Saw Palmetto
The men's prostate / hair herb. Modest 5-alpha-reductase inhibition — fewer effects than finasteride, but without the sexual side-effect risk.
Moderate evidence for BPH symptoms — improved IPSS score, urinary flow, nocturia in some trials; null in others (CAMUS, STEP). Real-world clinical practice continues to support it. Modest evidence for hair density preservation in androgenic alopecia. Effects: 8–12 weeks.
Saw palmetto (Serenoa repens) is a palm native to the southeastern US. Its berry extract weakly inhibits 5-alpha-reductase — the enzyme that converts testosterone into DHT (dihydrotestosterone), the more potent androgen that drives prostate enlargement and male pattern baldness. Effects are real but modest — useful as a milder, safer alternative to finasteride for benign prostatic hyperplasia (BPH) and hair loss. Some men get noticeable benefit; many don't notice much. Decades of European use, well-tolerated, and a reasonable first try before pharmaceuticals.
- Form
- Liposterolic saw palmetto extract standardised to 85–95% fatty acids and sterols. Permixon and Prostamol are well-studied European brands.
- Dose
- 320 mg/day of standardised extract (single or split dose). 160 mg twice daily is the European standard.
- Timing
- With food. AM or PM.
- Schedule
- Daily, ongoing. Effects accumulate over months.
- Side effects
- Generally well-tolerated. Mild GI upset, headache, dizziness. Rare: decreased libido, mild gynecomastia (much less than finasteride).
- Interactions
- Anticoagulants — mild additive (case reports of bleeding). Hormonal medications (androgens, anti-androgens) — interaction with mechanism. Iron — saw palmetto may reduce absorption.
- Contraindications
- Pregnancy / breastfeeding (theoretical hormonal effects). Bleeding disorders. Pre-surgery (stop 1–2 weeks before). Hormone-sensitive cancers — coordinate with oncology.
- Lab markers
- PSA (saw palmetto generally doesn't lower PSA the way finasteride does — useful to know for cancer screening interpretation). DHT, testosterone, IPSS score for BPH.
- Food sources
- Not present in everyday food.
Pairs with
Pygeum, nettle root — traditional prostate stack. Zinc, lycopene, pumpkin seed oil (additive prostate support). Topical minoxidil for hair (additive but different mechanism).
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