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Saw Palmetto

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**DRAFT – Please note that this article is a draft and may not be up to my usual standard. I thought you might like to read it for the information in the meantime.  Thanks for your understanding **

Saw Palmetto may be useful to women with PCOS in relation to several issues:

  • It may help to normalise hormone levels, particularly testosterone and oestrogen.
  • It may help reduce the growth of body and facial hair.
  • It may help to reduce the loss of head hair.

Saw Palmetto (serenoa repens) is a smallish palm tree, about 2 meters in height.  The reddish-brown berries of this palm have been used by those natives to south-eastern USA for hundreds of years.  In more recent times, it has been well studied with respect to benign prostatic hyperplasia in men, as it has quite a potent blocking effect on the 5-alpha reductase enzyme.  This enzyme is responsible for converting free testosterone into the much more troublesome dihydrotestosterone (DHT) form.  It is currently thought that it is this form of testosterone which is responsible for causing the enlargement of the prostate in older men.  It is also known to be a causative factor in androgenetic alopecia or male pattern baldness, which despite it’s name can affect women as well as men.  Elevated levels of DHT are also responsible for the growth of facial and body hair on men and women.

Whilst it is perfectly normal for women to have a small amount of testosterone in their bodies, women with PCOS tend to have far more than is normal for other women.  They also tend to have a higher proportion of DHT and the enzyme 5-alpha reductase which can cause havoc with hair growth – it won’t grow where it’s supposed to (your head) and it gets overly enthusiastic about growing where it shouldn’t (your face, chest, stomach, back, legs, buttocks – you name it!).

Saw Palmetto has been shown in studies to work in 3 ways to help combat this:

  • Firstly, it inhibits the production of DHT in the first place.
  • Secondly, it increases the rate at which the DHT that is created breaks down.
  • Thirdly, it inhibits the ability of DHT to bind to it’s receptors in your body where it causes problems.

Many women with PCOS suffer from oestrogen dominance – a condition where oestrogen levels are either higher than normal or way too high comparatively to the levels of other hormones in the body, especially progesterone which can be low.  Oestrogen dominance can be a component of many symptoms and disease processes, from minor and generic problems such as fatigue and irritability, mood swings, PMS, swollen or fibrocystic breasts, irregular menstruation, allergies and asthma to more serious concerns such as thyroid dysfunction, fibroids, PCOS and infertility.  Preliminary studies indicate that saw palmetto may have an anti-oestrogenic effect, helping to reduce oestrogen dominance.  High levels of oestrogen may impair the body’s ability to clear DHT from the blood so reducing elevated oestrogen levels may also be beneficial to dysregulated hair growth.

Saw Palmetto is frequently used together with Vitex Agnus Castus in women with PCOS to help restore hormone balance.  Stinging nettle (pygeum) is also frequently used when hair loss is a problem and can be used topically.


Most of the clinical studies to date have focussed on the benefits of Saw Palmetto in relation to benign prostatic hyperplasia in men. The majority of those studies found 320 mg. of extract per day, standardized to at least 85-95% fatty acids with a minimum of 0.2-0.4% sterols was both safe and effective. This is best taken in one dose, on an empty stomach before breakfast.  There has been talk of further studies utilising 640 mg to treat men with more advanced BPH who did not respond to the lower dose. As there were no significant side effects noted from the studies using 320 mg a day, there is no concern about any potential toxicity from this dose.

Until further studies are done specifically targeting women with androgenetic alopecia a good place to start would be with a single daily dose of 320 mg of Saw Palmetto extract (not whole fruit – it’s important to check for this), which has been standardised as above. If the extract you use is standardised to 40-50% fatty acids as some are, then you will need to take twice as much to get the same amount of the active constituents.

There is some anecdotal evidence that much higher doses may be required to have an appreciable effect on hair loss, however, there are no scientific studies relating to saw palmetto and hair loss, so ultimately this will be a decision for each woman to make for herself.  Certainly a good starting place would be 320 mg a day as described above.

Don’t forget that everyone is different and the amount that will be effective for you may be higher or lower than that which would work for someone else. Herbs have potent physiological actions in the body, just as synthetic drugs do and it is always best to have the guidance of a qualified medical herbalist or naturopathic physician if you are taking herbs.

Interactions With Other Drugs or Herbs:

It is possible that Saw Palmetto may alter the way some drugs work, for instance doxazosin, prazosin, tamsulosin and terazosin as it has alpha-adrenergic blocking activity.  It may also theoretically interfere with female hormone replacement therapy or birth control pills and would be best avoided during pregnancy due to it’s hormonal actions.  As Saw Palmetto works in a similar way to finasteride and flutamide, brand names of which include Propecia, Prosca and Eulexin it is likely to increase the effect of these medications.  Herbs which have oestrogen-like properties, such as alfalfa, black cohosh, bloodroot, burdock, hops, kudzu, licorice, pomegranate, red clover, soy, thyme, white horehound and yucca are also likely to be affected by saw palmetto.

More Information:

Vassiliadi DA, Barber TM, Hughes BA, McCarthy MI, Wass JA, Franks S, Nightingale P, Tomlinson JW, Arlt W, Stewart PM. Increased 5 alpha-reductase activity and adrenocortical drive in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2009 Sep;94(9):3558-66.

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