Saw palmetto vs finasteride: a supplement against a medicine

Saw palmetto is often sold as a "natural finasteride". Both are said to act on DHT (dihydrotestosterone), the hormone linked with male pattern hair loss, and saw palmetto supplements are easy to buy without a prescription. But a supplement and a medicine are not the same thing, and the evidence behind them is very different. If you are weighing up saw palmetto against finasteride, it helps to know what the head-to-head study found, how strong the wider evidence is, and what the safety picture looks like for each.

This article compares the two directly, looks at the one two-year comparison study, summarises what reviews and health agencies say, and offers practical points for buying and using either in Malaysia. (This is general information, not personal medical advice.)

Short answer

Finasteride is a prescription medicine for male pattern hair loss, usually taken as 1mg once a day; the NHS says improvement can be expected after 3 to 6 months and that hair loss usually comes back if you stop ¹. Saw palmetto is a plant extract sold as a supplement. In a two-year open-label study of 100 men with mild to moderate pattern hair loss, 68% of those on finasteride improved compared with 38% on saw palmetto 320mg a day ². A systematic review found some positive results for saw palmetto but said robust high-quality data are lacking ³, and the National Center for Complementary and Integrative Health (NCCIH) in the United States says the evidence for hair loss is too limited to allow conclusions ⁴. Finasteride has better evidence but known side effects, including sexual side effects and, rarely, low mood ¹⁵. Saw palmetto appears well tolerated but is less proven. Discuss the choice with a doctor.

How each is meant to work

Finasteride is a 5-alpha reductase inhibitor. It reduces the conversion of testosterone into DHT, which helps reduce hair loss in men with male pattern baldness ¹. It comes as tablets and, for hair loss, the usual dose is 1mg once a day ¹. See finasteride for hair loss and DHT and hair loss.

Saw palmetto comes from the berries of a small palm native to the south-east United States and the West Indies. It is promoted as a supplement for prostate symptoms and for male pattern baldness, among other uses ⁴. It is described as having antiandrogenic properties ³, but supplements vary widely in extract type and dose. See saw palmetto and hair loss.

The head-to-head study

The main direct comparison is an Italian study published in 2012 ²:

• Who: 100 men with clinically diagnosed mild to moderate androgenetic alopecia.
• Groups: one group took saw palmetto (Serenoa repens) 320mg every day; the other took finasteride 1mg every day.
• How long: 24 months.
• How it was measured: a score comparing global photographs taken at the start and at the end of treatment.
• Design: open label, meaning participants and doctors knew which treatment was being used.

Results: 38% of men on saw palmetto had an increase in hair growth, compared with 68% of men on finasteride. Finasteride was more effective in most men with more advanced (level II and III) hair loss. The authors observed that finasteride acted at both the front and the crown, while saw palmetto acted mainly at the crown. They concluded that saw palmetto could lead to some improvement, while finasteride confirmed its efficacy ².

What the study cannot tell you

• It was open label. Knowing which treatment you are on can influence how results are judged.
• There was no placebo group. It is hard to know how much of the improvement with saw palmetto was due to the extract.
• It used one product and dose. Saw palmetto supplements differ, so results may not apply to what you buy.
• It was one study in men. It does not tell you about women, or about combinations of supplements.

What reviews and agencies say

A 2020 systematic review of saw palmetto in alopecia looked at randomised trials and other studies of oral and topical products containing saw palmetto, with oral doses from 100 to 320mg ³. It reported improvements in hair quality, hair count and density in some patients, and said saw palmetto was well tolerated without serious adverse events. However, many products combined saw palmetto with other ingredients, and the authors said robust high-quality data are lacking and that larger trials focusing on saw palmetto alone are needed ³.

The National Center for Complementary and Integrative Health notes that a few small studies have tested saw palmetto, by mouth or on the scalp, for male pattern hair loss, and that the evidence is too limited to allow conclusions ⁴. It also reports that, for urinary symptoms of an enlarged prostate, a 2023 review found saw palmetto alone provides little or no benefit ⁴.

By contrast, finasteride is a well-established medicine for male pattern hair loss. A 2025 Canadian expert consensus included oral finasteride among the interventions it recommended for androgenetic alopecia ⁶.

Side by side

Side effects and safety

Finasteride. According to the NHS, common side effects (more than 1 in 100 people) include problems getting an erection, less interest in sex and problems with ejaculation. These usually improve, but can sometimes continue after stopping ¹. Serious side effects are rare and include low mood; if this happens while taking it for hair loss, the NHS advises stopping straight away and contacting a doctor. Breast lumps, pain or nipple discharge also need prompt review ¹. A meta-analysis of 15 placebo-controlled trials found finasteride for hair loss was associated with an increased risk of sexual dysfunction compared with placebo ⁵. Finasteride is generally not recommended for women or children and can affect PSA test results, so tell your doctor if you need one ¹. See finasteride side effects and post-finasteride syndrome.

Saw palmetto. The NCCIH describes saw palmetto as well tolerated in studies of up to three years, with mild and infrequent side effects such as digestive symptoms, dizziness and headache ⁴. It may be unsafe during pregnancy or breastfeeding, and some herbs interact with medicines, so check with a doctor or pharmacist if you take other medicines ⁴. Because saw palmetto is thought to have antiandrogenic effects, it is not a good idea to assume it is risk free just because it is natural.

