Is it worth using saw palmetto to treat alopecia and recover lost hair, or is it just another scam from the hair industry that does nothing at all? If it works, what dosage should I use, and how should I use it, orally or topically? Can I combine saw palmetto with finasteride or dutasteride? In this video, we will see all the science behind this extract, and we will debunk all the unfounded myths, even by doctors supposedly experts in trichology. The reality is that most cosmetic and beauty products for hair recovery that are sold freely in pharmacies, parapharmacies, and different retail stores are not effective in any way and are a real waste of time and money. In many cases, it would be more interesting to apply onion juice to your head than to use this type of product. But what about saw palmetto? Well, let's see what science says about this extract, and among others, we will see a really interesting study published just 2 months ago.

Saw Palmetto is a botanical extract with antiandrogenic properties, which has gained tremendous popularity in recent years for its supposed benefits on hair growth. If you stop for a moment to look at the ingredients of most topical and oral anti-hair loss formulations sold on the market, you will see that most of them contain saw palmetto. If you see the name “serenoa repens” on the label, it is indeed saw palmetto. The first thing you have to know is that androgenetic alopecia, the most common of all, is mainly caused by two factors. First, the sensitivity of your follicles to DHT, and second, the amount of DHT you have on your scalp. The enzyme 5 alpha reductase is responsible for transforming testosterone into dihydrotestosterone or DHT, and the most effective drugs to treat this condition, finasteride and dutasteride, inhibit the activity of this enzyme, thus reducing part of this conversion of testosterone into DHT, effectively decreasing

the amount of DHT we have in our blood and on our scalp. Additionally, you have to know that there are 2 main types of the 5 alpha reductase enzyme. The enzyme 5 alpha reductase type 1 is produced primarily in the liver and skin and is transported to the prostate via the systemic circulation. Type 2 enzyme is the main form of this enzyme in the prostate. Although at first it was thought that type 1 enzyme was the one most present in the frontal area and type 2 was more present in the crown, later studies showed that type 2 enzyme is the one that plays a role. most important role in androgenetic alopecia and how finasteride, a type 2 enzyme inhibitor, is effective in growing hair in the frontal area. Since 1994 we have known that saw palmetto acts as an inhibitor of the enzyme 5-alpha reductase type 1 and type 2. This 1995 study compared the in vitro efficacy of finasteride, turosteride

and 4-MA, 3 competitive inhibitors of both types of the enzyme 5 alpha reductase against saw palmetto. In this study, the inhibition of saw palmetto was non-competitive for the enzyme 5 alpha reductase type 1 and uncompetitive for the enzyme type 2. Stay with this because it will be very important in order to know if it can make sense to combine saw palmetto with treatments such as finasteride. According to this study, since saw palmetto similarly inhibits both types of the 5 alpha reductase enzyme, it is more similar to 4-MA than to finasteride or turosteride, which are more effective in inhibiting the type 2 5 alpha reductase enzyme. Another study in vitro from 2002 suggests that saw palmetto at a concentration of 10 nanograms per milliliter inhibits the activity of both types of the 5 alpha reductase enzyme by

50%. In this study, the type 2 5 alpha reductase enzyme was shown to be much more active than type 1, and saw palmetto was shown to be a non-competitive inhibitor. On the other hand, another in vitro study from 1994 suggests that although 4-MA and finasteride are competitive inhibitors of the enzyme 5 alpha reductase type 1, saw palmetto is a non-competitive inhibitor of this enzyme. Furthermore, this study confirms that 4-MA is significantly more effective than finasteride in inhibiting the enzyme 5 alpha reductase type 1, while 320 mg per day of saw palmetto is 3 times more effective than 5 mg per day of finasteride. Another in vitro study from 2010 analyzed the effectiveness of an extract of saw palmetto and finasteride in inhibiting the enzyme 5 alpha reductase type 2. In this study, the effectiveness of 6 nanomoles

of finasteride in inhibiting the enzyme 5 alpha reductase type 2 was 61%, serving as the control of the study. Concentrations of 5 nanograms per milliliter and 10 nanograms per milliliter of saw palmetto managed to inhibit the enzyme 5 alpha reductase type 2 by 73 and 95%, respectively. On the other hand, in another in vitro study from 2016, 6 nanomoles of finasteride, which served as a control, inhibited the activity of the enzyme 5 alpha reductase between 63 and 75%. On the other hand, concentrations of 50 nanograms per milliliter or higher of saw palmetto inhibited the activity of the enzyme 5 alpha reductase type 2 by 99% and the concentration of 10 nanograms between 91 and 93%. In this study, saw palmetto showed competitive binding towards the active site of the enzyme.

