Journal of Cutaneous and Aesthetic Surgery
Print this page
Email this page
Small font size
Default font size
Increase font size
Home About us Current issue Archives Instructions Submission Subscribe Editorial Board Partners Contact e-Alerts Login 

DRUG REVIEW Table of Contents   
Year : 2009  |  Volume : 2  |  Issue : 1  |  Page : 31-32
Serenoa repens: Does it have any role in the management of androgenetic alopecia?

Consultant Dermatologist, Chennai, Tamil Nadu, India

Click here for correspondence address and email

Date of Web Publication1-Jul-2009


Serenoa repens is one among the many naturally occurring 5 alpha reductase (5aR) inhibitors which has gained popularity as a magical remedy for androgenetic alopecia. It is widely advertised on the web and sold by direct marketing. Used as a self-medication, there is a risk of missing the early detection of prostate cancer. There is little evidence to support its efficacy, warranting larger clinical trials on androgenetic alopecia.

Keywords: Androgenetic alopecia, serenoa repens, 5 alpha reductase

How to cite this article:
Murugusundram S. Serenoa repens: Does it have any role in the management of androgenetic alopecia?. J Cutan Aesthet Surg 2009;2:31-2

How to cite this URL:
Murugusundram S. Serenoa repens: Does it have any role in the management of androgenetic alopecia?. J Cutan Aesthet Surg [serial online] 2009 [cited 2022 Jun 29];2:31-2. Available from:

   Introduction Top

Many plant extracts claimed to have an inhibitory effect on the enzyme 5 alpha reductase (5aR) are widely advertised and sold on the internet as magic remedies for benign prostatic hypertrophy and androgenetic alopecia (AGA). Extract of serenoa repens (SR) is the most popular among the botanically derived 5aR inhibitors. Despite lack of proper clinical trials to support their efficacy, these products enjoy popularity among patients. They are also advocated by the so-called "trichologists" who promote the drug as a "safer" alternative to finasteride.

   Source and Contents of Serenoa Repens Top

Saw palmetto is an extract from the berries of the palm tree saw palmetto (also called serenoa repens, serenoa serrulata or sabal serrulata). The plant is a native of West Indies and is grown in plenty on the Atlantic southeast coast of North America. It is a tall tree of 6 to 10 feet with a crown of thorn-shaped leaves arranged like a fan. The berries are oblong in shape and maroon colored [Figure 1]. The extract of these berries is easily available and inexpensive.

The purified extract of SR contains 85-90% fatty acids and sterols, with an abundance of carotenoids, lipases, tannin, sugars and fatty acids like caprylic acid, palmitic acid, oleic acid and beta sitosterol. The combination of saw palmetto's liposterolic extract (LSESr) and beta sitosterol has been claimed to give improvement in AGA.

   Actions of Serenoa Repens Top

The mechanism of action is thought to be similar to finasteride i.e., blocking 5aR. Also, SR is thought to decrease dihydrotestosterone (DHT) uptake by hair follicle and decrease the binding of DHT to androgenetic receptors.

   Uses of Serenoa Repens Top

Saw palmetto extracts have been used anecdotally for a number of indications:

  1. In baldness and prostate enlargement.
  2. To help build and strengthen tissue and increase metabolism.
  3. As a diuretic which improves urinary flow.
  4. As an expectorant to relieve chronic bronchitis, asthma and chest congestion.
  5. In thyroid disorders.
  6. To stimulate appetite, digestion and absorption of nutrients.
  7. In polycystic ovary syndrome.

Use in androgentic alopecia

Very few studies exist to support the claims of its efficacy. In a small study of 10 males with AGA (23-64 years) on oral SR, improvement was seen in 60%. [1] In a study of 34 men and 28 women (18-48 years) topically applied SR extract in lotion and shampoo base for three months led to 35% increase in hair density and 67% increase in sebum reduction assessed by sebometry, pH metry, hydration studies and phototrichogram (study presented at the fourth intercontinental meeting of hair research societies, June 17-19, 2004). [2] Addition of extract of 0.5% SR to ketaconazole shampoo was shown to give better results compared to ketaconazole alone (presented at the 13th Annual meeting of the European Hair Research Society, Genoa, Italy). [3]

   Side-Effects Top

Side effects are said to be uncommon. The most common side effects is mild stomach discomfort which can be alleviated by taking it after food. Like other 5 alpha reductase inhibitors, SR may reduce PSA levels by 50% after 6 - 12 months of treatment. There is thus a risk of missing early detection of prostate cancer in patients self medicating with serenoa repens through the internet and direct marketing.

