not substantially shrink the gland.

See our BPH medication guide.

Does BPH Turn Into Prostate Cancer?

No.

This is one of the most important corrections to the old page.

The National Cancer Institute defines BPH as a benign condition and states that BPH does not increase a person’s risk of developing prostate cancer.

BPH and prostate cancer can occur in the same man because both become more common with age, but one does not transform into the other.

Should You Have a PSA Test at Age 69?

It is reasonable to discuss it.

The AUA/SUO prostate-cancer early-detection guideline recommends regular screening every two to four years for people aged 50–69 who choose screening after shared decision-making, with the interval personalized according to PSA, risk factors, health and preferences.

At 69, you are at the upper end of the group most likely to benefit from routine screening. Whether to continue after that should become increasingly individualized.

PSA should not be ordered simply because you have BPH. Infection, inflammation, urinary retention and recent urinary instrumentation can also temporarily raise PSA.

See our PSA guide.

Do You Need to See a Urologist Three or Four Times Every Year?

Not automatically.

Follow-up frequency should reflect:

• how bothersome your symptoms are;
• whether treatment has recently changed;
• prostate size and progression risk;
• post-void residual;
• PSA/risk findings when relevant; and
• whether complications are present.

Stable mild BPH does not automatically require four specialist visits per year.

Question 2: Can BPH Develop in Castrated Men?

This is an interesting question, and modern evidence gives a clearer answer than the original article did.

BPH Is Strongly Dependent on Androgen Signaling

The prostate depends heavily on androgens—particularly dihydrotestosterone (DHT)—for normal development and maintenance.

Testosterone is converted to DHT inside prostate tissue by the enzyme 5-alpha-reductase. DHT then activates androgen receptors within prostate cells.

This pathway is so important that modern BPH treatment uses finasteride and dutasteride specifically to block DHT production.

What Happens if Castration Occurs Before Puberty?

Historical human observations and modern reviews consistently show that men who lose testicular androgen production before puberty do not normally develop the prostate enlargement seen with aging.

The prostate remains very small because androgen signaling required for normal prostate development is absent.

Men with severe inherited 5-alpha-reductase deficiency—who cannot efficiently produce DHT—also tend to have small prostates and do not develop typical BPH.

What if a Man Is Castrated After BPH Has Already Developed?

This situation is different.

If a man has already developed BPH and later undergoes surgical castration (orchiectomy) or profound medical androgen-deprivation therapy, prostate tissue generally shrinks because androgen stimulation has been removed.

Historical observations found regression of enlarged prostate tissue after androgen withdrawal, and modern hormonal biology supports this effect.

However, urinary symptoms may not disappear completely.

Why Could Urinary Symptoms Continue After Castration?

Even if prostate tissue shrinks, an older man can still develop urinary symptoms from:

• overactive bladder;
• weak bladder muscle contraction;
• urethral stricture;
• bladder-neck narrowing;
• neurological disease;
• urinary infection;
• bladder stones;
• medications; or
• pre-existing structural changes caused by years of obstruction.

Therefore, urinary frequency or weak flow in a castrated man should not automatically be called BPH.

Can BPH Ever Occur After Castration?

The answer depends on when and how complete the androgen deprivation occurred.

Do the Adrenal Glands Compensate by Making Large Amounts of Estrogen?

No—not in the way described in the original answer.

The adrenal glands produce small amounts of androgen precursors such as DHEA and androstenedione. They do not simply replace lost testicular testosterone by producing enough estrogen to drive ordinary BPH.

Estrogen signaling may have complex roles in prostate biology, but human BPH fundamentally requires androgenic signaling. The observation that men castrated early do not develop BPH is strong evidence against the old estrogen-compensation explanation.

Why Do Finasteride and Dutasteride Work if Testosterone Is Still Present?

These medicines inhibit 5-alpha-reductase, reducing the conversion of testosterone into DHT within prostate tissue.

Current EAU guidance reports that:

• finasteride reduces circulating DHT by about 70%;
• dutasteride reduces it by about 95%; and
• long-term treatment can reduce prostate size by approximately 18–28%.

This is practical evidence of how strongly prostate growth depends on the androgen/DHT pathway.