These in vitro studies are very good, but do we have any studies carried out in humans? Well, yes. A randomized double-blind placebo-controlled study from 2002 analyzed the effectiveness of capsules with 200 mg of saw palmetto standardized to 85-95% liposterols or fatty acids in 26 men with androgenetic alopecia, of whom 19 completed the study. According to the patients' self-assessment, 33% of men in the placebo group worsened their hair condition compared to 0% in the saw palmetto group. On the other hand, according to the researcher's evaluation, 6 out of 10 patients improved their hair status in the saw palmetto group compared to 1 out of 9 in the placebo group. The problem with this study is that the capsules also contained other ingredients such as niacin and biotin, making it impossible to isolate the effectiveness of saw palmetto and, furthermore, the sample was very small.

On the other hand, in a 2012 study that lasted 2 years, the effectiveness of 1 mg per day of finasteride and 320 mg per day of saw palmetto was compared in 100 men with androgenetic alopecia. In this study, 38% of patients who used saw palmetto managed to improve their capillary status compared to 68% of patients in the finasteride group. Furthermore, something quite interesting is that in both groups, 10% of patients worsened their hair condition. To put this data in perspective, approximately 78% of patients who use dutasteride manage to improve their hair condition. It is important to note that, as the authors of this study point out, although saw palmetto was effective in growing hair in the vertex or crown area, finasteride was effective in growing hair in both the vertex and the frontal area. So, as you can see, it seems that saw palmetto can be effective in treating alopecia.

especially in patients with alopecia located on the crown of the head, and its effectiveness is much less than that of finasteride, which in turn is slightly less than that of dutasteride. Before continuing, if you like this video, give it a like, and if you are worried about the health of your hair, subscribe to the channel so you don't miss any videos. Let's look at the latest study conducted on saw palmetto, published in November 2023. This double-blind, randomized, placebo-controlled study analyzed the effectiveness of an oral formulation of saw palmetto and a saw palmetto oil in 80 men with androgenetic alopecia over 16 weeks. The really interesting thing about this study is that it analyzed formulations where only saw palmetto extracts were used without combining it with any other extract or vitamin. In this study, hair loss was reduced by 29% in the group that used the oral formulation and by 22% in the group that used the topical formulation.

compared to a significant increase in hair loss in the groups that used placebo. Furthermore, there was also a significant difference in the hair loss tests, both the hair pulling test and the hair combing test, in favor of the saw palmetto groups. On the other hand, hair density improved significantly in the groups that used saw palmetto compared to the placebo, but hair thickness and the ratio of hairs in the anagen and telogen phase did not improve significantly. Regarding the photographic evaluation, the subjects who used oral saw palmetto obtained a significant improvement compared to the placebo, something that did not occur in the topical saw palmetto group, although in this group there were fewer subjects who experienced capillary worsening in comparison with the group that used the placebo. Finally, the group using oral saw palmetto had a significant reduction in their serum DHT levels compared to placebo, and the group using topical saw palmetto did not experience any alteration in these levels.

