The Over-The-Counter Finasteride Alternative: A Critical Review of Saw Palmetto's Efficacy, Safety, and Regulatory Concerns

Saw palmetto extract (SPE) is gaining popularity as an over-the-counter alternative to finasteride for treating androgenetic alopecia (AGA) and benign prostatic hyperplasia (BPH). While SPE can inhibit 5-alpha reductase and potentially improve hair density and quality, its effects are less pronounced than finasteride. A study of 39 SPE products found that 25.6% were marketed for hair loss and 79.5% for prostate health, with varying safety information and few reporting adverse effects. Unlike regulated prescription drugs, SPE lacks rigorous testing and defined dosage guidelines, posing safety and efficacy concerns. Although generally well-tolerated, SPE can cause minor side effects, and rare serious adverse events have been reported. The lack of regulation and comprehensive clinical trials highlights the need for more stringent evaluations of SPE's efficacy and safety.