Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia

Abstract

Saw palmetto (SP), a botanical extract with antiandrogenic properties, has gained commercial popularity for its purported benefits on hair regrowth. To summarize published evidence on the efficacy, safety, and tolerability of supplements containing SP in the treatment of alopecia, we conducted a PubMed, Google Scholar, and Cochrane database search using the following terms: (saw palmetto and hair loss), (saw palmetto and androgenetic alopecia), and (saw palmetto and natural supplement and alopecia). Five randomized clinical trials (RCTs) and 2 prospective cohort studies demonstrated positive effects of topical and oral supplements containing SP (100-320 mg) among patients with androgenetic alopecia (AGA) and telogen effluvium. Sixty percent improvement in overall hair quality, 27% improvement in total haircount, increased hair density in 83.3% of patients, and stabilized disease progression among 52% were noted with use of various topical and oral SP-containing supplements. SP was well tolerated and not associated with serious adverse events in alopecia patients. Although robust highquality data are lacking, supplements containing SP may be a treatment option for patients with AGA, telogen effluvium, and self-perceived hair thinning. Further large-scale RCTs focusing on the sole contribution of SP to hair growth outcomes are needed to confirm efficacy and determine longterm adverse events.

Pharmacological Management of Pattern Hair Loss

“…1,4,20,59 Saw Palmetto (Serenoa repens) Saw palmetto (SP), a botanical extract from the berries of Serenoa repens, is one among the many naturally occurring SRD5A inhibitors which has gained popularity as a magical remedy for MPHL. 59,109,110 Very few studies of efficacy of SP in PHL exist and most of the data on SP is from studies of its use in BPH. 110 It is listed in US Pharmacopeia under food supplements and available as dried berries or tablets of the extract.…”

“… 59 109 110 Very few studies of efficacy of SP in PHL exist and most of the data on SP is from studies of its use in BPH. 110 It is listed in US Pharmacopeia under food supplements and available as dried berries or tablets of the extract. The dosage is 160 mg twice a day.…”

Serenoa repens en el tratamiento de la alopecia androgenética. Revisión de la literatura

“…Estos autores realizaron el primer ensayo clínico doble ciego con buenos resultados a favor de S. repens, hasta un 60% de eficacia, pero el número de pacientes fue únicamente de 10 casos. En 2020, Evron et al [17] realizaron una revisión sistemática sobre el efecto de S. repens en el tratamiento de la alopecia, analizando 5 ensayos clínicos aleatorizados y 2 estudios de cohortes prospectivos. Según sus resultados, todos los trabajos demostraron efectos positivos de los suplementos orales que contenían S. repens, tanto en pacientes con alopecia androgenética como en pacientes con efluvio telógeno.…”

Biomolecules of Fermented Tropical Fruits and Fermenting Microbes as Regulators of Human Hair Loss, Hair Quality, and Scalp Microbiota

“…As a general mechanism, many herbs, higher plants, and their active constituents used for the management of alopecia target the hair cycle - keratinocyte proliferation, apoptosis, angiogenesis, microcirculation around hair bulb, hormones, and inflammation [ 21 ]. Numerous secondary metabolite-enriched extracts of plants/algae, such as Serenoa repens [ 22 , 23 ], Panax ginseng Mayer [ 24 ], bergamot [ 25 ], Pinus thunbergii [ 26 ], Crataegus pinnatifida [ 27 ], Aconiti Ciliare Tuber [ 28 ], Caesalpinia sappan L. [ 29 ], Ecklonia cava [ 30 ], and many others have been investigated in preclinical studies for their hair growth-promoting or hair loss-inhibiting actions. Among the biologically active substances, plant polyphenols, alkaloids, terpenoids have been identified, along with lipids and fatty acids, reviewed in [ 31 , 32 ].…”