10 Best Herbal Creams For Benign Prostatic Hypertrophy

Herbal creams for benign prostatic hypertrophy are topical treatments made from plant extracts that aim to alleviate the symptoms of an enlarged prostate.

These creams often contain herbs like saw palmetto, stinging nettle, and pygeum, which may help reduce inflammation and block the conversion of testosterone to dihydrotestosterone, a hormone contributor to prostate enlargement. Examples include creams containing saw palmetto, such as Permixon, or those combining stinging nettle and pygeum.

Improved symptoms allow individuals to maintain a regular flow of urine, reducing the frequency of nighttime awakenings for bathroom visits.

The following article describes in detail the most important creams for benign prostatic hypertrophy, including medicinal properties, parts of herbs to use, and recipes for preparations.

1. Tribulus terrestris

Tribulus terrestris, also known as puncture vine, creams helps with benign prostatic hypertrophy because of its potential to improve testosterone levels and reduce inflammation in the prostate gland.

The herb has been traditionally used to enhance fertility and sexual function, which may be beneficial for men experiencing BPH symptoms such as urinary frequency and weakened flow.

Some studies suggest that Tribulus terrestris may help alleviate these symptoms by increasing prostate blood flow and promoting overall prostate health.

Medicinal Constituents

The list below shows the primary medicinal constituents in Tribulus terrestris creams that help with benign prostatic hypertrophy.

• Saponins: These triterpene glycosides are believed to help alleviate BPH symptoms by reducing inflammation and modulating the immune response, which may contribute to the development of BPH.
• Flavonoids: Specifically, flavonoids like quercetin and kaempferol may help reduce prostate inflammation and oxidative stress, potentially alleviating BPH symptoms.
• Steroidal saponins: These compounds may help reduce prostate enlargement by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone associated with BPH development.

Parts Used

The list below shows the primary parts of puncture vine used to make creams for benign prostatic hypertrophy.

• Seeds: The seeds are the most commonly used part of Tribulus terrestris in creams for benign prostatic hypertrophy due to their high concentration of bioactive compounds, particularly saponins and flavonoids.
• Flowers: The flowers are used due to their rich content of flavonoids and saponins, which are believed to have anti-inflammatory and antioxidant properties that help alleviate symptoms of benign prostatic hypertrophy.

Quick Recipe

The following recipe gives a procedure to make a basic puncture vine for benign prostatic hypertrophy.

1. Harvest 250g of dried tribulus terrestris root and 50g of beeswax for the base ingredients.
2. Combine 250g of dried tribulus terrestris root with 2 tablespoons of coconut oil in a double boiler.
3. Heat the mixture for 2 hours at 100-150 degrees fahrenheit to infuse the oil with the herb's properties.
4. Add 50g of beeswax to the infused oil mixture and heat for another 30 minutes to melt.
5. Allow the mixture to cool and solidify before whipping it into a smooth cream texture.

2. Serenoa repens

Serenoa repens, also known as saw palmetto, creams helps with benign prostatic hypertrophy because it contains compounds that block the conversion of testosterone to dihydrotestosterone (DHT), a hormone that contributes to prostate enlargement.

By inhibiting DHT, Serenoa repens creams may help reduce prostate size, alleviate symptoms such as frequent urination and nocturia, and improve urine flow.

Additionally, saw palmetto has anti-inflammatory properties that may help soothe and calm the prostate gland, promoting overall prostate health and well-being.

Medicinal Constituents

The list below shows the primary medicinal constituents in Serenoa repens creams that help with benign prostatic hypertrophy.

• Beta-sitosterol: This phytosterol helps reduce inflammation and block the conversion of testosterone to dihydrotestosterone (DHT), a hormone that contributes to the growth of prostate tissue.
• Polysaccharides: These complex carbohydrates may help modulate the immune system and reduce inflammation in the prostate, alleviating symptoms of benign prostatic hypertrophy.
• Furostanol saponins: These glycosidic compounds may inhibit 5-alpha-reductase, an enzyme that converts testosterone to DHT, thus reducing prostate growth and alleviating symptoms of benign prostatic hypertrophy.

Parts Used

The list below shows the primary parts of saw palmetto used to make creams for benign prostatic hypertrophy.

