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Hair loss and propecia and saw palmetto

  I have recently been taking propecia for my hair loss.  I am aware that the active ingredient in propecia is finasteride, the same ingredient in PROSCAR to treat enlarged prostates except a fifth of the amount.  There is a herbal medicine that supposed to reduce the prostate by inhibiting the action of 5-alpha reductase and preventing the formation of DHT ( the same reaction that causes hair loss) and is found in the herbal drug labelled as Saw Palmetto.  My question is that can Saw Palmetto be used to treat hair loss, and is it possible to use both Saw Palmetto and Propecia without any adverse side effects?  Thanks for your time
Dear Mikhail,
The most commonly suggested mechanism of action of Saw palmetto is inhibition of the 5 alpha-reductase mediated conversion of testosterone to dihydrotestosterone (DHT).  This action has been shown in In vitro studies (outside the body, in the lab) but not in human studies.  There is no study that shows a clinically significant drop in DHT after taking saw palmetto, which as you state is responsible for the action associated with hair growth.  Other proposed actions of saw palmetto are inhibition of the androgen receptor binding and antiestrogenic activity.  However none of these actions have been proven.
Therefore we are unable to speculate if saw palmetto can be used for hair growth.  To my knowledge this study has never been performed.  There is no stated interaction between Finasteride and saw palmetto as indicated in the PDR or package insert of Proscar or Propecia.
I would caution your use of these plant extracts due to the fact that no studies are needed to sell theses products and make claims about there function.  Many people spend a lot of money on natural treatment plans that are marketed (misrepresented) as cures.  For instance, a patient came to my clinic last week claiming that she had just finished a kidney cleanse and wanted me to repeat an x-ray before removing her stone surgically which is what she needed.  Due to the fact that she was convinced the kidney cleanse had dissolved her stone and that she had spent a lot of money, we decided reluctantly to get another film (it never hurts to identify the location of a stone before a procedure).  The stone was still present and the patient was surprised.  After the surgery which eliminated her stone, we looked at what comes with a kidney cleanse.  It was nothing more than some compounds that acidify the urine.  Yes, acidifying the urine is a treatment for infectious type stones (struvite) but these types of stones account for less than 5% of all kidney stones. A simple urine test and pH coupled with the appearance of the stone on X-ray would probably have indicated whether acidification of the urine would have any chance to work.  Nevertheless, the kidney cleanse is still marketed for all stones even though it has very little chance of being successful.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
*keyword: Saw Palmetto

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