Lower urinary tract symptoms (LUTS) are common in aging men and can significantly impact quality of life. In a 12-week randomized pilot study, 30 men with LUTS received either 400 mg/day of Salvia miltiorrhiza extract (SAGX) or 320 mg/day of saw palmetto extract. SAGX produced significantly greater improvements in overall urinary symptoms, particularly storage symptoms such as urinary frequency and urgency, compared with saw palmetto. Participants taking SAGX also reported better LUTS-related quality of life and significant improvements in erectile function. Both interventions were well tolerated, with only mild, transient adverse events and fewer treatment-related events reported in the SAGX group. These findings suggest that 400 mg/day of SAGX may offer a promising, well-tolerated nutritional approach for supporting urinary function, prostate health, and quality of life in men experiencing LUTS.