Saw palmetto (SP), a botanical extract with antiandrogenic properties, has gained commercial popularity for its purported benefits on hair regrowth. To summarize published evidence on the efficacy, safety, and tolerability of supplements containing SP in the treatment of alopecia, we conducted a PubMed, Google Scholar, and Cochrane database search using the following terms: (saw palmetto and hair loss), (saw palmetto and androgenetic alopecia), and (saw palmetto and natural supplement and alopecia). Five randomized clinical trials (RCTs) and 2 prospective cohort studies demonstrated positive effects of topical and oral supplements containing SP (100–320 mg) among patients with androgenetic alopecia (AGA) and telogen effluvium. Sixty percent improvement in overall hair quality, 27% improvement in total haircount, increased hair density in 83.3% of patients, and stabilized disease progression among 52% were noted with use of various topical and oral SP-containing supplements. SP was well tolerated and not associated with serious adverse events in alopecia patients. Although robust high-quality data are lacking, supplements containing SP may be a treatment option for patients with AGA, telogen effluvium, and self-perceived hair thinning. Further large-scale RCTs focusing on the sole contribution of SP to hair growth outcomes are needed to confirm efficacy and determine long-term adverse events.

1.
Gordon
AE
,
Shaughnessy
AF
.
Saw palmetto for prostate disorders
.
Am Fam Physician
.
2003
;
67
(
6
):
1281
3
.
2.
Zeiger
E
,
Tice
R
.
Saw palmetto (Serenoa repens) and one of its constituent sterols-sitosterol. Review of toxicological literature
.
Nov 1997
. .
3.
Bach
D
,
Ebeling
L
.
Long-term drug treatment of benign prostatic hyperplasia: results of a prospective 3-year multicenter study using Sabal extract IDS 89
.
Phytomedicine
.
1996
;
3
(
2
):
105
11
.
4.
Gerber
G
.
Saw palmetto for the treatment of men with lower urinary tract symptoms
.
J Urol
.
2000
;
163
(
5
):
1408
12
.
5.
Wilt
TJ
,
Ishani
A
,
Stark
G
,
MacDonald
R
,
Lau
J
,
Mulrow
C
.
Saw palmetto extracts for treatment of benign prostatic hyperplasia: a systematic review
.
JAMA
.
1998
;
280
(
18
):
1604
9
.
6.
Booker
A
,
Suter
A
,
Krnjic
A
,
Strassel
B
,
Zloh
M
,
Said
M
, et al.
A phytochemical comparison of saw palmetto products using gas chromatography and (1) H nuclear magnetic resonance spectroscopy metabolomic profiling
.
J Pharm Pharmacol
.
2014
;
66
(
6
):
811
22
.
7.
Chatterjee
S
,
Agrawala
S
.
Saw palmetto (Serenoa repens) in androgenic alopecia, an effective phytotherapy. NISCAIR Online Periodicals Repository
.
Dec 2003
. .
8.
Iehlé
C
,
Délos
S
,
Guirou
O
,
Tate
R
,
Raynaud
JP
,
Martin
PM
.
Human prostatic steroid 5 alpha-reductase isoforms--a comparative study of selective inhibitors
.
J Steroid Biochem Mol Biol
.
1995
;
54
(
5–6
):
273
9
.
9.
Sultan
C
,
Terraza
A
,
Devillier
C
,
Carilla
E
,
Briley
M
,
Loire
C
, et al.
Inhibition of androgen metabolism and binding by a liposterolic extract of “Serenoa repens B” in human foreskin fibroblasts
.
J Steroid Biochem
.
1984
;
20
(
1
):
515
9
.
10.
Liang
T
,
Liao
S
.
Inhibition of steroid 5 alpha-reductase by specific aliphatic unsaturated fatty acids
.
Biochem J
.
1992
;
285
(
Pt 2
):
557
62
.
11.
Sargent
NSE
,
Habib
FK
.
Partial purification of human prostatic 5α-reductase (3-oxo-5α-steroid: NADP+ 4-ene-oxido-reductase; EC 1.3.1.22) in a stable and active form
.
J Steroid Biochem Mol Biol
.
1991
;
38
(
1
):
73
7
.
12.
Strauch
G
,
Perles
P
,
Vergult
G
,
Gabriel
M
,
Gibelin
B
,
Cummings
S
, et al.
Comparison of finasteride (Proscar) and Serenoa repens (Permixon) in the inhibition of 5-alpha reductase in healthy male volunteers
.
Eur Urol
.
1994
;
26
(
3
):
247
52
.
13.
