Pachypodium bispinosum is a almost entirely confined to the Southern and Eastern Cape Province in South Africa. Usually found in sunny positions on stony places, where they are associated with other representatives of the succulent flora of dry areas. This species, along with Pachypodium succulentum, can tolerate subzero temperatures in its natural environment in winter. They are found in xeric habitats, and are naturally well adapted to the hot and dry environment in which they grow. The succulent stems act as water stores, and enable the plants to survive the harshest conditions. The thick tuberous underground stems also help the plants to survive long periods without water. They can therefore withstand intense heat and long periods of drought. It predominantly occurs on rocky slopes that are not impacted by land transformation, harvesting for trade is suspected to occur at very low volumes and has never been observed to be causing declines in subpopulations.