B25017 I By M. Faisal Hossain, BPharm, MPharm, PhD

Hormonal hair loss is common, with androgenetic alopecia (AGA) being the most frequent type. Androgenetic alopecia (AGA) is characterized by structural miniaturization of androgen-sensitive hair follicles in a defined scalp pattern. A key biochemical factor is the conversion of testosterone (T) to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase (5AR), which then binds to androgen receptors and drives follicle shrinkage (Prager et al., 2002). This results in gradual thinning and patterned baldness in men and women.

What Is Saw Palmetto?

Saw palmetto (Serenoa repens) is a small palm native to the southeastern United States, traditionally used for prostate and urinary health. Saw palmetto extract, derived from the berries of the American dwarf palm tree, contains fatty acids, beta carotene, polysaccharides, and phytosterols. It is thought to competitively inhibit both isoenzymes of 5-alpha reductase, thereby reducing DHT production and its binding to androgen receptors (Valladares et al., 2022). The National Center for Complementary and Integrative Health (NCCIH) notes that there is still insufficient clinical evidence to recommend it for any medical condition, including hair loss (NCCIH, 2023).

How It Works: Natural DHT Blocking

DHT and Hair Loss

DHT binds to androgen receptors in hair follicles, causing miniaturization and progressive thinning, leading to male or female pattern baldness.

Saw Palmetto’s Role

Saw palmetto acts as a natural 5-alpha reductase inhibitor, slowing testosterone’s conversion to DHT and potentially protecting hair follicles from damage.

What Does the Evidence Say?

Randomized Controlled Trials

• In a randomized, double-blind, placebo-controlled trial, a liposterolic extract of Serenoa repens combined with beta-sitosterol improved hair growth in 60% of participants versus placebo (Prager et al., 2002).

• Compared to finasteride (1 mg/day, a prescription medication ), saw palmetto (320 mg/day) improved hair growth in 38% of men after 24 months, while 68% of finasteride users improved. Finasteride was more effective overall, but saw palmetto still showed benefit, especially at the vertex (Rossi et al., 2012).

Systematic Review (Evron et al., 2020)

• Analyzed five randomized clinical trials and two cohort studies using oral and topical saw palmetto in androgenetic alopecia and telogen effluvium.
• Results showed:
• 60% improvement in overall hair quality
• 27% increase in hair count
• 83% increased hair density
• 52% stabilization of hair loss progression
• No serious adverse events were reported (Evron et al., 2020).

Recent Therapy Update (Devjani et al., 2023)

A 2023 review of all treatments for androgenetic alopecia noted that saw palmetto has antiandrogenic activity via 5-alpha reductase inhibition, but clinical evidence is limited and mixed. While it may be considered for patients seeking natural alternatives, finasteride remains more effective. The authors emphasized the need for high-quality randomized controlled trials to better define saw palmetto’s role (Devjani et al., 2023).

How to Use Saw Palmetto

Dosing (WebMD)

• Oral: 320–960 mg/day (softgels or oil-based extracts preferred) for up to 3 years

• Topical: Shampoos, serums, and lotions often combined with pumpkin seed oil or caffeine (WebMD, 2025).

Safety & Precautions

Saw palmetto is generally well tolerated, with mild side effects like digestive upset, dizziness, or headache. Avoid during pregnancy or breastfeeding and consult a healthcare provider if taking blood thinners or hormone therapy (NCCIH, 2023).

Supporting Hair Health Naturally

• Scalp massage: promotes blood flow
• Nutrient-rich diet: ensure protein, iron, vitamin D, and biotin
• Stress management: yoga, meditation, or breathing exercises to reduce telogen effluvium flare-ups

Conclusion

Saw palmetto is a natural DHT blocker with promising but limited evidence for improving hair density and slowing hair loss, particularly in androgenetic alopecia. Its safety profile and natural origin make it appealing for those seeking plant-based options. However, clinical data are limited, and professional guidance is recommended before starting supplementation.

References

1. NCCIH. Saw Palmetto. 2023 
2. Prager N. et al., 2002. J Altern Complement Med, 8(2):143–152 
3. Rossi A. et al., 2012. Int J Immunopathol Pharmacol, 25(4):1167–1173 
4. Evron S. et al., 2020. Skin Appendage Disord, 6(6):329–339 
5. Devjani S. et al., 2023. Drugs, 83(8):701–715 
6. Valladares J. et al., 2022. 5AR inhibition mechanisms 
7. WebMD: Saw Palmetto Dosing 

Acknowledgment: 
This blog was prepared with assistance from ChatGPT by OpenAI. The featured image was also created with the help of AI tools.

Note:
This content is for informational purposes only and is not intended as medical advice. Always consult your healthcare provider before starting any supplement.

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