Saw Palmetto

What is saw palmetto?

According to NCCIH, saw palmetto is a small tree 6–10 feet (about 1.8–3 m) tall, native to the West Indies and the southeastern coast of North America; its fruits have been used for health purposes. The plant’s botanical name in the Cochrane review is Serenoa repens (synonym Sabal serrulatum); the product examined in the reviews is the fruit extract of the plant. ^{[1] [2]} In Turkish it is referred to as “cüce palmiye” (dwarf palm); the Ministry of Agriculture and Forestry Plant List uses this name and the fruit part. ^[9]

Role in the body and purpose of use

Saw palmetto is not a nutrient; it has no required function or deficiency in the body. NCCIH states that the plant is marketed as a supplement for conditions such as urinary tract symptoms due to prostate enlargement (BPH), male-pattern hair loss, and chronic prostatitis/chronic pelvic pain syndrome. ^[1] The sections below address these three claims separately on the basis of controlled studies.

What is prostate enlargement (BPH)?

The Cochrane review defines benign prostatic hyperplasia (BPH) as non-malignant enlargement of the prostate; this enlargement can cause obstructive and irritative lower urinary tract symptoms. To measure symptoms, the review uses the IPSS (International Prostate Symptom Score); the scale ranges from 0 to 35 and a high score means worse symptoms. The review counts outcomes measured up to 12 months after randomization as short-term and those after 12 months as long-term. ^[2]

Does saw palmetto help urinary complaints due to prostate enlargement?

The 2023 update of the Cochrane review (Franco et al., search up to September 16, 2022) limited the question to placebo comparisons only. 27 studies (4,656 participants) were included: 19 compared saw palmetto with placebo, and 8 compared it with placebo in combination with other herbal agents. Most studies included men over 50 with moderate urinary tract symptoms (mean age range 52–68; IPSS range 8–19). Ten studies were funded by the pharmaceutical industry and two by government agencies; the rest did not state funding. ^[2]

According to the predefined sensitivity analyses limited to studies at low risk of bias, saw palmetto alone made little or no difference in urinary tract symptoms in the short term of 3–6 months (mean difference −0.90 on the IPSS 0–35 scale; 95% CI −1.74 to −0.07; 9 studies, 1,681 participants; high certainty). There was also little or no difference in quality of life (mean difference −0.20; 95% CI −0.40 to 0.00; 5 studies). In the long term of 12–17 months, there was again no difference (IPSS mean difference 0.07; 95% CI −0.75 to 0.88; 3 studies, 898 participants). There was likely no difference in adverse events (RR 1.01; 95% CI 0.77–1.31; 12 studies, 2,399 participants; moderate certainty). The authors’ conclusion: saw palmetto alone provides little or no benefit in men with urinary tract symptoms; the role of combinations with other herbs is more uncertain. ^[2] In mixtures given together with other herbs, the short-term IPSS mean difference was −2.41 (95% CI −4.54 to −0.29; 4 studies, 460 participants); the authors stated that these mixtures may make little or no difference in urinary symptoms compared with placebo and rated certainty as low; it is not possible for mixture studies to show the effect of a single component.

NCCIH reports that in both of the two NIH-supported studies included in the review (one at the standard dose, the other with doses increased up to three times the standard dose), symptoms did not improve; and that when products prepared by hexane extraction and other products were analyzed separately, there was no difference between the two groups. ^[1]

What did the CAMUS trial show?

The JAMA study by Barry and colleagues is a double-blind, placebo-controlled RCT conducted at 11 North American centers: 369 men aged 45 and over with an AUA symptom score of 8–24 received saw palmetto extract (with doses increased at weeks 24 and 48) or placebo for 72 weeks. The AUASI score fell by 2.20 points in the saw palmetto group (95% CI −3.04 to −1.36) and by 2.99 points in the placebo group (95% CI −3.81 to −2.17); the difference between groups was 0.79 points in favor of placebo. Secondary outcomes covered urinary bother, nocturia, peak urine flow, post-void residual volume, PSA, participants’ global assessment, sexual function, urinary continence, sleep quality, and prostatitis symptoms; saw palmetto was not superior to placebo in any of them, and no side effects clearly attributable to the product were detected. ^[3] An erratum was later published for the article (JAMA 2012;307:2374); the values above are from the corrected version of the PubMed abstract. The symptom score had also fallen by 2.99 points in the placebo group.

