Saw palmetto has antiandrogenic activities, for which it has been used historically to treat benign prostatic hyperplasia as an oral agent. It exerts this action through competitive, nonselective inhibition of 5-alpha-reductase and increasing activity of 3-alpha-hydroxysteroid dehydrogenase, which converts dihydroxytestosterone to its less active metabolite androstanediol. It has been used to treat androgenetic alopecia, telogen effluvium, hirsutism and seborrheic dermatitis, through either an oral or topical vehicle. Its use in alopecia may be related to its antiandrogenic activity or its activation of transforming growth factor-beta.
Saw palmetto is an extract from the berries of Serenoa repens trees. These trees are native to the subtropical, southern United States. It is comprised of fatty acids, phytosterols and polysaccharides that exert its beneficial actions.
Saw palmetto is likely safe for all skin types and tones based on available evidence.
Saw palmetto is reported to have a minimal adverse effect profile with low drug interaction potential, but other studies suggest it may interact with some medications.
Bassino E, Gasparri F, Munaron L. Serenoa repens and N-acetyl glucosamine/milk proteins complex differentially affect the paracrine communication between endothelial and follicle dermal papilla cells. J Cell Physiol. 2019;234(5):7320-7329.
Bayne CW, Ross M, Donnelly F, Habib FK. The selectivity and specificity of the actions of the lipido-sterolic extract of Serenoa repens (Permixon) on the prostate. J Urol. 2000;164(3 Pt 1):876-881.
Evron E, Juhasz M, Babadjouni A, Mesinkovska NA. Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia. Skin Appendage Disord. 2020;6(6):329-337.
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):311-312.
Sultan C, Terraza A, Devillier 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):515-519.
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