   Formulations Top

There are two types of herb palmetto supplements available in the market. One type is dried saw palmetto berries and the other type saw palmetto extract in the form of tablets. Recommended dose is 160 mg twice a day. Although saw palmetto is listed in the US pharmacopoeia, it falls under the guidelines for food supplements. It is not regulated by the Federal drug authority FDA.

   Conclusion Top

Significant evidence for advocating the use of the drug in AGA is lacking. However, physicians need to be aware of the drug as it is being used by patients and opinion will be sought about its efficacy.

   References Top

1.Prager N. 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 Complent Med 2002;8:413-52.  Back to cited text no. 1    
2.Fasculo C. Effectiveness of serenoa repens in androgenetic alopecia. JDDG, 6.2004 (Band 2) 552 abstracts, 4th intercontinental meeting of hair research societies, June 17-19, 2004.  Back to cited text no. 2    
3.Tosti A. Ketoil shampoo (ketaconazole 0.5%, serenoa repens, taurine) Vs ketaconazole 1% shampoo (Triatop ) in patients with dandruff and seborrheic dermatitis. Abstract book, 13 th Annual meeting of European Hair research society, Genoa, Italy: 2008. p. 3-5.  Back to cited text no. 3    

Correspondence Address:
Sundaram Murugusundram
Skin, Hair and Nail Clinic, 853, P.H. Road, Kilpauk, Chennai - 600 010, Tamil Nadu
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-2077.53097

Rights and Permissions


  [Figure 1]

This article has been cited by
1 Pharmacological Management of Pattern Hair Loss
Sandeep Suresh Sattur, Indu Sandeep Sattur
Indian Journal of Plastic Surgery. 2021;
[Pubmed] | [DOI]
2 Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics
Mark S. Nestor, Glynis Ablon, Anita Gade, Haowei Han, Daniel L. Fischer
Journal of Cosmetic Dermatology. 2021;
[Pubmed] | [DOI]
3 Fenugreek and Management of Androgenetic Alopecia: Fact or Fiction
Arpita Arghya, Venkataram N. Mysore
International Society of Hair Restoration Surgery. 2021; 31(4): 148
[Pubmed] | [DOI]
4 Modulation of Hair Growth Promoting Effect by Natural Products
Seyeon Park, Joomin Lee
Pharmaceutics. 2021; 13(12): 2163
[Pubmed] | [DOI]
5 Protective Role of Nutritional Plants Containing Flavonoids in Hair Follicle Disruption: A Review
Eleonora Bassino, Franco Gasparri, Luca Munaron
International Journal of Molecular Sciences. 2020; 21(2): 523
[Pubmed] | [DOI]
6 Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia
Evyatar Evron, Margit Juhasz, Arash Babadjouni, Natasha Atanaskova Mesinkovska
Skin Appendage Disorders. 2020; 6(6): 329
[Pubmed] | [DOI]
7 Efficacy and safety of a novel herbal solution for the treatment of androgenetic alopecia and comparison with 5% minoxidil: A double-blind, randomized controlled trial study
Farid Masoud, Hamideh Azimi Alamdari, Solmaz Asnaashari, Javad Shokri, Yousef Javadzadeh
Dermatologic Therapy. 2020; 33(6)
[Pubmed] | [DOI]
8 A Systemic Review on Topical Marketed Formulations, Natural Products, and Oral Supplements to Prevent Androgenic Alopecia: A Review
Sumel Ashique, Navjot Kaur Sandhu, Sk. Niyamul Haque, Kartick Koley
Natural Products and Bioprospecting. 2020; 10(6): 345
[Pubmed] | [DOI]
9 Serenoa repens and N -acetyl glucosamine/milk proteins complex differentially affect the paracrine communication between endothelial and follicle dermal papilla cells
Eleonora Bassino, Franco Gasparri, Luca Munaron
Journal of Cellular Physiology. 2019; 234(5): 7320
[Pubmed] | [DOI]
10 An Update on Plant Derived Anti-Androgens
Paul Grant, Shamin Ramasamy
International Journal of Endocrinology and Metabolism. 2012; 10(2): 497
[VIEW] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  

    Source and Conte...
    Actions of Seren...
    Uses of Serenoa ...
    Article Figures

 Article Access Statistics
    PDF Downloaded1055    
    Comments [Add]    
    Cited by others 10    

Recommend this journal