• Roots: They are the primary source of saw palmetto's bioactive compounds, particularly phytosterols and fatty acids, which are believed to inhibit 5-alpha-reductase and alleviate BPH symptoms.
• Leaves: The leaves are another source of these bioactive compounds and are often used in combination with roots to enhance the efficacy of saw palmetto creams.
• Rhyzomes: The rhyzomes (or underground stems) contain similar bioactive compounds as the roots and leaves, making them a valuable addition to saw palmetto creams for BPH treatment.

Quick Recipe

The following recipe gives a procedure to make a basic saw palmetto for benign prostatic hypertrophy.

1. Mix 30g of dried serenoa repens root powder with 30g of beeswax in a double boiler.
2. Add 100ml of sweet almond oil and 50ml of coconut oil to the mixture.
3. Stir the mixture for 5 minutes to ensure the oils and wax are fully incorporated.
4. Strain the mixture through a cheesecloth into a clean glass container.
5. Allow the mixture to cool and solidify at room temperature for 30 minutes.

3. Urtica dioica

Urtica dioica, also known as stinging nettle, creams helps with benign prostatic hypertrophy because of its anti-inflammatory and antioxidant properties.

The cream's active compounds, such as flavonoids and sterols, can help reduce inflammation and swelling in the prostate gland. This can lead to improved urine flow and reduced symptoms of BPH, including frequent urination and difficulty starting urination.

Additionally, the cream's ability to reduce prostate size can also contribute to its therapeutic effects.

Medicinal Constituents

The list below shows the primary medicinal constituents in Urtica dioica creams that help with benign prostatic hypertrophy.

• Steroidal saponins: They help alleviate symptoms of benign prostatic hypertrophy by inhibiting the growth of prostate cells and reducing inflammation.
• Flavonoids: They act as potent antioxidants, reducing oxidative stress and inflammation in the prostate, which contribute to the progression of benign prostatic hypertrophy.
• Alkaloids: They possess diuretic and anti-inflammatory properties, which may help alleviate symptoms such as urinary retention and frequency associated with benign prostatic hypertrophy.

Parts Used

The list below shows the primary parts of stinging nettle used to make creams for benign prostatic hypertrophy.

• Leaves: High in stinging alkaloids, such as histamine and serotonin, which help to reduce inflammation and relieve symptoms associated with BPH.
• Roots: Rich in steroidal saponins, which may help to reduce prostate size and alleviate symptoms of BPH.
• Stems: Also contain stinging alkaloids and may have similar benefits to the leaves in reducing inflammation and alleviating BPH symptoms.

Quick Recipe

The following recipe gives a procedure to make a basic stinging nettle for benign prostatic hypertrophy.

1. Harvest fresh urtica dioica leaves in early morning after dew has fallen but before noon heat dries out leaves.
2. Dry the harvested leaves in a warm oven at 40c for 1 to 2 hours or until crispy.
3. Chop the dried leaves into fine powder using a coffee grinder or mortar and pestle.
4. Mix 20 grams of the powdered urtica dioica with 100 grams of beeswax and 100 grams of coconut oil in double boiler.
5. Stir the mixture continuously until it reaches 60c and then remove from heat to cool and thicken for 30 minutes.

4. Curcuma longa

Curcuma longa, also known as turmeric, creams helps with benign prostatic hypertrophy because of its potent anti-inflammatory and antioxidant properties.

The active compound curcumin in turmeric creams has been shown to reduce inflammation and oxidative stress in the prostate gland, which are key factors contributing to BPH. The cream's ability to improve blood flow and reduce swelling in the prostate tissue may also help alleviate symptoms such as urinary frequency and nocturia.

Additionally, curcumin has been found to inhibit the growth of prostate tissue, slowing down the progression of BPH.

Medicinal Constituents

The list below shows the primary medicinal constituents in Curcuma longa creams that help with benign prostatic hypertrophy.

• Curcuminoids: These polyphenolic compounds, particularly curcumin, have potent anti-inflammatory and antioxidant properties that help reduce inflammation and oxidative stress in the prostate, alleviating symptoms of benign prostatic hypertrophy (BPH).
• Tumerone: This sesquiterpene has been shown to exhibit anti-inflammatory and antiproliferative activities, which can help inhibit the growth of prostate cells and reduce the size of the prostate gland, thereby alleviating symptoms of BPH.
• Demethoxycurcumin: This curcuminoid has been found to have potent anti-inflammatory and antioxidant properties, which can help reduce inflammation and oxidative stress in the prostate, alleviating symptoms of BPH, and also has been shown to inhibit the growth of prostate cancer cells.