Buying in Malaysia

In Malaysia, finasteride is a medicine that should be prescribed and dispensed by a doctor or pharmacist. Avoid buying it from unverified online sellers, where the product, dose or source may be unclear. See buying hair loss products at a pharmacy.

Saw palmetto is sold in pharmacies, health shops and online, often in combination products with biotin, pumpkin seed oil or other ingredients. Check the ingredient list, dose and registration details, and be cautious about products that promise dramatic results. See hair growth supplements in Malaysia, pumpkin seed oil for hair and red flags in hair product claims.

When comparing cost, think about the monthly cost over at least a year, since both need long-term use to judge results.

Can you take both?

There is little good evidence on combining saw palmetto with finasteride. Since both are thought to act on the same pathway, combining them may not add much, and it adds another product to track. If you want to try both, discuss it with a doctor first. Many people who want more than finasteride alone discuss adding minoxidil instead, which works in a different way. See minoxidil and finasteride together.

Who might choose which

You might lean towards finasteride if:

• you are a man with male pattern hair loss confirmed by a doctor
• you want the option with stronger evidence
• you are comfortable discussing and monitoring possible side effects

You might consider saw palmetto if:

• you have discussed it with a doctor and understand the evidence is limited
• you do not want to take a prescription medicine, and accept that results may be smaller or absent
• you are not relying on it as your only approach to fast or worrying hair loss

Younger men sometimes have particular concerns about finasteride. See post-finasteride syndrome for what is and is not known about lasting concerns. Women should not assume either is suitable; their hair loss needs separate assessment. See topical finasteride for a related option some doctors discuss.

Life in Malaysia

Supplements are widely marketed in Malaysia through pharmacies, social media and direct sellers, and saw palmetto often appears in "men's health" or "DHT blocker" combination products. Friends and family may recommend these as gentler options. It is reasonable to ask questions about any product, but also reasonable to ask what evidence supports it. If you take medicines for other conditions, such as blood thinners, mention any supplement to your doctor or pharmacist. Keep track of what you take, the dose and when you started, so you can judge results later.

Common myths

• "Saw palmetto is natural finasteride." It may act on similar pathways, but in the head-to-head study it helped fewer men than finasteride.
• "Supplements have no side effects." Saw palmetto is usually well tolerated, but side effects and interactions are possible.
• "Finasteride always causes sexual problems." Sexual side effects occur in some people, not everyone.
• "If you stop finasteride, you keep the results." The NHS says hair loss usually comes back.
• "More DHT blockers means better results." Combining products on the same pathway is not proven to help.

Common mistakes

• Switching from finasteride to saw palmetto without discussing it with a doctor.
• Buying finasteride from unverified sellers.
• Taking several supplements at once, making it hard to know what helps or causes side effects.
• Judging results after a few weeks.
• Not telling the doctor about supplements when having blood tests or a PSA test.
• Ignoring low mood or other side effects.

How a doctor assesses you

A doctor can confirm whether you have male pattern hair loss or another cause, such as telogen effluvium, thyroid problems or iron deficiency. They can discuss whether finasteride is suitable, check your history of mood problems or other conditions, and advise on whether a supplement is reasonable. They can also suggest how to track progress with photos. See hair loss treatment guide and blood tests for hair loss.

Questions to ask

1. Is my hair loss male pattern hair loss?
2. Is finasteride suitable for me, and what side effects should I watch for?
3. Is saw palmetto reasonable for me, and at what dose?
4. Can I take it with my other medicines?
5. Should I combine any treatments?
6. How long should I try before judging results?
7. What should I do if I get side effects?
8. When should I come back for a review?

Bottom line

Saw palmetto and finasteride are often compared, but they are not equals. In the one two-year comparison study, finasteride helped more men than saw palmetto. Finasteride has much stronger evidence and is recommended by expert groups, but has known side effects that need monitoring. Saw palmetto appears well tolerated, but the evidence for hair loss is limited. Talk to a doctor about the cause of your hair loss and which option suits you. See finasteride for hair loss and saw palmetto and hair loss.

Frequently asked questions

Is saw palmetto as effective as finasteride?

In a two-year study of 100 men, 68% on finasteride improved compared with 38% on saw palmetto, so the evidence favours finasteride.

Is saw palmetto a natural finasteride?

It is thought to act on similar pathways, but it is a supplement with limited evidence, and products vary widely.

What dose of saw palmetto was studied?

The two-year comparison study used 320mg a day. Products sold in shops vary in extract type and dose.

What are the side effects of saw palmetto?

The NCCIH describes it as well tolerated, with mild and infrequent side effects such as digestive symptoms, dizziness and headache. It may be unsafe in pregnancy or breastfeeding.

What are the side effects of finasteride?

The NHS lists erection problems, less interest in sex and ejaculation problems as common, and low mood as rare but serious.

Can I take saw palmetto with finasteride?

There is little good evidence on combining them. Discuss with a doctor before adding a supplement.

Can women take saw palmetto or finasteride?

Finasteride is generally not recommended for women. Women with hair loss need separate assessment before trying either.

What happens if I stop finasteride?

The NHS says hair loss usually comes back if you stop. Talk to a doctor before stopping.

Educational content. Not medical advice.