4/26/2021 "Follically Challenged": Research Finds Link Between Hair Loss Drug Finasteride and DepressionFor many people, as they age, hair loss can be a pressing — at times upsetting — concern. Androgenetic alopecia is the most common cause, which is experienced by more than 50 percent of people over age 50, according to the U.S. National Library of Medicine. There are countless over-the-counter and prescription treatments for hair loss. Still, one popular anti-baldness drug, in particular, has generated controversy over recent reports that tie it to the incidence of depression — including suicidal ideation — and other negative health effects among users. The headlines concerning these reports offer a reminder to those seeking anti-baldness treatments to consult their doctors about any new medication they might be considering. Concerning Findings The drug in question is finasteride, which is sold under the brand name Propecia. Due to an investigation by Reuters, unsealed court documents and records reveal that U.S. regulators and drug manufacturer Merck were aware of reports of suicidal behavior among users of the drug. They failed to include information of these potential risks in a 2011 update of the drug’s warning label. Reuters revealed that since that call over whether that information be included on the warning label, the Food and Drug Administration (FDA) received more than 700 reports of suicidal thoughts and deaths by suicide among those using Propecia or its off-brand generic versions. That number included at least 100 deaths. The news agency reports that within the first 14 years of Propecia sales, the FDA received 34 of these reports, which include those of 10 deaths. They report that an internal company assessment shows that in 2009, Merck itself received 200 reports of depression — including suicidal ideation — among male users. It was determined there wasn’t a high enough number of reports or enough specifics about cases of suicidal behavior and depression to require more than what was deemed regular monitoring of this data. It’s not the only worrying data around this medication. A studyTrusted Source published in 2020 showed that reports of anxiety, depression and suicidal thoughts among young men 45 or younger who used this drug increased significantly in the years since 2012. That information was derived from a World Health Organization (WHO) database of drug safety reports from more than 150 nations, mirroring a 2015 study that looked at cases of sexual dysfunction and suicidal thoughts among people ages 18 to 45. For its part, Merck said that “the scientific evidence does not support a causal link between Propecia and suicide or suicidal ideation and these terms should not be included in the labeling,” in a statement released to Reuters regarding the latest report. “Merck works continuously with regulators to ensure that potential safety signals are carefully analyzed and, if appropriate, included in the label for Propecia,” the statement reads. The FDA issued its own statement, asserting that it “continues to monitor postmarketing safety data for Propecia.” The agency added that these kinds of reports do not “mean the drug caused the adverse event” and that related medical problems can be due to the “underlying disease being treated, caused by some other drug being taken concurrently, or occurred for other reasons. What to ask your doctor before going on Propecia Given Propecia, and other drugs like it are so commonly used, how concerned should you be if you’re seeking hair loss treatment? “Patients should keep in mind that Propecia, or finasteride, is a very effective medication for most patients with male pattern hair loss, androgenetic alopecia, and that most people will feel better taking it because it is helping their hair loss,” said Dr. Carolyn Goh, associate clinical professor of dermatology at the David Geffen School of Medicine at UCLA. Goh added that people pursuing this medication “should be aware of their mood while taking it” and look to “alternatives if they have a history of depression or other mental health problems.” Dr. Barney Kenet, a New York City-based board-certified dermatologist, echoed those thoughts that if someone had a pre-existing mental illness, “it would be of concern that Propecia would unmask or exacerbate some mental health conditions symptoms.” “There is also a low incidence of sexual side effects — low libido and erectile dysfunction — and for those reasons, it’s important that they have a good working relationship with their doctor,” Kenet told Healthline. Despite the recent negative stories about the medication, a quick social media search finds direct-to-consumer companies such as Hims and Roman Health regularly touting the drug. When asked whether she felt this is a drug that should be highlighted right now, Goh told Healthline that it should be made clear that it is “generally a safe and effective drug.” “Direct-to-consumer companies have the benefit of making effective drugs more widely available, which is great, but perhaps discretion is advisable in this situation,” Goh