BACKGROUND Controversy regarding the relative efficacy of treatments for the relief of the symptoms of benign prostatic hyperplasia (BPH). METHODS This was a 6‐month double‐blind randomized equivalence study that compared the effects of a plant extract (320 mg Permixon®) with those of a 5α‐reductase inhibitor (5 mg finasteride) in 1,098 men with moderate BPH using the International Prostate Symptom Score (IPSS) as the primary end‐point. RESULTS Both Permixon® and finasteride decreased the IPSS (−37% and −39%, respectively), improved quality of life (by 38 and 41%), and increased peak urinary flow rate (+25% and +30%, P = 0.035), with no statistical difference in the percent of responders with a 3 ml/sec improvement. Finasteride markedly decreased prostate volume (−18%) and serum PSA levels (−41%); Permixon® improved symptoms with little effect on volume (−6%) and no change in PSA levels. Permixon® fared better than finasteride in a sexual function questionnaire and gave rise to less complaints of decreased libido and impotence. CONCLUSIONS Both treatments relieve the symptoms of BPH in about two‐thirds of patients but, unlike finasteride, Permixon® has little effect on so‐called androgen‐dependent parameters. This suggests that other pathways might also be involved in the symptomatology of BPH. © 1996 Wiley‐Liss, Inc.