Saw palmetto (Serenoa repens [Bartram] Small)

background

Saw palmetto (Serenoa repens, Sabal serrulata) is used popularly in Europe for symptoms associated with benign prostatic hypertrophy (enlargement of the prostate). Although not considered standard of care in the United States, it is the most popular herbal treatment for this condition.
Historical use of saw palmetto can be traced in the Americas to the Mayans who used it as a tonic and to the Seminoles who took the berries as an expectorant and antiseptic.
Saw palmetto was listed in the United States Pharmacopeia from 1906 to 1917 and in the National Formulary from 1926 to 1950. Saw palmetto extract is a licensed product in several European countries.
Multiple mechanisms of action have been proposed, and saw palmetto appears to possess 5-α-reductase inhibitory activity (thereby preventing the conversion of testosterone to dihydrotestosterone). Hormonal/estrogenic effects have also been reported, as well as direct inhibitory effects on androgen receptors and anti-inflammatory properties.

synonyms

American dwarf palm tree, Arecaceae (family), cabbage palm, dwarf palm, Elusan® Prostate, IDS 89, LSESR, PA 109, Palmae (family), palmetto scrub, palmier de l'amerique du nord (French), palmier nain (French), Permixon®, Prostagutt®, Prostaserine®, sabal, sabalfruchte (German), Sabal fructus, savpalme (Danish), saw palmetto berry, serenoa, Serona repens, Serenoa serrulata Hook F., SG 291, Strogen®, WS 1473, Zwegpalme.

evidence table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Enlarged prostate (benign prostatic hypertrophy/BPH) (Grade: A)
Numerous human trials report that saw palmetto improves symptoms of benign prostatic hypertrophy (BPH) such as nighttime urination, urinary flow, and overall quality of life, although it may not greatly reduce the size of the prostate. The effectiveness may be similar to the medication finasteride (Proscar®) with fewer side effects. Although the quality of these studies has been variable, overall they suggest effectiveness. Saw palmetto has not been thoroughly compared to other types of drugs used for BPH, such as doxazosin (Cardura®) or terazosin (Hytrin®). Most available studies have assessed the standardized saw palmetto product Permixon®.
Male-pattern hair loss (Grade: C)
It has been suggested that saw palmetto may block some effects of testosterone and therefore reduce male pattern hair loss, similar to the medication finasteride (Propecia®). More studies are necessary before saw palmetto can be recommended for this use.
Prostate cancer (Grade: C)
There is not enough scientific evidence to recommend the product PC-SPES® (which contains saw palmetto) for prostate cancer. PC-SPES® also contains seven other herbs (
Prostatitis/chronic pelvic pain syndrome (CP/CPPS) (Grade: C)
A prospective, randomized, open label, one-year study was designed to assess the safety and efficacy of saw palmetto and finasteride in the treatment of men diagnosed with category III prostatitis/chronic pelvic pain (CP/CPPS). CP/CPPS treated with saw palmetto had no appreciable long-term improvement. In contrast, patients treated with finasteride had significant and durable improvement in multiple parameters except for voiding.
Underactive bladder (Grade: C)
There is currently little information on the effectiveness of saw palmetto for the treatment of bladder disorders.