The Concern Around Hair Loss Treatments and Shedding
Starting a new treatment for hair loss can be a hopeful experience, but for some, it comes with an alarming side effect: an initial increase in hair shedding. This phenomenon, often called the 'dread shed,' is a common concern among individuals using treatments like minoxidil and finasteride. As saw palmetto gains popularity as a natural alternative for combating hair loss, many potential users ask the same critical question: does saw palmetto cause shedding?
Understanding Androgenetic Alopecia and DHT's Role
To understand how saw palmetto works, it's essential to grasp the primary cause of pattern hair loss, or androgenetic alopecia (AGA). This condition is largely driven by a genetic sensitivity to an androgen hormone called dihydrotestosterone (DHT).
The enzyme 5-alpha reductase converts testosterone into DHT. In genetically susceptible individuals, DHT binds to receptors in hair follicles, causing them to shrink in a process called miniaturization. Over time, these miniaturized follicles produce progressively shorter, thinner hairs until they eventually stop producing hair altogether. This process affects an estimated 50 million men and 30 million women in the United States.
Saw Palmetto's Mechanism of Action
Saw palmetto is a botanical extract from the berries of the Serenoa repens palm tree. Its active compounds, which include fatty acids and phytosterols like beta-sitosterol, are believed to combat hair loss primarily by inhibiting the 5-alpha reductase enzyme. By blocking this enzyme, saw palmetto reduces the conversion of testosterone to DHT, thereby lowering the levels of this follicle-shrinking hormone in the body. Studies suggest saw palmetto can reduce DHT levels by approximately 32%. Additionally, it has anti-inflammatory properties that can help improve overall scalp health.
The 'Dread Shed': Does Saw Palmetto Cause an Initial Shed?
While the direct link between saw palmetto and an initial shedding phase isn't as extensively documented as it is for minoxidil, the mechanism suggests it's possible. Effective hair loss treatments that alter the hair growth cycle can induce a temporary shedding phase known as telogen effluvium.
This 'dread shed' occurs when the treatment pushes many hair follicles from the resting (telogen) phase into the shedding (exogen) phase all at once. This makes way for new, healthier hairs to enter the growth (anagen) phase. While alarming, this increased shedding is often a sign that the treatment is working. The hairs that fall out are telogen hairs that were destined to shed anyway over the next few months; the treatment simply synchronizes and accelerates this process. This phase is temporary, typically lasting a few weeks to a few months. Because saw palmetto works to counteract the cause of AGA, it could theoretically trigger this same response as follicles are stimulated to begin a new, healthier growth cycle.
Scientific Evidence and Efficacy
Research on saw palmetto for hair loss, while more limited than for FDA-approved drugs, is promising.
- A systematic review of multiple studies found that saw palmetto use resulted in a 60% improvement in overall hair quality, a 27% increase in total hair count, and an 83.3% increase in hair density for many users.
- One study showed it stabilized disease progression in 52% of participants.
- Results generally take at least 3 to 6 months to become noticeable.
Saw Palmetto vs. Finasteride: A Comparison
Finasteride is an FDA-approved prescription medication that also works by inhibiting 5-alpha reductase. However, it is significantly more potent.
| Feature | Saw Palmetto | Finasteride |
|---|---|---|
| Mechanism | Inhibits 5-alpha reductase (Type I & II), may also block DHT receptors. | Potently inhibits 5-alpha reductase (Type II & III). |
| DHT Reduction | Modest, around 32-40%. | Significant, around 70% in serum. |
| Efficacy | A 2-year study showed a 38% increase in hair growth. | The same study showed a 68% increase in hair growth. |
| Side Effects | Generally mild; may include stomach discomfort, headache, and dizziness. | Higher potential for side effects, including sexual dysfunction and mood changes. |
| Availability | Over-the-counter supplement. | Prescription only. |
Other Potential Side Effects
Saw palmetto is generally well-tolerated. The most common side effects are mild and may include:
- Stomach discomfort, nausea, or diarrhea
- Headache
- Dizziness
- Decreased libido
It is not recommended for pregnant or breastfeeding women. As it can affect hormones, consulting a healthcare provider before use is crucial, especially for women or those on other medications.
Visit the National Center for Complementary and Integrative Health for more authoritative information on saw palmetto.
Conclusion
So, does saw palmetto cause shedding? It's possible. Like other effective hair loss treatments, saw palmetto's mechanism of restarting the hair growth cycle could lead to a temporary, initial shed. This is often a positive indicator that the treatment is stimulating follicles to produce new, healthier hair. While it is less potent than finasteride, studies show saw palmetto can improve hair count and density for many users with fewer side effects. Patience is key, as visible results typically require several months of consistent use.