added. Kenet said that when you offer these medications to a wide audience through these kinds of channels, some customers who are at higher risk for negative side effects might not be getting all the information they need from a “glorified mail-order company.” Both doctors said that, as with any medication, consult a doctor and medical team. Research the medication and review with a doctor or medical team to discuss any underlying medical conditions to ensure appropriate treatment. What else is out there? If you have a history of depression or other forms of mental illness, what are alternatives if the reports about Propecia are a concern? Goh suggested topical minoxidil, an FDA-approved treatment for baldness. Topical minoxidil is also FDA approved for this kind of baldness, while it might not be as effective as finasteride, she added. “Low dose oral minoxidil can be prescribed and may be a reasonable alternative. Topical finasteride can also be specially compounded and prescribed,” Goh said. She cited studies in a 2018 reviewTrusted Source that show there “may be some benefit and safety” in topical finasteride, but “the studies are not rigorous and there is no commercially available formulation of it to know if it would be consistently helpful.” “The laser comb, band, or cap — low-level laser therapy — is another option but tends to work less effectively. Platelet-rich plasma therapy with or without microneedling are other options as well,” Goh added. Kenet also cited low-dose systemic minoxidil, but he stressed that this needs to be under the direct care of a doctor. “There are weaves, toupees, and hair transplantation that are non-pharmaceutical,” Kenet added. Hair loss and mental health Underlying this discussion of safety around Propecia is the impact hair loss can have on one’s mental health. It can be distressing and sudden. It also must be stressed that it impacts both men and women. Estimates show that more than 50 percent of women will experience noticeable hair loss by age 50 and that female-pattern hair loss affects about 30 million women in the United States. Essentially, for all people, it can take a psychological toll, especially those with underlying mental health conditions. Whether compounded by the medication a person takes or not, what can one do to manage stress tied to balding? Kenet said that “baldness is a big part of our culture, from movie stars to athletes.” He said that while there is less shame attached to it now and that it doesn’t bear the stigma it had in the past, “it still can be quite traumatizing.” Kenet recommends support groups like the digital platform “Patients Like Me” as well as the “The Bald Truth,” a radio show that is all things hair loss. Goh highly recommends seeking help from a mental health professional. “Online forums can be very helpful and are easily accessible, but they may not be moderated, so should be approached with caution,” Goh explained. “Many people may be hesitant to discuss with family and friends, but they may be surprised by how many people have experienced similar situations, so could be a good source of support.” From Healthline
An article I shared with you a while back on balding and hair loss caught the attention of Kayla from Tuck, an organization devoted to promoting sleep health awareness. They recently discovered that by the age of fifty, 50% of men and 40% of women will experience androgenetic alopecia. They put a very comprehensive report together examining the connection between sleep and hair health and asked if I would share it with you. Of course I said yes. Here are a few take-aways from their report:
Below is the link to their full report on... Can Sleeping Better Slow Down Hair Loss?
By the age of fifty, 50% of men and 40% of women will experience androgenetic alopecia (male and female-pattern hair loss), while many others every year suffer from some other form of hair loss. The emotional toll is enough to make some people want to do nothing but hide in bed. As it turns out, there might be something to that: hair loss and sleep are connected on multiple levels. From the impact of sleep apnea to the role of circadian cycles, there is much to learn from the relationship between hair loss (particularly androgenetic alopecia) and sleep. We’ve put together the article below to explain hair loss, illuminate the relationship between hair loss and sleep, and inform you of your options in treating both hair loss and sleep dysfunction. Keep reading to learn more 10 facts that’ll change how you consume it. Can we all agree we’ve hit max CBD hysteria? With CBD markets and thousands of sites and products, there’s nearly just as much misinformation as there are facts. The hemp-derived oil is 100 percent federally legal and powerful, but there are a lot of misnomers out there too. We sat down with the new cool kids on the cannabis block, David Weiner and Verena von Pfetten, the founders of weed-positive media and product brand Gossamer. Both knowledgeable experts, they myth-busted everything from dosing to legality—buckle up, because there are a lot of concepts to clear up.