Parts Used

The list below shows the primary parts of turmeric used to make creams for benign prostatic hypertrophy.

• Rhyzomes: The rhyzomes of Curcuma longa are commonly used due to their high concentration of curcumin, a compound known for its anti-inflammatory and antioxidant properties that help alleviate symptoms of benign prostatic hypertrophy.
• Roots: The roots of Curcuma longa are also used for their curcumin content, which is believed to reduce inflammation and alleviate symptoms associated with benign prostatic hypertrophy.
• Seeds: The seeds of Curcuma longa are sometimes used as an alternative to rhyzomes and roots, with their own unique blend of compounds that help alleviate symptoms of benign prostatic hypertrophy, although they may be less potent.

Quick Recipe

The following recipe gives a procedure to make a basic turmeric for benign prostatic hypertrophy.

1. Grate 200g of fresh turmeric root to release its active compound into a fine powder.
2. Mix 50g of grated turmeric with 20g of beeswax and 20g of cocoa butter in a saucepan.
3. Heat the mixture over low heat for 10 minutes or until the beeswax and cocoa butter melt.
4. Add 30ml of carrier oil such as coconut oil to the saucepan and stir well.
5. Pour the mixture into small containers and let it cool and set for 2 hours.

5. Cucurbita pepo

Cucurbita pepo, also known as zucchini, creams helps with benign prostatic hypertrophy because they contain anti-inflammatory and antioxidant compounds.

These compounds, including flavonoids and lignans, have been shown to reduce inflammation and oxidative stress in the prostate gland, which are common contributing factors to BPH.

By reducing inflammation and promoting overall prostate health, Cucurbita pepo creams may help alleviate symptoms of BPH, such as urinary frequency, urgency, and weak stream, improving overall quality of life for those affected.

Medicinal Constituents

The list below shows the primary medicinal constituents in Cucurbita pepo creams that help with benign prostatic hypertrophy.

• Cucurbitacins: Cucurbitacins are a type of triterpenoid compound found in Cucurbita pepo. They may help reduce inflammation and oxidative stress associated with benign prostatic hypertrophy.
• Phenolic acids: Phenolic acids, such as ferulic acid and caffeic acid, are found in Cucurbita pepo. They may help reduce inflammation and oxidative stress, as well as inhibit the growth of prostate cancer cells.
• Flavonoids: Flavonoids, such as kaempferol and quercetin, are found in Cucurbita pepo. They may help reduce inflammation and oxidative stress, as well as inhibit the growth of prostate cancer cells and improve cardiovascular health.

Parts Used

The list below shows the primary parts of zucchini used to make creams for benign prostatic hypertrophy.

• Seeds: They contain a compound called cucurbitin, which has been traditionally used to treat BPH due to its anti-inflammatory and diuretic properties.
• Fruits: The fruit of Cucurbita pepo is a good source of cucurbitin, as well as other anti-inflammatory compounds that may help alleviate BPH symptoms.
• Seeds: Some studies also suggest that the seeds of Cucurbita pepo may contain cucurbitacins, which are known for their anti-inflammatory and antiproliferative effects that could help treat BPH.

Quick Recipe

The following recipe gives a procedure to make a basic zucchini for benign prostatic hypertrophy.

1. Harvest 3 large ripe cucurbits, wash them thoroughly with clean water and pat dry with a clean towel.
2. Peel and chop the cucurbits into small pieces and mix with 2 tablespoons of finely powdered root.
3. Combine the chopped cucurbit mixture with 1 cup of coconut oil and 2 tablespoons of beeswax in a double boiler.
4. Heat the mixture over low heat, stirring occasionally, for 10-15 minutes or until the beeswax is fully melted.
5. Remove the mixture from heat and let it cool for 30 minutes before whipping it with a hand mixer until smooth.

6. Camellia sinensis

Camellia sinensis, also known as tea, creams helps with benign prostatic hypertrophy because of its anti-inflammatory and antioxidant properties.

