Saw palmetto, sereano repans, is often known as sabal, especially in Europe but also found under a number of other names. It is a native fan palm of the south east United States of America, especially in Florida. It was at one time part of the regular diet of the native American Seminole people, even though the taste has been described as repugnant by some. They would collect it, dry it out and use as a year round staple food. It was also used by early settlers as a medicine for cattle with urinary problems and in 1907 a saw palmetto drying facility was set up in Florida by Lilly and Company. It began to be introduced by drug companies in the 1950s when it was used in the treatment of prostate enlargement. It was especially effective when treating the early stages of the disease and considered to be less likely to cause the patient harm from side effects than using other drugs. It was later found to help with hair loss problems by limiting 5 Alpha Reductase action and so promoting healthy hair follicles. Now saw palmetto is becoming the herbal treatment of choice for alopecia androgenica.

Saw palmetto baldness treatment is said to work by interrupting hormonal signals and therefore reducing the uptake by the hair follicles of a damaging chemical called dyhydrotestosterone (DHT ). There are both topical and oral preparations and these can complement each other by reducing DHT locally on the scalp and throughout the body so promoting healthy hair growth.

The study most often cited when explaining the benefits of saw palmetto baldness treatment was a trial run in 2002 by the group of scientists Nelson Prager, Karen Bickett, Nita French, and Geno Marcovici*. This was a relatively small study conducted under double-blind conditions on 19 men between the ages of 23 and 64 years with mild to moderate hair loss. The trial involved administering a oral daily dosage containing 400mg of liposterolic extract of saw palmetto (LESP) with additional [beta]-sitosterol and extra nutrients. Results after five months showed that there was an improvement in hair growth in 60% of the men taking the herbal combination. This compared to an 11% improvement of those receiving a placebo. Although the small number of men taking part in the study meant that the results could have occurred by chance the findings were still very encouraging.

There are now many companies selling saw palmetto baldness treatments and as such there can be problems with differences in recommended dosages. It is a natural product which means that there are variations in the amount of active ingredients that the berries contain. At present there are no regulated manufacturing standards for the purity of saw palmetto and so far the treatment has not yet been evaluated by the US food and Drugs Administration (FDA) for safety. Therefore purity and effectiveness cannot be guaranteed and there can also be wide variations in the quality and concentration from brand to brand. Customers should therefore only buy from reputable companies and must ensure that the preparation contains the saw palmetto lipid extracts. These are the plants natural active ingredients such as fatty acids, oils, waxes and steroids and these are not contained in the juice, bark or dried berries.

Saw palmetto baldness treatments are low in toxicity and now widely used in North America for the treatment hair loss and also used to treat prostate enlargement. Sometimes as an extra step, high concentration saw palmetto in gel form is applied topically to the scalp for improved results. For the early stages of male pattern baldness saw palmetto seems to offer a relatively safe form of treatment before resorting to prescribed drugs.

One note of caution, although saw palmetto can be used by most people, it has not been proven to be safe for women during pregnancy and lactation.

*Prager N, Bickett R, French N et al. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-[alpha]-reductase in the treatment of androgenetic alopecia. J Altern Complement Med 2002; 8(2): 143-152.