CBD Is Cool and All, But It Has Limits “CBD products do a lot of things and help a lot of cannabinoids do their specialties, but it isn’t actually a stand-alone,” says von Pfetten. While CBD is getting all the buzz right now, the other 80-plus cannabinoids in the cannabis plant are pretty undiscovered. “But there is a real opportunity for people to create these products that have very specific effects,” she says. In the next few years, look for the market to explode with products that not only feature but showcase things like CBN and terpenes. “CBD is not a myth or hoax, but it’s also not a cure-all,” says von Pfetten. “It’s a basis for all these other layers that could be incredibly promising and exciting.” CBD Is Not for Sleep We’ve said it once and we’ll say it a thousand times: CBD is not a sedative to be taken for sleep. It will help with things that might be keeping you awake though, like pain or anxiety, says von Pfetten, but it will not lull you into a deep snooze. It’s sister, CBN, is a sedative, though, and a powerful one at that. “However, it doesn’t work on its own. It needs to be taken with CBD in order to be effective,” she says. So while CBD is not the main ingredient in CBN sleep aids, it is a vital ingredient to make the product actually work better. It Probably Has THC in It Most users and non-users don’t realize that the full-spectrum classification means that it has the (admittedly small) legally allowed amount of THC in it (which is .3 percent). “It is a federally legal product and it will not make you feel high, but it does have THC in it,” says Verena. And Potentially More THC Than Legal That bottle of CBD? It can kind of say whatever it wants to say because, technically, there isn’t much oversight. It’s now under the FDA’s department to test and verify products, but testing is infrequent. The Gossamer duo and their labs have independently tested a number of products directly off the shelves and “some of them are crazy,” says Weiner. “Not only do some not have CBD in them, but some of them have much higher doses of THC than are legal.” Why? This is a plant-derived product, so each and every batch is going to have its own variations and differences. For Gossamer’s own CBN product Dusk, each round is slightly different than the next, and that’s exactly why they test every batch independently. “Think about how hard this is when you are mass-producing CBD edibles, chocolates, or caramels,” says Weiner. “To get between that very specific concentration in every single chocolate, if you didn’t get it right, you’d have to dump an entire batch.” There is natural deviation in plants, so it’s impossible to claim each batch is exactly the same in potency and amounts. Dosing Is Personal CBD, and all things cannabis, affects every person differently. “Everyone has a different reaction to so many things, from caffeine to salt to alcohol to food to antibiotics,” says Weiner. “We think of CBD as this cure-all, this one-size-fits-all solution, but it’s not.” With a plant-based product, there’s no guarantee, so consumers have to educate themselves on personal percentages and dosing. You Already Produce CBD—Yep, Really “There is not enough discussion about what actually happens when you consume it,” says von Pfetten. “Your body naturally produces small amounts of CBD on its own.” That’s why our bodies interact so well with cannabis oil. “There are cannabinoids that we produce and there are cannabinoids that we get from plants and outside sources,” she says. You have an endocannabinoid system (all vertebrae do) with specific receptors that react exclusively to cannabinoids. CBD binds to those receptors and helps to regulate and maintain homeostasis. “All of that is happening in your body when you take CBD,” she says. Terpenes Are the Future “Terpenes are going to be the thing in the next two years,” Weiner says. You probably don’t even know it, but terpenes are actually in a lot of the products you already use. “They’re in perfumes, skincare, candles, and medicine already,” says von Pfetten. They are bountiful in the cannabis plant; we have much further research and studies conducted on the efficacy of terpenes than other elements of the plant. “Each terpene has their own effects that we can gain benefits from,” says Weiner. For Dusk, they chose terpenes that have a sedative or calming effect so they complement the CBN and CBD to work together to promote better sleep. But there are energizing terpenes and beyond too. “People understand what CBD is now, and it’s basically a base,” says Weiner. “Now, we can take the conversation one step further, like adding CBN. And then we can take the conversation even one step further and lay in terpenes, and that’s where you start to get wildly specific effects. As consumer knowledge grows, so do the products.” Organic is Not Possible “In 99 percent of cases that have that organic stamp on the bottle, it is fake—they just put it on,” says von Pfetten. That’s because it’s incredibly difficult to become certified organic in hemp and extraction processes. “It’s not that they aren’t organic, but the actual certification process requirements are very, very high,” she says. The farm that creates Dusk is organic, but it cannot put that claim on the bottle because legally it’s nearly impossible. “Your space might be organic, but one or two farms over is not, and those heavy metals pesticides can end up in the soil and your product as well,” she says. “You want consumers to be wary, but people in the [market] space are taking advantage of the consumer and muddying the waters.” That’s not to say what you’re consuming isn’t safe. A quality brand will test