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Saw Palmetto vs Finasteride: An Expert Review of Their Efficacy for Hair Loss
Dr Ahmad Moussa (FRCS)
Medically reviewed by
Dr Ahmad Moussa (FRCS)
Updated on March 29, 2024

An increase in the popularity of natural hair loss treatments makes many wonder who would win an efficacy contest between a natural remedy such as saw palmetto vs Finasteride, the most prescribed treatment for androgenetic alopecia (male pattern baldness).

Finasteride is currently prescribed by over 69% of world surgeons, who report that they frequently recommend it due to its powerful dihydrotestosterone (DHT) blocking effect. Saw palmetto is advertised as the most effective phytotherapeutic agent for the management of androgenetic alopecia [1] – could it provide similar results?

Sadly, while the relationship between saw palmetto and hair loss has been investigated and showed some promising in vitro results, there is currently insufficient evidence of its effect when used on people. The few studies which report hair growth after saw palmetto use are methodologically flawed and their findings only reveal weak DHT blocking effects, significantly lower than Finasteride results [1].

Continue reading to find out all you need to know regarding the efficiency of saw palmetto vs Finasteride:

  • What saw palmetto and Finasteride are and how they reduce hair loss
  • Which is the superior hair treatment option between saw palmetto and Finasteride
  • Reasons you may be experiencing hair loss
  • Treatment alternatives to saw palmetto and Finasteride
Table of Contents

What is saw palmetto and how does it work?

saw palmetto growing on the plant

Saw palmetto is the common name of Serenoa repens, also known as Sabal serrulatum. It is a bushy dwarf palm tree which grows in the Southeastern US and the West Indies Islands.

An extract obtained from its fruit and seeds has been historically used in herbal medicine to treat a wide range of health conditions (stomach issues, reproductive issues, urinary and prostate issues and more recently, hair loss).

How does saw palmetto work?

Saw palmetto is said to be efficient in treating male pattern baldness (or female pattern baldness). This condition affects 85% of men, but only 50% of women by the time they are 50 [2 [3], as due to hormonal differences, hair loss is more common in men than in women.

An enzyme called 5 alpha reductase converts testosterone into dihydrotestosterone (DHT). DHT binds to androgen receptors in the hair follicles, making them shrink and stop producing new hair. While some amount of DHT is necessary for physiological processes, long and excessive exposure to this hormone results in androgenetic alopecia.

miniaturisation leading to hair loss informational graphic

Saw palmetto has performed well in in-vitro studies, but at concentrations which could never be safely used in vivo (on actual people) [1]. The few in-vivo clinical trials performed on humans show no evidence of lowering serum DHT levels [4] and only a mild effect against less advanced forms of androgenetic alopecia [1].

Several studies performed on men and women with male/female pattern baldness and telogen effluvium found that using saw palmetto extract improved hair count ranging from 3.4% – 27%, that it increased hair density in 83.3% of patients and that it stopped the hair loss from advancing in 52% of patients [5].

However, other researchers point out that the sample size for these studies was small, the methodology was flawed and the saw palmetto extract used was often not pure, but mixed with other substances, such as vitamins, minerals or chemical additives [5].

What is Finasteride and how does it work?

Finasteride tablets

Finasteride is a medication commonly prescribed for androgenetic alopecia. It is available as a topical solution, but it is most frequently administered as oral tablets.

Its proven benefits for hair include lowering DHT levels, stimulating hair growth and density and preventing further hair loss[6][7][8].

Research shows that Finasteride is very effective in treating androgenetic alopecia. The most telling data comes from a meta-analysis [9] of 3 studies, with a total number of 1879 men with mild to moderate androgenetic alopecia.

The research revealed that 48% of participants had evident hair growth after one year of using Finasteride and this number rose to 66% after two years of use, compared to only a 7% improvement in the placebo group.

However, like other DHT blockers, Finasteride is only recommended for men and postmenopausal women, because if premenopausal women use Finasteride, it can cause hormonal imbalances and foetal defects.

How does Finasteride work?

Finasteride is a DHT blocker, which means it works by inhibiting the activity of 5 alpha-reductase, the enzyme which converts testosterone into DHT. Lower amounts of DHT mean less follicle shrinkage and thus, more hair growth.

Results of using Finasteride

Saw palmetto vs Finasteride – Which one works best for hair loss?

While Finasteride’s excellent results against androgenetic alopecia have been amply documented by clinical trials[6][7][8], saw palmetto’s efficiency in reducing hair loss is not yet sufficiently demonstrated.

A clinical trial [10] conducted on 100 male patients with androgenetic alopecia separated the participants into two groups – one was treated with 320 mg of saw palmetto, while the other received Finasteride 1 mg.

After 24 months of daily treatments, only 38% of the saw palmetto group showed an increase in hair growth, as opposed to 68% of the Finasteride group. Moreover, Finasteride was shown to act both in the front area of the scalp and on the vertex, while saw palmetto only seemed to act on the vertex.

