Homeopathy: Evidence So Tiny That It’s Not there?

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The 10almonds Team

Homeopathy: Evidence So Tiny That It’s Not There?

Yesterday, we asked you your opinions on homeopathy. The sample size of responses was a little lower than we usually get, but of those who did reply, there was a clear trend:

  • A lot of enthusiasm for “Homeopathy works on valid principles and is effective”
  • Near equal support for “It may help some people as a complementary therapy”
  • Very few people voted for “Science doesn’t know how it works, but it works”; this is probably because people who considered voting for this, voted for the more flexible “It may help some people as a complementary therapy” instead.
  • Very few people considered it a dangerous scam and a pseudoscience.

So, what does the science say?

Well, let us start our investigation by checking out the position of the UK’s National Health Service, an organization with a strong focus on providing the least expensive treatments that are effective.

Since homeopathy is very inexpensive to arrange, they will surely want to put it atop their list of treatments, right?

❝Homeopathy is a “treatment” based on the use of highly diluted substances, which practitioners claim can cause the body to heal itself.

There’s been extensive investigation of the effectiveness of homeopathy. There’s no good-quality evidence that homeopathy is effective as a treatment for any health condition.❞

The NHS actually has a lot more to say about that, and you can read their full statement here.

But that’s just one institution. Here’s what Australia’s National Health and Medical Research Council had to say:

❝There was no reliable evidence from research in humans that homeopathy was effective for treating the range of health conditions considered: no good-quality, well-designed studies with enough participants for a meaningful result reported either that homeopathy caused greater health improvements than placebo, or caused health improvements equal to those of another treatment❞

You can read their full statement here.

The American FDA, meanwhile, have a stronger statement:

❝Homeopathic drug products are made from a wide range of substances, including ingredients derived from plants, healthy or diseased animal or human sources, minerals and chemicals, including known poisons. These products have the potential to cause significant and even permanent harm if they are poorly manufactured, since that could lead to contaminated products or products that have potentially toxic ingredients at higher levels than are labeled and/or safe, or if they are marketed as substitute treatments for serious or life-threatening diseases and conditions, or to vulnerable populations.❞

You can read their full statement here.

Homeopathy is a dangerous scam and a pseudoscience: True or False?

False and True, respectively, mostly.

That may be a confusing answer, so let’s elaborate:

  • Is it dangerous? Mostly not; it’s mostly just water. However, two possibilities for harm exist:
    • Careless preparation could result in a harmful ingredient still being present in the water—and because of the “like cures like” principle, many of the ingredients used in homeopathy are harmful, ranging from heavy metals to plant-based neurotoxins. However, the process of “ultra-dilution” usually removes these so thoroughly that they are absent or otherwise scientifically undetectable.
    • Placebo treatment has its place, but could result in “real” treatment going undelivered. This can cause harm if the “real” treatment was critically needed, especially if it was needed on a short timescale.
  • Is it a scam? Probably mostly not; to be a scam requires malintent. Most practitioners probably believe in what they are practising.
  • Is it a pseudoscience? With the exception that placebo effect has been highly studied and is a very valid complementary therapy… Yes, aside from that it is a pseudoscience. There is no scientific evidence to support homeopathy’s “like cures like” principle, and there is no scientific evidence to support homeopathy’s “water memory” idea. On the contrary, they go against the commonly understood physics of our world.

It may help some people as a complementary therapy: True or False?

True! Not only is placebo effect very well-studied, but best of all, it can still work as a placebo even if you know that you’re taking a placebo… Provided you also believe that!

Science doesn’t know how it works, but it works: True or False?

False, simply. At best, it performs as a placebo.

Placebo is most effective when it’s a remedy against subjective symptoms, like pain.

However, psychosomatic effect (the effect that our brain has on the rest of our body, to which it is very well-connected) can mean that placebo can also help against objective symptoms, like inflammation.

After all, our body, directed primarily by the brain, can “decide” what immunological defenses to deploy or hold back, for example. This is why placebo can help with conditions as diverse as arthritis (an inflammatory condition) or diabetes (an autoimmune condition, and/or a metabolic condition, depending on type).

Here’s how homeopathy measures up, for those conditions:

(the short answer is “no better than placebo”)

Homeopathy works on valid principles and is effective: True or False?

False, except insofar as placebo is a valid principle and can be effective.

