Saw Palmetto vs Finasteride for Hair Loss and BPH
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[Hair loss · Comparison]

Saw palmetto vs finasteride: what do the trials show?

Status · Hair loss study · Prostate trials · Safety

Short answer: Finasteride 1 mg (Propecia) is FDA approved for male pattern hair loss; saw palmetto is an herbal supplement that is not.12 In one open 2-year study of 100 men, hair improved in 68% on finasteride vs 38% on saw palmetto 320 mg.3 For enlarged prostate, a Cochrane review found saw palmetto alone did little more than placebo.4

How do saw palmetto and finasteride compare side by side?

From the US Propecia label, NCCIH and published trials.
Saw palmettoFinasteride (Propecia)
What it isBerry extract of a small palm, sold as a supplement25-alpha-reductase inhibitor tablet1
FDA approved for hair lossNo2Yes, men only1
Amount usedHair study: 320 mg a day3Label: 1 mg once a day1
Hair study, 2 yearsImproved in 38%3Improved in 68%3
Time to judgeNot setUsually 3 months or more of daily use; benefit reverses within 12 months of stopping1
Effect on PSADoes not appear to change PSA2Lowers PSA1
Side effectsMild and infrequent: digestive symptoms, dizziness, headache2Year 1: decreased libido 1.8% vs 1.3% on placebo; erectile dysfunction 1.3% vs 0.7%1
PregnancyMay be unsafe2Contraindicated; women who may be pregnant should not handle broken tablets1

Reviewed . Half-life figures are shown only where the value Dose Track uses agrees with the cited source.

Has saw palmetto been compared with finasteride for hair loss?

Yes, in one open-label study. 100 men with mild to moderate male pattern hair loss took saw palmetto 320 mg or finasteride 1 mg every day for 24 months. Judged from photos, 38% on saw palmetto and 68% on finasteride had more hair. The authors noted finasteride helped both the front and the crown, while saw palmetto helped mostly the crown.3

Open-label means everyone knew what they were taking, and there was no placebo group. NCCIH says the evidence for saw palmetto in hair loss is too limited to draw conclusions.2 These are study protocols, not personalized advice; confirm any dosing with your prescriber.

What about an enlarged prostate (BPH)?

Finasteride 5 mg is a different product for BPH; Propecia 1 mg is for hair. A 1996 six-month double-blind trial of 1,098 men compared a saw palmetto extract (Permixon 320 mg) with finasteride 5 mg. Symptom scores fell 37% and 39%. Finasteride shrank the prostate by 18% and lowered PSA by 41%; the extract shrank it 6% and did not change PSA. Its first author worked for the extract's maker.5

Later placebo-controlled research is less positive. A 2023 Cochrane review of 27 studies with 4,656 men found that saw palmetto alone makes little to no difference to urinary symptoms compared with placebo (high-certainty evidence).4

What are the safety points?

  • Saw palmetto: NCCIH says it is well tolerated and has been used safely in studies for up to 3 years. It does not appear to change PSA readings.2
  • Finasteride: it lowers PSA, so a confirmed rise while taking it should be checked. The label also lists possible higher risk of high-grade prostate cancer, and depression and suicidal thoughts from reports after approval.1

More detail: Propecia side effects, the Propecia dosing schedule, and the Saw Palmetto (Serenoa repens) and Finasteride guides.

This page summarizes labels and published studies. It is not personalized medical advice; confirm any dose or change with your prescriber.
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Frequently asked questions

Does saw palmetto work like finasteride?+
Not as far as trials show. In a 2-year open study, 38% of men on saw palmetto 320 mg vs 68% on finasteride 1 mg had more hair.3 In a BPH trial, finasteride shrank the prostate and lowered PSA, while saw palmetto barely did.5
Is saw palmetto FDA approved for hair loss?+
No. It is sold as a supplement, and NCCIH says the hair loss evidence is too limited for conclusions.2
Does saw palmetto change PSA?+
NCCIH says it does not appear to affect PSA, even at higher amounts.2 Finasteride lowers PSA.1
How common are sexual side effects on finasteride?+
In year 1 of the Propecia trials, decreased libido was 1.8% vs 1.3% on placebo and erectile dysfunction 1.3% vs 0.7%.1
Can I track saw palmetto or finasteride in Dose Track?+
Yes. Both are in the library, so you can log each dose with reminders.

Sources

  1. Propecia (finasteride) tablets prescribing information, sections 1, 2, 5, 6, 12 and 14. DailyMed, version of October 2024.
  2. NIH National Center for Complementary and Integrative Health. Saw palmetto (updated April 2025).
  3. Rossi A, et al. Comparitive effectiveness of finasteride vs Serenoa repens in male androgenetic alopecia: a two-year study. Int J Immunopathol Pharmacol. 2012;25:1167-1173.
  4. Franco JV, et al. Serenoa repens for the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Cochrane Database Syst Rev. 2023;6:CD001423.
  5. Carraro JC, et al. Comparison of phytotherapy (Permixon) with finasteride in the treatment of benign prostate hyperplasia: a randomized international study of 1,098 patients. Prostate. 1996;29:231-240.

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