While it is clear that Finasteride performed far better than saw palmetto in this trial, it is also important to note that there was no control group used. This means that the study cannot say how efficient the saw palmetto extract was in stimulating hair growth when compared to placebo [1].

Based on all the evidence existing at this point, it is safe to assert that Finasteride is superior to saw palmetto in treating androgenetic alopecia.

There is weak evidence that saw palmetto might affect telogen effluvium and self-perceived thinning as well [5], while Finasteride does not treat telogen effluvium.

However, neither of the two substances has proven themselves to be efficient in the treatment of other hair conditions, such as alopecia areata or hair loss caused by common scalp conditions.

 Saw palmettoFinasteride
AvailabilityOver the counterPrescription-only
TypeHerbal extract Medication
FormsTopical solution, oral capsulesTopical solution, oral tablets
Common brand namesPermixonPropecia, Proscar
Side effects
  • Sexual dysfunction
  • Headaches
  • Nausea
  • Dizziness
  • Gynecomastia
EligibilityMen, postmenopausal womenMen, postmenopausal women
Type of hair loss treatedAndrogenetic alopecia, telogen effluvium, self-perceived hair thinning (further evidence needed)Androgenetic alopecia

Does saw palmetto lower testosterone?

No, there is no evidence that saw palmetto impacts the natural production of testosterone in any way. It is only theorised to lower DHT levels – a different hormone which causes hair loss – by inhibiting the protein which transforms testosterone into DHT.

Does saw palmetto actually block DHT?

There is currently little evidence that saw palmetto blocks DHT in humans. Most of the arguments used to support palmetto’s effect as a 5 alpha-reductase inhibitor are extrapolated from the fact that using it showed symptom improvement in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms.

Since Finasteride is also effective in treating these conditions, it was assumed they function in the same way, by blocking DHT[1]. However, several comprehensive meta-analyses found no difference in DHT reduction from the placebo groups [1] [5][11].

While there may be alternative mechanisms behind the beneficial effects of saw palmetto on hair growth, these have not yet been sufficiently studied and understood.

Which is the best DHT blocker?

For a long time, Finasteride was held as the “gold standard” DHT blocker, outperforming other treatments like saw palmetto.

However, some studies indicate that Dutasteride may actually be the best DHT blocker. That is because on one hand, it inhibits all 3 types of 5 alpha-reductase enzymes, while Finasteride only inhibits two of them, and on the other hand, it leads to significantly more hair growth than Finasteride [12]

Is there anything better than Finasteride?

Finasteride is currently the most widely recommended hair loss medication for the treatment of androgenetic alopecia. However, it is not necessarily the most efficient one available.

As previously mentioned, some studies show that Dutasteride – a very similar DHT blocker – is more potent than Finasteride [12]. However, Dutasteride is not yet FDA-approved as a hair treatment, so it is an off-label treatment for male pattern baldness.

Furthermore, Finasteride does not treat any other hair conditions than male pattern balding. If you are experiencing hair loss from stress, auto-immune conditions, scarring alopecia, or other causes, you will require a different therapeutic approach. Different medications, such as Minoxidil or corticosteroid creams, might be more effective for your needs.

Always get the recommendation of a trichologist before taking any hair growth medication, to make sure you are a good candidate for that particular formulation and that you are receiving the best hair loss treatment.

Why am I losing my hair?

A certain amount of hair loss is normal in the shower and should not be a cause for concern. However, if you are constantly losing more than 50-100 strands a day, you may indeed be witnessing the first signs of hair thinning and balding.

100 hair strands in a person with short hair (left) and long hair (right)
Photo showing 100 hairs from a person with short hair (left) and longer hair (right)

There are numerous conditions which could make your hair fall out, the most common of which include:

If you are unsure what could be causing your hair woes, it is important that you consult a trichologist as soon as possible, so your condition doesn’t progress. They will provide you with an accurate diagnosis and the best hair loss treatment, personalised for your condition.

Treatment alternatives to Finasteride and saw palmetto for hair loss

There is no universally recommended treatment for hair loss, as the optimum course of therapy depends on the cause of your hair shedding. However, if you are interested in alleviating the symptoms of male pattern baldness, here are the best alternatives:

What if no hair loss treatment works for me?

There are hair conditions which are too advanced to be treatable with medication or conventional therapies. However, that doesn’t mean you’ll never have luxurious locks again. You still have the option to get a hair transplant to increase your hair density.

Recent advances in hair restoration surgery ensure that whether you opt for an FUE or FUT type of procedure, you will still get a natural-looking result, so you can get a hair transplant without anyone knowing. Moreover, hair transplants are permanent, meaning that they still look great after 10 years.

Book a consultation now at your most convenient clinic location to find out if you are a good candidate for a hair transplant. Our world-class surgeons will answer all your questions and give you the best recommendations for your hair and scalp needs.

Saw Palmetto vs Finasteride: An Expert Review of Their Efficacy for Hair Loss, Wimpole Clinic

Dr Ahmad Moussa (FRCS)
Medically reviewed by Dr Ahmad Moussa (FRCS)Updated on March 29, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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