The Snapshot
Finasteride
• Efficacy Score: 9.5/10
• Cost: Low
• Risk: Moderate (hormonal side effects possible)
Saw Palmetto
• Efficacy Score: 3.8/10
• Cost: Low–Moderate
• Risk: Low
Summary: One is a clinically proven DHT inhibitor with robust, long-term data. The other is a mild botanical extract with inconsistent results and no equivalence to drug therapy.
The Mechanism
Finasteride
Finasteride inhibits Type II 5-α-reductase, the enzyme that converts testosterone → dihydrotestosterone (DHT).
• Reduces serum DHT by ~60–70%
• Reduces scalp DHT by ~40–50% (Clark et al., 2004)
• Directly slows follicle miniaturization in androgenetic alopecia
This is the most validated mechanism in male pattern hair loss.
Saw Palmetto
Saw palmetto (Serenoa repens) is believed to have mild 5-α-reductase inhibitory activity.
• In-vitro studies show partial inhibition (Habib et al., 2006)
• Human systemic DHT reduction is minimal or inconsistent
• Mechanism involves weak competitive enzyme inhibition + anti-inflammatory effects
It does not replicate finasteride’s potency or pharmacodynamics.
The Data
1. Finasteride – High-Quality Evidence
Multiple Phase III randomized trials (>1500 men) show:
• ~90% halt in hair loss progression
• ~65% measurable hair regrowth
• Sustained results 10+ years with continued use (Kaufman et al., 2008)
Strong, reproducible, dose–response data.
2. Saw Palmetto – Weak and Inconsistent Evidence
Studies are typically:
• Small sample sizes
• Low methodological quality
• Non-standardized extracts
• Subjective endpoints
Examples:
• Prager et al., 2002 (n=34): 38% improvement vs 68% in finasteride group; underpowered and short duration.
• Foletto et al., 2020: Mild increases in hair density but far below finasteride outcomes.
Meta-analyses conclude:
→ Saw palmetto may modestly improve AGA but is not a substitute for finasteride.
3. DHT Suppression Comparison
| Agent | Serum DHT Reduction | Evidence Quality |
|---|---|---|
| Finasteride 1 mg | ~60–70% | Strong (multiple RCTs) |
| Saw Palmetto | ~5–15% (inconsistent) | Weak (small trials) |
Finasteride is an order of magnitude more potent.
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The Protocol
Finasteride
Dose: 1 mg daily (oral)
Alternatives: 0.25–0.5 mg daily for sensitive users; topical 0.1–0.25% for reduced systemic exposure.
Onset: 3–6 months
Full evaluation: 12 months
Saw Palmetto
Dose: 160–320 mg/day (lipidosterolic extract preferred)
Onset: 3–6 months (mild)
Expectation: Stabilization at best; meaningful regrowth is uncommon.
Combination Use?
Saw palmetto does not boost finasteride’s efficacy. No additive DHT blockade has been shown.
Verdict: Professional Assessment
Finasteride is the gold standard oral therapy for androgenetic alopecia. It has:
✓ Strong biological rationale
✓ Extensive clinical proof
✓ Long-term outcome data
Saw palmetto is not comparable. While it has mild anti-androgenic activity, its impact is weak, inconsistent, and insufficient for moderate or advanced AGA. It may be reasonable only for:
• Individuals refusing pharmaceutical therapy
• Very early hair loss
• Adjunct use with no expectation of major improvement
Bottom line:
If the goal is real, measurable hair preservation or regrowth, finasteride is in a different league entirely.