Saw Palmetto & 5α-Reductase

Today I was listening to Jon Gabriel talking to Dr Howard Liebowitz about hormones and the role they play in weight gain.  They had a question from a listener who has PCOS and one of her symptoms is facial hair.

I have underlined the really important parts of the transcript of the discussion relevant to Saw Palmetto and an enzyme called 5α-Reductase:


JON: Okay. So, hirsutism is facial hair for everyone that’s listening.

DR LIEBOWITZ: What she’s describing are a number of the diagnostic criteria for a condition call polycystic ovary syndrome, and the polycystic ovary syndrome is a very, very frustrating syndrome because it’s part of the syndrome that’s insulin-resistance in obesity.

And what happens is, the ovaries are making a lot of cysts and they’re not ovulating on a normal schedule. They’re not making the normal rhythmic patterns of hormones, and when the hormones are irregular like this it produces, like we were talking before, it can produce stress in the body and abnormal cortisol levels and abnormal hormone levels and all sorts of things like that.

Patients like this are very, very challenging. To me, what a lot of doctors will do for them is put them on the birth control pill and, again, what

they’re doing is just treating the symptoms and that doesn’t really correct anything, it just gets the ovaries to stop functioning. Now, sometimes women will feel better on the birth control pill and their skin might get better, but it usually doesn’t help them lose weight and it doesn’t correct the problem.

What I try to do is I actually look at the hormones and try to get their hormones balanced. Oftentimes, these women have very low estrogen and they often have high androgens which are male hormones. So they have high levels of testosterone and DHEA and they also have a high enzyme called five alpha reductase. So, in other words, they’re converting more estrogen into testosterone, and what I try to do is to balance them and get their testosterone levels down and raise their estrogen levels, and many times that helps a lot.

It depends on how -- there’s all sorts of different levels of this condition. It could be mild to severe, and I’ve seen young girls with this who don’t look abnormal at all, and I’ve seen other girls who are very overweight and have a lot of facial hair and acne and obesity.

JON: So how do you treat the -- how can you lower the testosterone level?

DR LIEBOWITZ: I often give them five alpha reductase blockers. Saw palmetto is one. Beta sitosterols will do it, too, and if it’s very severe I’ll go into the prescription like the propecia and things like that.

JON: Okay. All right. So basically what you’re saying, for people who are listening, is that their testosterone levels are too high because they’ve got an enzyme converting estrogen to testosterone; is that right?
DR LIEBOWITZ: Yeah.

JON: The five alpha reductase.

DR LIEBOWITZ: And also their ovaries are producing too much testosterone as well.

JON: Okay. All right. So what would you recommend? She’s in Belgium. What would you recommend for her to do?

DR LIEBOWITZ: Well, there’s actually a fantastic hormone doctor in Belgium that I know. A Dr. Thierry Hertoghe, H-E-R-T-O-G-H-E, and he’s in -- what’s the capital of Belgium, do you know? Brussels.

JON: Brussels, yeah.

DR LIEBOWITZ: Yeah, I think he’s in Brussels. Thierry, T-H-I-E-R-R-Y, Hertoghe. He’s absolutely a brilliant hormone specialist and he has a clinic there and he would probably be able to help her.


So, ladies, if any of you are lucky enough to live close to Belgium, look up Dr Thierry Hurtogh!

But for those of us who aren't so lucky, there are other things we can do to REDUCE the amount of 5α-Reductase enzyme.

As Dr Liebowitz says:

• 5α-Reductase enzyme converts oestrogen into testosterone
• when we are experiencing too much oestrogen in our bodies, this enzyme is converting the oestrogen into even more testosterone, which in turn stimulates excess facial hair.

What does Saw Palmetto have to do with this?

Saw Palmetto is a 5α-Reductase inhibitor, meaning that it decreases the levels of available testosterone that binds itself to the enzyme.  When the binding of the hormone to the enzyme is prevented, this reduces the amount of dihydrotestosterone (DIH - the stronger form of testosterone).

So what else can we do to reduce the amount of 5α-Reductase?

• Cutting out dairy is number one
• Drink 2 cups of spearmint tea every day