Carraro
,
JC
,
Raynaud
JP
,
Koch
G
,
Chisholm
GD
,
Di Silverio
F
,
Teillac
P
, et al.
Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients
.
Prostate
.
1996
;
29
(
4
):
231
40
; discussion 241–2.
14.
Dedhia
RC
,
McVary
KT
.
Phytotherapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
J Urol
.
2008
;
179
(
6
):
2119
25
.
15.
Tacklind
J
,
Macdonald
R
,
Rutks
I
,
Stanke
JU
,
Wilt
TJ
.
Serenoa repens for benign prostatic hyperplasia
.
Cochrane Database Syst Rev
.
2012
;
12
:
Cd001423
.
16.
Agbabiaka
TB
,
Pittler
MH
,
Wider
B
,
Ernst
E
.
Serenoa repens (saw palmetto): a systematic review of adverse events
.
Drug Saf
.
2009
;
32
(
8
):
637
47
.
17.
Markowitz
JS
,
Donovan
JL
,
Devane
CL
,
Taylor
RM
,
Ruan
Y
,
Wang
JS
, et al.
Multiple doses of saw palmetto (Serenoa repens) did not alter cytochrome P450 2D6 and 3A4 activity in normal volunteers
.
Clin Pharmacol Ther
.
2003
;
74
(
6
):
536
42
.
18.
Morganti
P
,
Fabrizi
G
,
James
B
,
Bruno
C
.
Effect of gelatin-cystine and Serenoa repens extract on free radicals level and hair growth
.
J Appl Cosmetol
.
1998
;
16
:
57
64
.
19.
Prager
N
,
Bickett
K
,
French
N
,
Marcovici
G
.
A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia
.
J Altern Complement Med
.
2002
;
8
(
2
):
143
52
.
20.
Rossi
A
,
Mari
E
,
Scarno
M
,
Garelli
V
,
Maxia
C
,
Scali
E
, et al.
Comparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year study
.
Int J Immunopathol Pharmacol
.
2012
;
25
(
4
):
1167
73
.
21.
Narda
M
,
Aladren
S
,
Cestone
E
,
Nobile
V
.
Efficacy and safety of a food supplement containing L-cystine, Serenoa repens extract and biotin for hair loss in healthy males and females. A prospective, randomized, double-blinded, controlled clinical trial
.
J Cosmo Trichol
.
2017
;
3
(
127
):
2
.
22.
Morabito
P
,
Miroddi
M
,
Giovinazzo
S
,
Spina
E
,
Calapai
G
.
Serenoa repens as an endocrine disruptor in a 10-year-old young girl: a new case report
.
Pharmacology
.
2015
;
96
(
1–2
):
41
3
.
23.
Gómez Grau
E
,
Lladós Sevilla
M
,
Mira
J
,
Vivancos
F
.
Eficacia de un complemento alimenticio con serenoa serrulata y tocotrienol-tocoferol frente a la alopecia androgenética y el efluvio telógeno femeninos: a propósito de un estudio piloto
.
J Rev Argent Dermatosifilol
.
2015
;
96
(
1
):
43
55
.
24.
Zanzottera
F
,
Bizzaro
G
,
Michelotti
A
,
Nobile
V
.
Efficacy of a nutritional supplement, standardized in fatty acids and phytosterols, on hair loss and hair health in both women and men
.
J Cosmo Trichol
.
2017
;
3
(
121
):
2
.
25.
Pezza
M
,
Carlomagno
V
,
Casucci
G
.
Telogen effluvium treated with Serenoa repens supplement
.
J Senses Sci
.
2014
;
1
(
1
).
26.
Murugusundram
S
,
Repens
S
.
Serenoa repens: does it have any role in the management of androgenetic alopecia?
J Cutan Aesthet Surg
.
2009
;
2
(
1
):
31
2
.
27.
Togni
S
,
Maramaldi
G
,
Meneghin
M
,
Giacomelli
L
.
Effective oral treatment for scalp disorders: results from a double blind, placebo-controlled study
.
Esperienze Dermatol
.
2016
;
8
:
187
91
.
28.
Dobrev
H
.
Clinical and instrumental study of the efficacy of a new sebum control cream
.
J Cosmet Dermatol
.
2007
;
6
(
2
):
113
8
.
29.
Wessagowit
V
,
Tangjaturonrusamee
C
,
Kootiratrakarn
T
,
Bunnag
T
,
Pimonrat
T
,
Muangdang
N
, et al.
Treatment of male androgenetic alopecia with topical products containing Serenoa repens extract
.
Australas J Dermatol
.
2016
;
57
(
3
):
e76
82
.
30.
Farris
PK
,
Rogers
N
,
McMichael
A
,
Kogan
S
.
