Episode #170: Saw Palmetto & PCOS: Can This Herb Help Balance Hormones?

Hi, and welcome back to the PCOS Repair Podcast, where today we get to do a supplement spotlight on saw palmetto and PCOS, and how it can be a helpful herb when it comes to hormone balance. If you’ve looked into any PCOS supplements, you’ve probably seen this one. Generally speaking, in the world of supplements, saw palmetto is something we hear about in the context of men’s prostate health because of its anti-androgen effects. But what’s fascinating is how this extract can also help women with PCOS because of our excess androgens—those male hormones like testosterone that tend to run high and cause symptoms like acne, hair thinning, and unwanted hair growth, whether that’s body or facial hair. These symptoms are directly related to testosterone. So, if you struggle with any of those symptoms, you may be interested in saw palmetto.

Let’s dive in and learn more about it. Saw palmetto is a type of palm native to the Southeastern U.S., and its berries have been used for centuries in traditional medicine. Today, it’s mostly known, like I mentioned, for men’s prostate health because it has anti-androgenic properties. Basically, it reduces the production of male hormones like testosterone, and that’s exactly why it has become a supplement of interest for women with PCOS.

It’s not one of the mainstream ones, but it becomes more relevant when you’ve addressed your root cause health—you’re managing your nutrition and exercise, and your basic hormone balance is mostly covered—but you’re still struggling with things like acne, hair growth, or hair loss. If those are problematic for you, this can be a good option.

Now, I do want to address a common question. Last week’s episode touched on testosterone being a big player in LH and why women with PCOS have a hard time ovulating regularly. Saw palmetto, although helpful in lowering testosterone, is not my go-to recommendation when trying to regulate your cycle—primarily because it’s not recommended during pregnancy. It messes with hormones, so if I’m recommending something for fertility, I prefer supplements that are safe even during that two-week wait when you might or might not be pregnant. That’s why saw palmetto may not be the best choice for fertility-focused support. But for high testosterone symptoms, it’s worth discussing with your healthcare provider.

It’s important to understand that saw palmetto doesn’t just block testosterone outright. Instead, it primarily inhibits the enzyme 5-alpha-reductase, which converts testosterone into a stronger form called dihydrotestosterone, or DHT. DHT is really the big troublemaker when it comes to hair loss, oily skin, acne, and excessive hair growth on the body or face—those classic signs of excess androgens in PCOS. Saw palmetto helps block that conversion.

Women with PCOS experience varying degrees of elevated androgens. Some don’t struggle much with this, so you may not see signs like hair loss, excess hair growth, or acne. But whether your labs show elevated levels or not, you may still be showing symptoms. I always recommend following your symptoms more than your lab work.

With hormones, the acceptable range from person to person is very wide, but your body’s ideal range is actually very narrow. That makes lab interpretation tricky. When I order labs, I use them to get a baseline, but I’m more interested in correlating the symptoms with the lab values. I’ll often document exactly what the person is experiencing alongside the numbers because your body might feel like testosterone is high even if it’s in the mid-to-high lab range. If we lowered it just slightly, your body might feel significantly better—even if it’s still technically within the normal range.

So, where saw palmetto comes in is by helping reduce that conversion of testosterone into DHT. It can soften those high androgen symptoms without drastically lowering your hormone levels. Hormones are very sensitive—just a little too much or a little too little, and we feel the effects. Sometimes, an herb can be a gentler approach than medication.

It’s actually hard to find medications that lower testosterone. Metformin can help indirectly by reducing insulin resistance, which then reduces testosterone, but that can be fairly strong. Saw palmetto can be a good supplemental addition when you’re doing everything else right dietarily, but still struggling.

As with all lifestyle and supplementation strategies, results don’t happen overnight—and saw palmetto is not a cure-all. It won’t override a poor diet. So, of course, supplements need to be layered on top of a healthy lifestyle. That’s our main focus. But sometimes, we need a little extra help. You don’t have to wait until a certain point in your journey—you can add it in at any time—but always remember, supplements support your lifestyle. They don’t replace it.

So, who should consider talking to their healthcare provider about adding saw palmetto? As we discussed, it’s great for symptoms like excess body hair, thinning hair, and hormonal acne. Hormonal acne is typically deep, painful, lasts several weeks, and follows the jawline. Also, if your labs show elevated DHT or testosterone, it’s a good one to bring up with your provider—someone who understands PCOS and your root causes.

Again, saw palmetto is not ideal if you’re trying to get pregnant, and it’s not considered safe during pregnancy.

As for dosage and safety, saw palmetto typically comes in either capsules or soft gels, and the recommended dosing is between 160 mg and 320 mg per day. So what should you start with? I suggest starting with the lower dose—160 mg. You’re not going to see results right away, but it lets you monitor for any side effects like upset stomach, rashes, or anything unusual. Then you can try increasing to the higher dose if your body tolerates it well.

Make sure you know exactly what you’re trying to improve. Are you targeting acne, hair loss, or body hair? Those symptoms take time to improve—acne takes about three months, and hair loss closer to six. For body hair, you may notice it grows back slower, but it won’t kill existing hair follicles. So, if you’ve had laser hair removal, saw palmetto can help maintain lower testosterone levels so new hairs aren’t triggered.

If you’re already at the 320 mg dose and want more androgen-lowering effects, you can consider adding supplements like zinc and Ovasitol. And of course, continue focusing on diet and stress management, both of which are critical for lowering testosterone.

I hope this gives you a good starting point—what to take, how much to take—but remember, consistency matters. Track your symptoms, take pictures when possible, note your starting point, and stick with it for several months before evaluating progress.

A few side effects to watch for: headaches, digestive upset, and mild dizziness have been reported, with digestive upset being the most common. Taking it on an empty stomach is more likely to cause nausea or even vomiting for some people. That doesn’t mean it’s a true side effect—it may just mean it’s best to take it with food. Some people may have an upset stomach regardless, but usually these symptoms go away with time. Starting at a lower dose and slowly increasing over two weeks to a month can help ease into it.

As we wrap up today’s episode, I hope you found it helpful to learn about an herb that can reduce the impact of high androgens in PCOS. It’s a more natural option that may assist you in addition to your healthy lifestyle—your nutrition, stress management, and everything else you’re working on.

Supplements are just one piece of the puzzle. Saw palmetto may be a great option for certain symptoms. If you’re interested in learning more, I invite you to grab a copy of my free PCOS Supplement Guide. It walks you through which brands I recommend. Not all supplement brands are reputable, but the ones on my Fullscript dispenser are carefully selected, and Fullscript itself only supplies high-quality brands. Plus, you get a 20% discount as one of my amazing listeners.

I hope you found today’s episode helpful. If so, make sure you hit that subscribe button so you get notified each week when a new episode becomes available. And until next time, bye for now.