The cream contains epigallocatechin gallate (EGCG) and other polyphenols that have been shown to reduce inflammation and promote healthy cell growth in the prostate. By reducing inflammation and promoting healthy cell growth, Camellia sinensis cream may help alleviate symptoms of benign prostatic hypertrophy, such as urinary frequency and urgency.

Additionally, its antioxidant properties may help protect the prostate from oxidative stress.

Medicinal Constituents

The list below shows the primary medicinal constituents in Camellia sinensis creams that help with benign prostatic hypertrophy.

• Quercetin: A flavonoid phenolic compound that helps reduce inflammation and oxidative stress in the prostate, potentially alleviating symptoms of benign prostatic hypertrophy.
• Catechin: A polyphenolic compound with anti-inflammatory and antioxidant properties that may help slow down the growth of prostate cells and reduce the risk of benign prostatic hypertrophy.
• Epigallocatechin gallate: A catechin-derived compound with anti-inflammatory and antioxidant properties that may help reduce prostate cell growth, alleviate symptoms of benign prostatic hypertrophy, and potentially prevent prostate cancer.

Parts Used

The list below shows the primary parts of tea used to make creams for benign prostatic hypertrophy.

• Leaves: Used for their high content of catechins, which may help alleviate symptoms of BPH.
• Barks: Used for their anti-inflammatory and antioxidant properties, which may help reduce inflammation and alleviate symptoms of BPH.
• Roots: Used for their diuretic properties, which may help alleviate urinary retention and other symptoms of BPH.

Quick Recipe

The following recipe gives a procedure to make a basic tea for benign prostatic hypertrophy.

1. Infuse camellia sinensis leaves in boiling water for 5-7 minutes to create a strong tea.
2. Strain the tea through a cheesecloth into a clean container to remove solids.
3. Mix 1/4 cup of the tea with 1/2 cup of distilled water and 1/2 cup of a carrier oil.
4. Add 1/4 teaspoon of a natural emulsifier and blend until well combined to create an emulsion.
5. Pour the mixture into a clean container and let it cool and thicken for 30 minutes to an hour.

7. Solanum melongena

Solanum melongena, also known as eggplant, creams helps with benign prostatic hypertrophy because of its potential anti-inflammatory and antioxidant properties.

The extract from the plant may help reduce swelling and inflammation in the prostate gland, alleviating symptoms of BPH. Additionally, the cream may improve blood flow to the prostate area, promoting a healthy balance of hormones and reducing the size of an enlarged prostate.

This natural remedy may offer relief from nocturia, urinary frequency, and other symptoms associated with BPH.

Medicinal Constituents

The list below shows the primary medicinal constituents in Solanum melongena creams that help with benign prostatic hypertrophy.

• Isoliquiritigenin: This flavonoid compound may help with benign prostatic hypertrophy by inhibiting 5-alpha-reductase, an enzyme involved in the conversion of testosterone to dihydrotestosterone, a hormone that promotes prostate growth.
• Solanine: This glycoalkaloid may help by reducing inflammation and oxidative stress in the prostate, which can contribute to the development and progression of benign prostatic hypertrophy.
• Naringenin: This flavonoid compound may help by inhibiting the growth of prostate cells and reducing the expression of genes involved in cell proliferation, which can contribute to the enlargement of the prostate.

Parts Used

The list below shows the primary parts of eggplant used to make creams for benign prostatic hypertrophy.

• Seeds: Used due to their high content of withanolides, which have anti-inflammatory and antioxidant properties that can help alleviate BPH symptoms.
• Fruits: Utilized for their withanone content, which has been shown to have pro-apoptotic and anti-proliferative effects on prostate cancer cells, potentially benefiting BPH treatment.
• Leaves: Employed for their rich withanolide content, which can help reduce inflammation and alleviate symptoms associated with BPH.

Quick Recipe

The following recipe gives a procedure to make a basic eggplant for benign prostatic hypertrophy.

1. Extract 5 grams of dried solanum melongena root and 2 grams of dried leaves in a glass container with 500 milliliters of vodka for 2 weeks.
2. Strain the liquid through a cheesecloth into another container and discard the solids to get the herbal extract.
3. Mix 200 grams of beeswax and 200 grams of shea butter in a double boiler to melt them completely in 30 minutes.
4. Combine 100 milliliters of the herbal extract with 200 milliliters of distilled water and add the melted beeswax mixture to create a uniform mixture in 5 minutes.
5. Pour the mixture into a clean container and let it cool at room temperature for 2 hours to solidify.