A novel multi-targeting approach to treating hair loss, using standardized nutraceuticals
.
J Drugs Dermatol
.
2017
;
16
(
11
):
S141
8
.
31.
Ablon
G
,
Kogan
S
.
A six-month, randomized, double-blind, placebo-controlled study evaluating the safety and efficacy of a nutraceutical supplement for promoting hair growth in women with self-perceived thinning hair
.
J Drugs Dermatol
.
2018
;
17
(
5
):
558
65
.
32.
Miroddi
M
,
Carnì
A
,
Mannucci
C
,
Moleti
M
,
Navarra
M
,
Calapai
G
.
Hot flashes in a young girl: a wake-up call concerning Serenoa repens use in children
.
Pediatrics
.
2012
;
130
(
5
):
e1374
6
.
33.
Cabrita
SF
,
Silva
R
,
Correia
MP
.
Allergic contact dermatitis due to glycyrrhizic acid as an ingredient of a hair restorer
.
Contact Derm
.
2003
;
49
(
1
):
46
.
34.
Sinclair
RD
,
Mallari
RS
,
Tate
B
.
Sensitization to saw palmetto and minoxidil in separate topical extemporaneous treatments for androgenetic alopecia
.
Australas J Dermatol
.
2002
;
43
(
4
):
311
2
.
35.
Reid
EE
,
Haley
AC
,
Borovicka
JH
,
Rademaker
A
,
West
DP
,
Colavincenzo
M
, et al.
Clinical severity does not reliably predict quality of life in women with alopecia areata, telogen effluvium, or androgenic alopecia
.
J Am Acad Dermatol
.
2012
;
66
(
3
):
e97
102
.
36.
Schmitt
JV
,
Ribeiro
CF
,
Souza
FH
,
Siqueira
EB
,
Bebber
FR
.
Hair loss perception and symptoms of depression in female outpatients attending a general dermatology clinic
.
An Bras Dermatol
.
2012
;
87
(
3
):
412
7
.
37.
Grimalt
R
.
Psychological aspects of hair disease
.
J Cosmet Dermatol
.
2005
;
4
(
2
):
142
7
.
38.
Rogers
NE
,
Avram
MR
.
Medical treatments for male and female pattern hair loss
.
J Am Acad Dermatol
.
2008
.
59
(
4
):
547
66
; quiz 567–8.
39.
Lourith
N
,
Kanlayavattanakul
M
.
Hair loss and herbs for treatment
.
J Cosmet Dermatol
.
2013
;
12
(
3
):
210
22
.
40.
Zhu
HL
,
Gao
YH
,
Yang
JQ
,
Li
JB
,
Gao
J
.
Serenoa repens extracts promote hair regeneration and repair of hair loss mouse models by activating TGF-β and mitochondrial signaling pathway
.
Eur Rev Med Pharmacol Sci
.
2018
;
22
(
12
):
4000
8
.
41.
Chittur
S
,
Parr
B
,
Marcovici
G
.
Inhibition of inflammatory gene expression in keratinocytes using a composition containing carnitine, thioctic acid and saw palmetto extract
.
Evid Based Complement Alternat Med
.
2011
;
2011
:
985345
.
42.
Moon
EJ
,
Lee
YM
,
Lee
OH
,
Lee
MJ
,
Lee
SK
,
Chung
MH
, et al.
A novel angiogenic factor derived from Aloe vera gel: beta-sitosterol, a plant sterol
.
Angiogenesis
.
1999
;
3
(
2
):
117
23
.
43.
ClinicalTrials.gov [Internet]. Sadick Research Group: National Library of Medicine (US). Feb 2017. Identifier NCT03052413, Study to evaluate a nutraceutical supplement for treatment of hair loss and thinning in females. Available from: https://ClinicalTrials.gov/show/NCT03052413
.
44.
Cheema
P
,
El-Mefty
O
,
Jazieh
AR
.
Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature
.
J Intern Med
.
2001
;
250
(
2
):
167
9
.
45.
Jibrin
I
,
Erinle
A
,
Saidi
A
,
Aliyu
ZY
.
Saw palmetto-induced pancreatitis
.
South Med J
.
2006
;
99
(
6
):
611
2
.
46.
Wargo
KA
,
Allman
E
,
Ibrahim
F
.
A possible case of saw palmetto-induced pancreatitis
.
South Med J
.
2010
;
103
(
7
):
683
5
.
47.
Yeu
E
,
Grostern
R
.
Saw palmetto and intraoperative floppy-iris syndrome
.
J Cataract Refract Surg
.
2007
;
33
(
5
):
927
8
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.