Saw Palmetto for DHT Reduction
Saw palmetto has little measurable effect on circulating DHT at standard doses.
Overview
Verdict
How It Works
Dosing & Protocol
Typical dose
- Recommended dose
- 320 mg/day of liposterolic saw palmetto extract; measurable DHT reduction has not been consistently demonstrated
- Expected timeframe
- Not established
Protocol
- form
- Liposterolic Serenoa repens extract standardised to 85-95% fatty acids and sterols; Permixon was used in the main trials
- duration
- Trials measuring hormonal endpoints ran 6-12 months
- co factor
- Take with food to reduce gastrointestinal upset. Evidence is insufficient. Saw palmetto inhibits 5-alpha-reductase in vitro, which is the mechanistic claim, but human data are inconsistent: the large NIH-funded STEP and CAMUS trials found no significant change in serum or intraprostatic DHT at doses up to 960 mg/day, while some smaller studies report modest reductions in intraprostatic DHT. By contrast finasteride reduces serum DHT by around 70% and dutasteride by over 90%. Whatever saw palmetto does to DHT, it is a fraction of what the drugs do and it has not translated into clinical benefit.
- titration
- Not applicable - 320 mg/day is the standard studied dose and higher doses have not been tested for hormonal endpoints
- starting dose
- 160 mg twice daily with food if used, which is the dose studied for prostate symptoms
Evidence
What the studies say
Comparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year study
Rossi A
38% of patients treated with Serenoa repens had an increase in hair growth, while 68% of those treated with finasteride noted an improvement.
Safety
Caveats
The comparison with the pharmaceutical 5-alpha-reductase inhibitors is instructive: finasteride and dutasteride reduce DHT by 70-90% and produce measurable clinical effects on prostate volume and hair, and saw palmetto at triple the usual dose did not significantly change DHT in the largest well-conducted trials. Lowering DHT is also not a health goal in itself - it is relevant only through prostate symptoms or androgenetic alopecia, both of which have proper treatments. Safety of saw palmetto: generally well tolerated, with mild gastrointestinal upset, nausea and headache the main effects. It has weak antiplatelet activity, with case reports of bleeding, so use caution with warfarin, direct oral anticoagulants, aspirin and antiplatelet drugs, and stop two weeks before surgery. Rare cases of liver injury and pancreatitis have been reported. Critically, it is contraindicated in pregnancy and in women who may become pregnant, since antiandrogens can cause genital malformation in a male fetus, and it should not be handled by pregnant women. It may theoretically lower PSA, which can mask prostate cancer detection - tell your doctor if you are taking it before a PSA test.
Less likely to help if
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