Is saw palmetto effective for treating hair loss?

Saw Palmetto for Hair Loss: Evidence and Recommendations

Saw palmetto is not recommended as a primary treatment for hair loss due to limited high-quality evidence and potential bleeding risks. 1

Safety Concerns

According to the Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement, saw palmetto should be held for 2 weeks before surgery due to its potential to increase bleeding time, which can lead to increased risk of hematuria and operative bleeding 1. The mechanism is not precisely known, but saw palmetto has been found to inhibit cyclooxygenase in rodents, which may explain its antiplatelet effects.

Efficacy Evidence

While some research suggests potential benefits of saw palmetto for androgenetic alopecia:

• A 2020 systematic review found that supplements containing saw palmetto (100-320 mg) showed some positive effects in patients with androgenetic alopecia and telogen effluvium 2. The review noted improvements in overall hair quality (60%), total hair count (27%), and increased hair density in 83.3% of patients. However, the authors acknowledged that "robust high-quality data are lacking."

• A 2024 review of complementary and alternative medicines for androgenetic alopecia suggested that saw palmetto was among several natural ingredients that showed effectiveness in treating androgenetic alopecia with minimal side effects 3. However, this review also emphasized the need for more scientific research.

First-Line Treatments for Hair Loss

Current guidelines strongly recommend FDA-approved treatments as first-line options:

• Topical minoxidil 5% (once or twice daily) is the recommended first-line treatment for female pattern hair loss and androgenetic alopecia 4
• Oral finasteride 1mg daily is recommended as a first-line treatment for androgenetic alopecia, with proven efficacy in promoting hair regrowth 4

Potential Role of Saw Palmetto

Saw palmetto may be considered as part of adjunctive therapy or in combination treatments:

• A 2023 study found that a combination of redensyl, saw palmetto, and biotin with platelet-rich plasma (PRP) therapy showed significant improvement in androgenetic alopecia compared to other treatments 5
• Another 2023 study mentioned saw palmetto extract as one of several bioactive natural products in a novel topical serum that showed evidence of efficacy for hair growth 6

Cautions and Contraindications

• Risk of sensitization: There is at least one case report of a patient becoming sensitized to topical saw palmetto after using it for androgenetic alopecia 7
• Bleeding risk: As mentioned, saw palmetto may increase bleeding time 1
• Potential for drug interactions due to its effects on cyclooxygenase pathways

Practical Recommendations

1. First consider FDA-approved treatments like minoxidil and finasteride, which have stronger evidence for efficacy
2. Evaluate for nutritional deficiencies that may contribute to hair loss, including iron, zinc, and vitamin D 4
3. If considering saw palmetto:
   • Use as an adjunctive therapy, not as a replacement for proven treatments
   • Be aware of the limited evidence for its efficacy
   • Discontinue use at least 2 weeks before any surgical procedure
   • Monitor for signs of sensitization or allergic reactions

Monitoring Treatment Response

• Take baseline photos before starting any treatment
• Document progress with standardized photos at 3,6, and 12 months
• Make initial assessment of treatment response at the 3-month mark
• The 6-month mark is a critical evaluation point for determining efficacy 4

In conclusion, while saw palmetto shows some promise as a complementary treatment for hair loss, it should not be recommended as a primary treatment due to limited high-quality evidence and potential bleeding risks. FDA-approved treatments like minoxidil and finasteride remain the gold standard for addressing androgenetic alopecia.