Is there evidence for hair loss and chronic prostatitis?

The systematic review by Evron and colleagues included five RCTs and two prospective cohorts examining the use of topical and oral supplements containing saw palmetto in androgenetic alopecia and telogen effluvium; the authors reported positive effects but noted that robust, high-quality data are lacking. ^[6] NCCIH, however, says that saw palmetto taken orally or applied to the scalp for hair loss has been tried in a few small studies and that the evidence is too limited to reach a conclusion. ^[1] For chronic prostatitis/chronic pelvic pain syndrome, NCCIH reports that a 2022 review of five studies found no significant benefit from the plant. ^[1]

Does saw palmetto affect prostate cancer risk or change PSA?

In the VITAL cohort (35,239 men aged 50–76 living in western Washington state; 1,602 invasive prostate cancers from registries), no association was found between saw palmetto use and prostate cancer risk; because it is an observational study, it does not show causality. ^[8] In the PSA analysis of the CAMUS data, the change was 0.23 ng/mL in the saw palmetto group and 0.16 ng/mL in the placebo group (p = 0.50); the authors report no difference from placebo even at high doses. ^[5] NCCIH also states that saw palmetto does not appear to affect PSA measurement. ^[1]

Is saw palmetto safe?

According to NCCIH, saw palmetto is well tolerated and has been used safely in research for up to 3 years; side effects are mild and rare and can include digestive symptoms, dizziness, and headache. It is noted that it may not be safe during pregnancy and breastfeeding. ^[1]

In the safety analysis of CAMUS (357 of 369 people in the modified intention-to-treat analysis; 18 months), there was no significant difference between groups in rates of serious or non-serious adverse events, vital signs, digital rectal examination findings, and dropout rates; there was generally no difference in laboratory abnormalities and no dose–response relationship was detected. The authors report that the extract used in the study showed no evidence of toxicity at up to three times the usual clinical dose over 18 months. ^[4]

At the case level, however, a case report (a 55-year-old man, intermittent saw palmetto use for about four years) describes “probable” saw palmetto-induced acute hepatitis and pancreatitis: transaminases were elevated (AST 1265, ALT 1232), improvement followed stopping the product, and recurrence occurred twice on restarting; the authors interpret this picture as a pattern strongly supporting a drug effect. The same authors note that saw palmetto has also been associated with cholestatic hepatitis. ^[7] A single case report gives no information on frequency or causality; such events have not stood out in controlled studies.

How reliable is the overall evidence?

NCCIH says that many studies have been done on urinary tract symptoms due to prostate enlargement and that there is enough information to conclude that saw palmetto is probably not helpful for this purpose; for other purposes, there is not enough evidence. ^[1] Participants in the Cochrane update were mostly men over 50 with moderate symptoms; there were long-term (12–17 months) efficacy data, but long-term adverse event data were not available for this comparison. ^[2] For herbal mixtures, certainty for quality of life was very low, and for adverse events the confidence interval covered the possibility of both marked benefit and marked harm (RR 0.91; 95% CI 0.58–1.41; 4 studies, 481 participants). ^[2]

What is the status of saw palmetto in Türkiye?

In the July 16, 2026 update of the Ministry of Agriculture and Forestry Plant List, Serenoa repens (dwarf palm, fruit) is listed as positive (P); the row contains no additional warning condition. ^[9] In the September 21, 2026 version of the Restricted Substances List for Food Supplements, dwarf palm (Serenoa repens) appears as a source in the “Free fatty acid” row; in all of the ages 4–10 and ages 11 and over columns there is a dash instead of a numerical value (published May 2, 2016). ^[10] Saw palmetto is also addressed as a food supplement within the framework of Supplement regulation in Türkiye. This guide does not recommend products or places of purchase and does not set personal doses.

Evidence table: claim, population, and limits