By Scott Blaine Hoffman, founder of Regenepure and Regrowth.com · 30+ years in the hair-loss field · Published November 2026
If you shop for an "anti-DHT" or hair-loss shampoo, two ingredients come up again and again: ketoconazole and saw palmetto. People often ask me which one is better. The honest answer is that they do different jobs, the evidence for each is stronger in some areas than others, and neither replaces a proven hair-loss treatment.
Quick answer
- Ketoconazole has the stronger evidence in a shampoo. It is a proven antifungal for dandruff and seborrheic dermatitis, and small studies suggest a modest benefit for pattern hair loss.
- Saw palmetto is a plant extract studied mostly as an oral supplement or leave-on lotion. Evidence for it in a rinse-off shampoo is limited.
- They are not either/or. Many scalp shampoos, including ours, combine them.
- For real DHT reduction, talk to a doctor about prescription options. No shampoo does that reliably.
Side-by-side
| Ketoconazole | Saw palmetto | |
|---|---|---|
| What it is | Antifungal medicine (OTC 1%, Rx 2%) | Extract from the berries of Serenoa repens |
| Proven job | Controls dandruff and seborrheic dermatitis | No established scalp indication |
| Hair-loss evidence | Small studies of 2% shampoo show modest density improvement | Small, mostly supplement or lotion studies; mixed quality |
| Proposed DHT link | Possible local anti-androgen effect, not proven in humans | May weakly inhibit 5-alpha reductase in lab studies |
| Best for | Flaky, itchy or oily scalp plus thinning | People wanting a botanical ingredient in their routine |
Ketoconazole: the better-studied option
Ketoconazole's main job is controlling Malassezia, the scalp yeast behind dandruff and seborrheic dermatitis. A calmer scalp can mean less shedding. The best-known hair-loss study found men using 2% ketoconazole shampoo for six months had improved hair density compared with an unmedicated shampoo (Piérard-Franchimont et al., 1998). A 2020 systematic review concluded it shows promise for pattern hair loss but called for larger trials (Fields et al., 2020). My full breakdown is in Ketoconazole Shampoo for Hair Loss.
Saw palmetto: promising but thin evidence
Saw palmetto is believed to weakly inhibit 5-alpha reductase, the enzyme that makes DHT. A 2020 systematic review found 5 randomized trials and 2 cohort studies and concluded that saw palmetto may offer a modest benefit, but that robust, high-quality evidence is lacking (Evron et al., Skin Appendage Disorders, 2020). In the only head-to-head trial in that review, oral saw palmetto did less well than finasteride.
The topical evidence is even smaller. One uncontrolled study of 50 men using a leave-on saw palmetto lotion and serum for 24 weeks reported increases in total and terminal hair counts (Wessagowit et al., 2016), but without a control group it is hard to know how much was due to saw palmetto, and leave-on products stay on the scalp far longer than shampoo. More detail is in Saw Palmetto for Hair Loss.
Why contact time matters
A shampoo is on your scalp for a few minutes, then rinsed away. That is one reason ingredients that look promising in pills or leave-on lotions may do less in a shampoo. Whatever you use, massage it into the scalp and leave it on for a few minutes before rinsing.
So which should you choose?
- Flaking, itching, redness or an oily scalp? Ketoconazole first. It has a proven job to do.
- Healthy, calm scalp and genetic thinning? Either is a reasonable support ingredient, but put your effort into a proven treatment such as topical minoxidil, and talk to a doctor about DHT-reducing medicine.
- Want both? Combination shampoos give you ketoconazole's scalp benefits plus saw palmetto in one step.
That combination approach is how I built Regenepure DR: ketoconazole with saw palmetto, caffeine, niacin, vitamin B6 and zinc in a sulfate-free base. For people who also use minoxidil, the Regrowth Combo for Him pairs DR with our 5% Minoxidil Spray for Men. If you're weighing DR against a drugstore option, see Regenepure DR vs Nizoral.
Frequently asked questions
Is ketoconazole or saw palmetto better for hair loss?
In shampoo form, ketoconazole has stronger evidence and a proven scalp benefit. Saw palmetto's evidence is mostly from supplements and lotions and is limited.
Do saw palmetto shampoos block DHT?
There is no good evidence that a rinse-off saw palmetto shampoo meaningfully lowers scalp DHT. See DHT Blocking Shampoo: Does It Work?
Can I use ketoconazole and saw palmetto together?
Yes. They are commonly combined in scalp shampoos.
Should women use these shampoos?
Women can use ketoconazole shampoo for scalp care. Women who are pregnant, trying to conceive or breastfeeding should ask a doctor before using saw palmetto products, because of its possible hormonal effects.
Sources
- Piérard-Franchimont C et al. Ketoconazole shampoo: effect of long-term use in androgenic alopecia. Dermatology, 1998.
- Fields JR et al. Topical ketoconazole for the treatment of androgenetic alopecia: a systematic review. Dermatologic Therapy, 2020.
- Evron E et al. Natural hair supplement: friend or foe? Saw palmetto, a systematic review in alopecia. Skin Appendage Disorders, 2020.
- Wessagowit V et al. Treatment of male androgenetic alopecia with topical products containing Serenoa repens extract. Australas J Dermatol, 2016.
Educational content only, not medical advice. Talk to a doctor or dermatologist about diagnosis and treatment of hair loss.