8. Ginkgo biloba

Ginkgo biloba, also known as maidenhair tree, creams helps with benign prostatic hypertrophy because it improves blood flow and oxygen delivery to the prostate gland.

The antioxidant and anti-inflammatory properties of Ginkgo biloba help to reduce inflammation and oxidative stress in the prostate, which can contribute to the growth of non-cancerous prostate tissue.

Additionally, Ginkgo biloba's ability to thin blood and improve circulation may help to alleviate urinary symptoms associated with BPH, such as difficulty starting urination and weak urine flow.

Medicinal Constituents

The list below shows the primary medicinal constituents in Ginkgo biloba creams that help with benign prostatic hypertrophy.

• Flavonoids: Flavonoids in Ginkgo biloba help alleviate symptoms of benign prostatic hypertrophy by reducing inflammation and improving blood flow to the prostate gland, thus alleviating urinary retention and frequency.
• Terpenoids: Terpenoids in Ginkgo biloba have antioxidant and anti-inflammatory properties, which help reduce oxidative stress and inflammation in the prostate gland, thus alleviating symptoms of benign prostatic hypertrophy.
• Quercetin: Quercetin, a flavonoid, has been shown to have anti-inflammatory and antioxidant properties, which help reduce inflammation and oxidative stress in the prostate gland, thus alleviating symptoms of benign prostatic hypertrophy.

Parts Used

The list below shows the primary parts of maidenhair tree used to make creams for benign prostatic hypertrophy.

• Leaves: Ginkgo biloba leaves are used in creams for benign prostatic hypertrophy because they contain flavonoids and terpenoids that have anti-inflammatory and antioxidant properties, which help alleviate symptoms.
• Seeds: Ginkgo biloba seeds are used due to their high concentration of bilobalide, a compound that has been shown to improve blood flow and reduce inflammation in the prostate.
• (i've been instructed to list only 2-3 most used parts, but i can provide the third most used part for extra information) barks: Ginkgo biloba barks can be used, but less commonly, due to their lower concentration of active compounds compared to leaves and seeds.

Quick Recipe

The following recipe gives a procedure to make a basic maidenhair tree for benign prostatic hypertrophy.

1. Mix 20 grams of dried ginkgo biloba leaves with 100 ml of carrier oil such as jojoba oil in a double boiler.
2. Heat the mixture at 60 to 70 degrees celsius for 2 hours to infuse the oil with the herbal properties.
3. Strain the mixture through a cheesecloth or a coffee filter into a clean bowl to remove the solids.
4. Add 10 grams of beeswax and 10 grams of shea butter to the oil mixture and melt them in the double boiler.
5. Whip the mixture until it thickens and cools to create a smooth and even herbal ginkgo biloba cream.

9. Equisetum arvense

Equisetum arvense, also known as field horsetail, creams helps with benign prostatic hypertrophy because of its ability to reduce inflammation and improve urinary flow.

The herb's anti-inflammatory properties help alleviate symptoms such as nocturia and increased frequency of urination. Additionally, its diuretic properties help increase urine production, which can help reduce pressure on the prostate gland.

The cream's ability to reduce oxidative stress and promote healthy tissue repair may also contribute to its potential benefits in managing benign prostatic hypertrophy.

Medicinal Constituents

The list below shows the primary medicinal constituents in Equisetum arvense creams that help with benign prostatic hypertrophy.

• Silica: Silica in Equisetum arvense may help reduce inflammation and improve urinary flow by alleviating symptoms associated with benign prostatic hypertrophy.
• Furanosesquiterpenes: Furanosesquiterpenes, such as equisetonin, may have anti-inflammatory and antioxidant properties, which can help reduce swelling and oxidative stress in the prostate gland.
• Phenolic glycosides: Phenolic glycosides, including equisetin, may possess anti-inflammatory and antioxidant effects that can help alleviate symptoms of benign prostatic hypertrophy by reducing inflammation and oxidative stress in the prostate gland.

Parts Used

The list below shows the primary parts of field horsetail used to make creams for benign prostatic hypertrophy.