Obviously, we need more rigorous studies that analyze the effectiveness of saw palmetto in oral and topical formulations to treat alopecia. But after analyzing all the science regarding this extract, we can affirm that it is not a cheap scam or a product that has no effectiveness. As you can imagine, there are multiple clinical studies that have analyzed the effectiveness of different formulations of saw palmetto to treat benign prostatic hyperplasia, another condition related to DHT, such as this study where the use of saw palmetto relieved patients' urinary symptoms at the same level as finasteride, or this other study where the use of 160 mg of saw palmetto daily for 2 years significantly improved the symptoms, urinary flow, and prostate size of the patients when compared to placebo. Let's now see if it makes sense to combine saw palmetto with drugs such as finasteride or dutasteride. First, the combination with dutasteride would not make sense since dutasteride is

more effective at inhibiting both types of the 5-alpha reductase enzyme, but it might make sense to combine it with finasteride since saw palmetto is more effective at inhibiting the 5-alpha reductase type 1 enzyme. If Although it is true that the activity of the 5AR type 2 enzyme is more present in the follicles than the 5AR type 1 enzyme, it is not unreasonable to think that one of the reasons why dutasteride is more powerful than finasteride is because it is up to 100 times more effective at inhibiting the 5AR type 1 enzyme. Now, this combination with finasteride may make sense as long as saw palmetto does not act as a competitive inhibitor of the 5 alpha reductase enzyme. Competitive inhibitors bind to the active site of the enzyme and prevent its binding to the substrate. On the other hand, a non-competitive inhibitor binds to a different site on the enzyme, does not block the binding of the substrate but produces other changes.

in the enzyme so that it can no longer catalyze the reaction efficiently. What this means is that if saw palmetto acts as a competitive inhibitor of the enzyme 5 alpha reductase type 2, and we combine it with finasteride, which we know is a competitive inhibitor of this enzyme, then we could reduce the effectiveness of finasteride by binding part of saw palmetto to the active site of the enzyme and prevent its binding to the substrate instead of finasteride. If this were so, then the combination of finasteride and saw palmetto would not make sense, since the enzyme 5 alpha reductase type 2 is the most important in androgenetic alopecia, and finasteride is much more effective in inhibiting the activity of this enzyme. Now, most in vitro studies suggest that saw palmetto is a non-competitive inhibitor of the 5 alpha reductase enzyme. We have seen that all studies suggest that saw palmetto is a non-competitive inhibitor of 5 alpha reductase type 1.

one suggests that saw palmetto is a non-competitive inhibitor of the 5 alpha reductase type 2 enzyme, and another study suggests that it is a competitive inhibitor of this enzyme. Uncompetitive inhibition occurs when an enzyme inhibitor binds only to the complex formed between the enzyme and the substrate. So, while saw palmetto is not a competitive inhibitor of the enzyme 5 alpha reductase, combining this extract with finasteride could make sense. Now, to clear up doubts, we would need a double-blind, randomized controlled study that analyzed the use of finasteride and finasteride combined with saw palmetto. You may have noticed that it seems that the effectiveness of saw palmetto is different depending on which study we look at, and yes, this is true, and furthermore, it is something that some of the authors of these studies point out. In general, we can say that clinical studies on saw palmetto have shown mixed results. Some studies have shown significant results, and others have not. As

different scientists point out, this discrepancy in results may be due, in part, to the different bioactivities of the saw palmetto extracts used in the studies. Unfortunately, we do not have a standardized dose of saw palmetto to treat alopecia, but we can say that the doses that have been shown to be effective had between 85 and 90% fatty acids and between 2 to 3% β-sitosterol. Additionally, the most common dose to treat alopecia was 320 mg per day. Obviously, we are talking about saw palmetto in its oral version; in its topical version, at the moment, the evidence we have is not enough to think that its use can report significant results. And in what cases would the use of saw palmetto be interesting? In small alopecia located in the crown area and in patients who present clinical side effects with the use of finasteride or dutasteride. It is true that the percentage of patients who present side effects with these drugs

is very small. Specifically, if we eliminate the users who used the placebo, we would be left with 0.5% of finasteride users experiencing decreased libido, 0.6% experiencing erectile dysfunction, and 0.4% experiencing a decrease in ejaculate volume. In these cases, saw palmetto could be interesting, although it would surely be more interesting to reduce the dose of finasteride or dutasteride or use any of these drugs on alternate days. If you want to know more about a natural treatment that can have a similar effectiveness to Minoxidil, click here, and to see more videos like this, subscribe to the channel here.

Saw Palmetto ¿La Alternativa Natural A Finasteride?

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