For the average balding person reading your manuscript, what would you say is the key point from your experience and report?

For patients who cannot tolerate standard, FDA-approved androgenetic alopecia medications, Serenoa repens can be an over-the-counter alternative.

Can you tell us what balding patients you consider would potentially be good candidates for this treatment approach?

Patients with hair thinning, but not complete hair loss are good candidates.

Do you believe topical or oral Serenoa would produce the best results to treat thinning or bald scalps?

There are no direct head-to-head studies comparing Serenoa extract vs FDA-approved medication. Besides, according to our study, the more concentrated Serenoa serum was used for just one month. Patients lost medium-sized and vellus hair towards the end of the study. Thus, prolonged use of Serenoa extract should be advised with caution.

Would a scalp biopsy be helpful before trying this approach to treating hair loss?

It depends on whether hair loss is typical for androgenetic alopecia or not. In general, we do not perform scalp biopsies for male-pattern hair loss unless the diagnosis is doubtful. Dermoscopy can be of benefit in certain cases.

Do you always recommend minoxidil or other adjustments to your hair loss patients?

Patient empowerment is the critical step before embarking on any treatment regimen. Patients might prefer toupees to oral medications. Some might prefer oral medications to topical ones, whereas some are at risk of side effects of 5-alpha reductase medications. Certain minoxidil preparation contains propylene glycol, which can irritate the scalp. Thus consultation prior to treatment is very important.

Would you suggest a scalp biopsy in all your alopecia patients?

No. We only perform scalp biopsies when clinically dictated, such as in cases of lichen planopilaris or scarring alopecias.

What do you think will be the next big breakthrough in hair loss and/or hair transplants?

In vitro bioengineering of hair follicles.

Do you plan a follow-up report and/or study?

Not at the moment, but we are considering a direct comparison between this medication and topical minoxidil lotion.

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