Saw Palmetto
Saw palmetto is often marketed as a “natural” supplement for hair loss and prostate symptoms, but “natural” doesn’t mean neutral. Multiple reviews describe saw palmetto extract as anti-androgenic in vitro, including inhibition of 5-alpha-reductase (the enzyme that converts testosterone to DHT) and reduced DHT binding to androgen receptors (AR) in relevant models (1). Because DHT/AR signaling plays a central role in androgen-driven hair loss, these anti-androgen effects are a plausible reason some people see benefits for hair—though results vary depending on the extract/preparation and the clinical impact in humans is less clear than the marketing suggests (2).
(1) https://www.ncbi.nlm.nih.gov/books/NBK216069/
(2) https://pmc.ncbi.nlm.nih.gov/articles/PMC7706486/
Why this matters for PFS/PSSD communities
For people dealing with PFS/PSSD/PAS, anything that meaningfully interferes with androgen signaling is often treated as a high risk potential trigger—especially when the goal is to stabilize. While many clinical trials in BPH report adverse events as generally mild on average, there are published reports of sexual side effects (including erectile dysfunction) occurring during saw palmetto use, and individual sensitivity can be very different from “average trial outcomes.”
Crash Anecdotes:
My Personal Risk Ranking:
Extreme Risk of Permanent Worsening (for PFS/PSSD/PAS):
If you currently have PFS/PSSD/PAS, this substance may carry an extreme risk of worsening symptoms—potentially in a lasting way—and is best avoided.
For those without these conditions, there are reports of a “post–saw palmetto syndrome” that can resemble PFS/PSSD/PAS although much less frequent for this over the counter supplement. Given the uncertainty and the potential severity of outcomes, the risk may not be worth the advertised benefits.