Historically, the bark of this plant has been used primarily for the treatment of urinary tract disorders. It, being included in traditional African medicine, was administered as a tea for urinary problems found exclusively in men. The tea was made from the powdered bark of the Pygeum tree. Like Saw palmetto, Pygeum has been studied extensively for the treatment of benign prostatic hypertrophy (BPH). Although the two botanicals have a similar mechanism of action, Pygeum is considered most effective at reducing the signs and symptoms of BPH in early diagnosed cases.
Pygeum has been a government-sanctioned medicine in Europe for the treatment of BPH since for over 30 years. Pygeum seems to work on the prostate gland by decreasing inflammation and removing cholesterol deposits from the gland, encouraging complete flow of urine. Other traditional uses of Pygeum include; kidney disorders, malaria, upset stomach, fevers, inflammatory conditions, as an aphrodisiac, and even to treat psychological disturbances (i.e. madness). 
The medicinal component of Pygeum is its bark. The major medicinal constituents include certain types of fatty acids and fat-soluble sterol compounds. One of the main constituents, beta-sitosterol, has been shown to be effective at treating BPH when administered alone. Beta-sitosterol is thought to reduce elevated prostaglandin levels in those taking it, which can lead to decreased BPH symptoms. Little else is known about the exact constituents of this medicine, however, the bark is the only component currently applied for medicinal use.
Pygeum is primarily indicated for benign prostatic hypertrophy. Pygeum seems to exert its effects by having an antiproliferative effect on prostatic fibroblasts and epithelial cells; two main types of cells in the gland.  One large study evaluated all investigations of the efficacy of pygeum in treating BPH. Overall, nighttime urination was reduced by 19%; residual bladder urine volume by 24% and peak urine flow was increased by 23%.  In addition, pygeum caused only mild side effects, similar to those caused by a placebo drug.
Pygeum combined with saw palmetto may prove to be a formidable treatment for BPH and other prostate conditions as well, as Pygeum works similarly to saw palmetto on the prostate.  Additionally, Pygeum seems to improve the function of the bladder by assisting with bladder contractile mechanisms, improving the removal of urine.
The anti-inflammatory effects of Pygeum seem to be related to its abilty to slow the production of inflammatory chemicals in the body, such as leukotrienes and the pro-inflammatory enzyme 5-lipoxygnease. 
Other studies of pygeum demonstrate benefits when taken by men for prostate problems, in the absence of other medical therapies. [6, 7] One study focusing on Pygeum combined with nettle root (another beneficial herb for the prostate gland), also showed positive benefits on benign prostatic hypertrophy. 
Pygeum is typically standardized to contain 13% sterols, which is usually calculated as beta-sitosterol. It is found mainly in combination herbal products, most of which target prostate function.
Generally, 50 to 100 milligrams twice per day is taken for improvement of prostate conditions. Pygeum can be found in tincture and capsule delivery forms as well.
Pygeum Side effects
Pygeum is generally well tolerated and virtually without side effects. Limited reports exist, mentioning nausea and abdominal pain as a direct result of taking this herb. 
Pygeum General interactions (supplement, herb, food, lab)
There are no reported interactions between this herb and any other supplements, herbs, foods, or lab tests.
Pygeum Drug interactions
1. Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml
2. Yablonsky F, Nicolas V, Riffaud JP, Bellamy F. Antiproliferative effect of Pygeum africanum extract on rat prostatic fibroblasts. J Urol 1997;157:2881-7.
3. Wilt T, et al. Pygeum africanum for benign prostatic hyperplasic. Cochrane Database Syst Rev 2002;(1):CD001044
4. Levin RM, Das AK. A scientific basis for the therapeutic effects of Pygeum africanum and Serenoa repens. Urol Res 2000;28:201-9.
5. 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. Am J Med 2000;109:654-64.
6. Barlet A, Albrecht J, Aubert A, et al. Efficacy of Pygeum africanum extract in the treatment of micturational disorders due to benign prostatic hyperplasia. Evaluation of objective and subjective parameters. A multicenter, randomized, double-blind trial. Wein Klin Wochenschr 1990;102:667–73.
7. Andro M-C, Riffaud J-P. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia: A review of 25 years of published experience. Curr Ther Res 1995;56:796 [review].
8. Krzeski T, Kazón M, Borkowski A, et al. Combined extracts of Urtica dioica and Pygeum africanum in the treatment of benign prostatic hyperplasia: Double-blind comparison of two doses. Clin Ther 1993;15:1011–20. 5 Ibid