each batch a minimum of three times to ensure safety. “You test it at harvest, distillation, and right again before it goes into the bottle,” says von Pfetten. “The reason you test it those three times is to ensure you don’t have any runoff pesticides from nearby farms.” You Can Be Price-Agnostic CBD on its own is not a particularly expensive item, yet you’ll see a product for $10 and the same size bottle from a different brand for $110. What gives? “What they are doing with it, where they source it, terpenes, the formulations, the packaging, the cannabinoids, their willingness to dump a batch—there is a reason for different price points,” says von Pfetten. “CBD itself is not super cheap, but it’s also not insanely expensive, so at a certain point, you are absolutely paying for marketing,” she says. The main thing to ask yourself is “Does the product work for you?” “If it does, that’s all that matters,” says Weiner. But they suggest checking your product’s certificate of authenticity (COA) for your specific batch to verify what you’re consuming. But what you’re comfortable paying for is totally up to you. How You Consume It Matters—a Lot The effectiveness of CBD is based on how you consume it. “The number one most effective way is to vape it,” says von Pfetten. “The second most effective way is a sublingual tincture, meaning absorbing under your tongue—not swallowing it.” That means actually holding it under your tongue for 30, 60, or even 90 seconds to try to absorb as much as you can sublingually. The number one least effective way to consume CBD? Eating it. “You lose up to 70 percent of the active cannabinoids,” she says. So if you’re eating a 10 milligram gumdrop: you firstly have to hope it actually has 10 milligrams in it, which you don’t have any guarantee of at this point, and secondly, you’re losing 70 percent of it, so you’re maybe getting three percent at most, and that was only if it had 10 milligrams in the first place. “That’s why we stand behind tinctures at this point,” says von Pfetten. “Sure, vaping, but a lot of people are just reluctant to vape something at this point, and that we can understand.” The Gossamer duo isn’t over CBD though. Every day they get emails and notes from users of their CBN/CBD tincture, saying how much it’s helped them. “What we’re over is the gimmicks,” says Weiner. “CBD in coffee, etc.—the overpromising.” This information is from Domino You may recall from chemistry class the term “half-life”—the time it takes for an element to decay by half its original value. While often utilized in nuclear physics to describe the decay of radioactive atoms, the concept also applies to the metabolization of substances by biological processes in the human body. Alcohol, prescription medications, metals, and even water have biological half-lives and deteriorate at different rates.
In this blog post, we’ll address the following:
So, How Long Does CBD Stay in Your System? CBD is no different. It decays like all other compounds, but that rate of decay varies depending on many factors. A 2014 study titled Cannabidiol: Promise and Pitfalls concluded that the half-life of orally-administered CBD was about 1 to 2 days. In other words, if you were to take 40 mg of CBD, only 20 mg would remain after 1 to 2 days. As noted in a 2012 study, CBD half-life changes based on the method of consumption:
A general rule of thumb in pharmacokinetics, which studies how drugs move throughout the body, is that it takes 4 – 5 half-lives for a drug to be effectively eliminated. The point at which the intake of a drug is at equilibrium with its elimination is known as its “steady state.” In keeping with the previous example, if the half-life of CBD is assumed to be 1 to 2 days, then it would take anywhere between 4 to 10 days for any given dosage of CBD to reach this steady state. What Factors Contribute to How Long CBD Stays in Your System? It’s important to note that these are merely ballpark estimates, and that multiple other factors contribute to varying rates of CBD decay, including:
Because of this, it can be very difficult to assess exactly how long CBD lingers in the body, and at what concentrations. CBD is fat-soluble and can build up and store in fat cells for quite a while, especially in daily and high-BMI users. Those who live very active lifestyles, on the other hand, will most likely metabolize CBD at a faster rate than even a moderately active person. Likewise, all other things being equal, a younger person will naturally metabolize CBD faster than someone much older. Does Frequency of Use Change How Long CBD Stays in the System? Arguably, the most crucial factor when it comes to drug elimination is the frequency of use. How much and how often someone uses a substance will have a major and perhaps the most significant effect on how long it takes for that substance—be it CBD or any other drug—to dissipate completely. Unfortunately, there is no single definitive answer to the question of how long CBD stays in your system; there are just too many different contributing factors. But it’s also essential to address the reasoning behind such an inquiry. Too often, it’s a question pitched by CBD enthusiasts who are worried about testing positive for THC in a drug test as a result of their CBD use, although this is exceptionally rare (as discussed in a separate blog post). As the market for CBD continues to expand, so will the need for additional clinical trials and other scientific testing. In due time, we may yet gain more detailed insight into the effects—and duration—of CBD in the body. This information is from Zatural |
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