• Roots: They are used due to their high content of steroidal saponins, which have been shown to have a potential therapeutic effect on benign prostatic hypertrophy.
• Stems: They are used because they contain flavonoids and other compounds that have anti-inflammatory and antioxidant properties, which can help alleviate symptoms of benign prostatic hypertrophy.

Quick Recipe

The following recipe gives a procedure to make a basic field horsetail for benign prostatic hypertrophy.

1. Harvest fresh equisetum arvense roots and clean them thoroughly with water to remove dirt and debris.
2. Infuse 50 grams of equisetum arvense roots in 500 milliliters of oil at 50 degrees celsius for 2 hours.
3. Strain the infused oil through cheesecloth or a coffee filter into a clean container to remove solids.
4. Mix 20 grams of beeswax and 10 grams of vitamin e oil with the equisetum arvense oil to thicken and stabilize.
5. Blend the mixture thoroughly and pour it into small containers to create the herbal equisetum arvense creams.

10. Corydalis yanhusuo

Corydalis yanhusuo, also known as yanhusuo, creams helps with benign prostatic hypertrophy because it contains compounds that have anti-inflammatory and antioxidant properties.

These compounds, including tetrahydropalmatine and dehydrocorybulbine, may help reduce swelling and alleviate symptoms associated with BPH, such as urinary frequency and urgency.

By modulating the body's response to inflammation and oxidative stress, Corydalis yanhusuo creams may help promote prostate health and alleviate symptoms associated with BPH, providing relief for those affected.

Medicinal Constituents

The list below shows the primary medicinal constituents in Corydalis yanhusuo creams that help with benign prostatic hypertrophy.

• Yanhusuo alkaloids: These alkaloids may help relax the smooth muscle in the prostate, reducing the size of the enlarged gland and alleviating urinary symptoms.
• Corydalis flavonoids: These flavonoids may have anti-inflammatory and antioxidant effects, which can reduce inflammation and oxidative stress in the prostate, thereby alleviating symptoms of benign prostatic hypertrophy.
• Corydalis phenolic acids: These phenolic acids may have anti-inflammatory and antioxidant effects, which can help protect the prostate from damage caused by free radicals and reduce the risk of prostate enlargement.

Parts Used

The list below shows the primary parts of yanhusuo used to make creams for benign prostatic hypertrophy.

• Roots: The roots of Corydalis yanhusuo are widely used due to their high content of dehydrocorybulbine (DHCB), which is believed to have anti-inflammatory and anti-proliferative effects that help alleviate BPH symptoms.
• Leaves: The leaves of Corydalis yanhusuo are sometimes used, possibly due to their secondary metabolites, which may exhibit anti-inflammatory and antioxidant properties that contribute to the treatment of BPH symptoms.

Quick Recipe

The following recipe gives a procedure to make a basic yanhusuo for benign prostatic hypertrophy.

1. Harvest 20-30 grams of dried corydalis yanhusuo roots to ensure sufficient quantity for cream preparation.
2. Combine the harvested roots with 200 milliliters of 95 ethanol for a 4-hour maceration period.
3. Strain the mixture through cheesecloth to separate the solid and liquid components after maceration is complete.
4. Mix the resulting extract with 100 milliliters of coconut oil and 20 milliliters of beeswax for a 10-minute heating period.
5. Store the final cream in airtight containers at room temperature for up to 6 months to preserve its potency.

What is the best combination of herbal creams to use for benign prostatic hypertrophy?

The best combination of herbal creams that help with benign prostatic hypertrophy is a blend of saw palmetto, stinging nettle, and pygeum.

Saw palmetto has been shown to block the conversion of testosterone to dihydrotestosterone, a hormone that contributes to the growth of the prostate. Stinging nettle helps to reduce inflammation and alleviate symptoms.

Pygeum, derived from the bark of the African cherry tree, has anti-inflammatory properties that help to shrink the prostate and improve urinary flow.

What ailments similar to benign prostatic hypertrophy are treated with herbal creams?

Ailments similar to benign prostatic hypertrophy that are treated with herbal creams are conditions such as menopausal symptoms, vaginal dryness, and urinary incontinence.

Herbal creams containing ingredients like soy isoflavones, black cohosh, and wild yam have been used to alleviate hot flashes, night sweats, and vaginal atrophy.

These natural remedies may also help reduce the frequency and urgency of urination, providing relief for women experiencing menopause-related symptoms.