Saw Palmetto and PCOS
Saw palmetto (also known as sabal palmetto) is a reddish brown-to-black berry growing on a 6'-8" palm tree (Serenoa repens). The fruit of this palm have been part of the diet of natives of the southeastern U.S. for hundreds of years.
It is widely used for the treatment of enlarged prostate glands in men. It is thought that prostate glands become enlarged primarily because of a metabolite of testosterone, called dihydrotestosterone, or DHT. Women with PCOS (polycystic ovarian syndrome) also tend to have higher levels of testosterone and DHT than other women. Therefore, what works for men may work for women.
Useful for Hirsutism?
How does it work in women?
One of the most troubling symptoms of women with PCOS is hirsutism (too much hair, in the wrong places). Hirsutism is thought to be mostly due to excessive levels of androgenic hormones. Examples of androgens are testosterone, androstenedione, and DHEA.
Testosterone is the main androgen we're concerned about. It's normal for men to have a lot of testosterone and for women to have some. In both men and women, testosterone is converted into a more potent hormone called DHT (dihydrotestosterone). DHT is the hormone in your skin that stimulates hirsutism, which is male pattern hair growth. If you can reduce DHT, you may be able to reduce hirsutism (hair growing where you don't want it) or male pattern hair loss (restoring hair where you do want it).
Palmetto extract appears to reduce DHT in three different ways:
- Inhibits DHT production;
- Inhibits the binding of DHT to its cell receptors;
- Promotes the breakdown of DHT.
Testosterone is converted into DHT by an enzyme called 5-alpha-reductase. 5-alpha-reductase is inhibited by saw palmetto extract, and thus less DHT is produced and hirsutism may be reduced.
A recent study at the University of Birmingham in the UK showed that both overweight and normal-weight women with PCOS had higher 5-alpha-reductase activity than women who did not have PCOS.
In other words, if you have polycystic ovary syndrome, it appears you also have a tendency for higher 5-alpha-reducase activity, which in turn makes it easier for you to convert testosterone into the undesirable DHT. The excessive levels of DHT in turn create some of the distressing symptoms of PCOS such as hair loss or facial and body hair growth.
Palmetto extract may be useful for reducing 5-alpha-reducase activity.
It may be helpful in another way. A high level of estrogen may inhibit the elimination of DHT. Some women with PCOS have estrogen levels that are too high. It is reported to have an anti-estrogenic effect, thus helping with the removal of DHT.
There have been many studies of men with testosterone disorders that demonstrate the effectiveness and safety of saw palmetto. There aren't yet any studies of hirsute PCOS women. However, naturopathic physicians using these herbs for PCOS are seeing consistently favorable results.
Palmetto extract may help with the following PCOS symptoms:
- Hirsutism (too much hair in the wrong places)
- Male pattern baldness or hair loss.
"Thank you so much for selling the Saw Palmetto-Pygeum-Nettle Root extract. I've been on 4 medications in the past for PCOS that never had an effect except for making me feel bad. I've been losing my hair for the past few years, despite not even being 30 yet, and it was very noticeable at my hair part.
After using the extract for 2 months, my once sparse hair part has visibly improved! There's also a lot less hair falling out on my hairbrush than there used to be!"
- Belinda Guerra
Is It Similar to Anti-Androgenic Drugs?
Two drugs commonly prescribed for PCOS women are spironolactone (Aldactone), and finasteride (Propecia, Proscar).
Spironolactone is a diuretic that blocks two pathways to the production of androgens, or male hormones. One of those pathways is inhibition of 5-alpha-reductase. Spironolactone may cause irregular bleeding in some women, as well as nausea, indigestion or fatigue.
Propecia and Proscar inhibit 5-alpha-reductase and are used mostly for male pattern baldness and men with enlarged prostate glands.
The Journal of the American Medical Association published a review of studies that concluded saw palmetto was as effective as finasteride in the treatment of enlarged prostates.
Two advantages of saw palmetto are:
- (1) it is free of side effects, and
- (2) it is less expensive than the drugs mentioned above.
Side Effects and Precautions
No significant side effects have been noted in clinical trials with this herbal extract, except for rare headache or stomach upset if taken on an empty stomach.
Because of possible hormonal activity, it is not recommended for women who are pregnant or breast-feeding.
Palmetto berry constituents have alpha-adrenergic blocking activity that may alter the effects of these medications: prazosin, terazosin, doxazosin mesylate, tamsulosin.
It may have an additive effect if taken with anti-androgen drugs that reduce the levels of male sex hormones, such as finasteride (Prosca, Propecia) or flutamide (Eulexin).
In theory, it could interfere with birth control pills or hormone replacement therapy in women.
If you're taking any of these drugs, check with your health professional advisor before taking saw palmetto.
How Much Should You Take?
Every women is unique, so the amount and form of saw palmetto you need won't be the same as for someone else.
As a general guideline, a common dose for men is 320 mg. of extract per day, standardized to at least 85-95% fatty acids with a guaranteed minimum of 0.2-0.4% sterols. ("Standardized" means you get the same amount of active ingredients every time). You may decide to start with a somewhat lower dose.
In men, it can be taken for six weeks before any effect is noticed. If improvement is noted, it is recommended that men take it continuously. Since you're trying to reduce DHT like the men are, you could do the same.
Vitex, Pygeum and Saw Palmetto
A number of herbal products and nutritional supplements work synergistically to modify your hormonal profile. A few examples include vitex (chasteberry), saw palmetto, stinging nettles and pygeum. You may wish to combine saw palmetto extract, stinging nettle root and pygeum for a greater effect. You may also wish to add vitex. As you can imagine, a supplement program can get complicated.
Pygeum africanum is an evergreen tree found in the higher elevations of Africa. The fatty acids in pygeum appear to have effects similar to those found in saw palmetto. Pygeum contains substances that have been reported to work synergistically to:
- Reduce levels of luteinizing hormone (LH) and testosterone.
- Reduce prolactin levels, thereby reducing uptake of testosterone and synthesis of dihydrotestosterone.
- Competes with testosterone, thus inhibiting its buildup in tissues.
Therefore, we recommend you seek guidance from a naturopathic physician, who would have extensive knowledge of herbs and botanical medicines.
WARNING: The quality of botanical supplements varies widely. Don't buy any herbal or botanical product unless it has a "standardized" amount of the active component listed on the label. A "standardized" product has a consistent amount of active ingredients from one bottle to the next. If you buy a product that is not standardized, you have no clue as to what you are actually getting and may be wasting your money.
You can obtain the highest quality saw palmetto extract or vitex products from our PCOS Supplements Store.
PCOS Health Review
This free newsletter gives you original and immediately usable information to help you deal with PCOS.
Get the latest research, tips for improving your health, answers to questions, success stories, and more!
Your e-mail address is totally secure. We will never misuse your information.
Click the Link Above to Subscribe Today
and Get Your Questions Answered in this Free Special Report!