The stated principles of homeopathy—”like cures like” and “water memory”—have no scientific basis.

We’d love to show the science for this, but we cannot prove a negative.

However, the ideas were conceived in 1796, and are tantamount to alchemy. A good scientific attitude means being open-minded to new ideas and testing them. In homeopathy’s case, this has been done, extensively, and more than 200 years of testing later, homeopathy has consistently performed equal to placebo.

In summary…

  • If you’re enjoying homeopathic treatment and that’s working for you, great, keep at it.
  • If you’re open-minded to enjoying a placebo treatment that may benefit you, be careful, but don’t let us stop you.
  • If your condition is serious, please do not delay seeking evidence-based medical treatment.

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  • Ear Candling: Is It Safe & Does It Work?

    The 10almonds Team

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Does This Practice Really Hold A Candle To Evidence-Based Medicine?

    In Tuesday’s newsletter, we asked you your opinion of ear candling, and got the above-depicted, below-described set of responses:

    • Exactly 50% said “Under no circumstances should you put things in your ear and set fire to them”
    • About 38% said “It is a safe, drug-free way to keep the ears free from earwax and pathogens”
    • About 13% said “Done correctly, thermal-auricular therapy is harmless and potentially beneficial”

    This means that if we add the two positive-to-candling answers together, it’s a perfect 50:50 split between “do it” and “don’t do it”.

    (Yes, 38%+13%=51%, but that’s because we round to the nearest integer in these reports, and more precisely it was 37.5% and 12.5%)

    So, with the vote split, what does the science say?

    First, a quick bit of background: nobody seems keen to admit to having invented this. One of the major manufacturers of ear candles refers to them as “Hopi” candles, which the actual Hopi tribe has spent a long time asking them not to do, as it is not and never has been used by the Hopi people. Other proposed origins offered by advocates of ear candling include Traditional Chinese Medicine (not used), Ancient Egypt (no evidence of such whatsoever), and Atlantis:

    Quackwatch | Why Ear Candling Is Not A Good Idea

    It is a safe, drug-free way to keep the ears free from earwax and pathogens: True or False?

    False! In a lot of cases of alternative therapy claims, there’s an absence of evidence that doesn’t necessarily disprove the treatment. In this case, however, it’s not even an open matter; its claims have been actively disproven by experimentation:

    In a medium-sized survey (n=122), the following injuries were reported:

    • 13 x burns
    • 7 x occlusion of the ear canal
    • 6 x temporary hearing loss
    • 3 x otitis externa (this also called “swimmer’s ear”, and is an inflammation of the ear, accompanied by pain and swelling)
    • 1 x tympanic membrane perforation

    Indeed, authors of one paper concluded:

    ❝Ear candling appears to be popular and is heavily advertised with claims that could seem scientific to lay people. However, its claimed mechanism of action has not been verified, no positive clinical effect has been reliably recorded, and it is associated with considerable risk.

    No evidence suggests that ear candling is an effective treatment for any condition. On this basis, we believe it can do more harm than good and we recommend that GPs discourage its use❞

    ~ Dr. Joy Rafferty et al.

    Source: Canadian Family Physician | Ear Candling

    Under no circumstances should you put things in your ear and set fire to them: True or False?

    True! It’s generally considered good advice to not put objects in general in your ears.

    Inserting flaming objects is a definite no-no. Please leave that for the Cirque du Soleil.

    You may be thinking, “but I have done this and suffered no ill effects”, which seems reasonable, but is an example of survivorship bias in action—it doesn’t make the thing in question any safer, it just means you were one of the one of the ones who got away unscathed.

    If you’re wondering what to do instead… Ear oils can help with the removal of earwax (if you don’t want to go get it sucked out at a clinic—the industry standard is to use a suction device, which actually does what ear candles claim to do). For information on safely getting rid of earwax, see our previous article:

    Ear Today, Gone Tomorrow

    Take care!

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  • How Are You?

    The 10almonds Team

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Answering The Most Difficult Question: How Are You?

    Today’s feature is aimed at helping mainly two kinds of people:

    • “I have so many emotions that I don’t always know what to do with them”
    • “What is an emotion, really? I think I felt one some time ago”

    So, if either those describe you and/or a loved one, read on…

    Alexithymia

    Alexi who? Alexithymia is an umbrella term for various kinds of problems with feeling emotions.

    That could be “problems feeling emotions” as in “I am unable to feel emotions” or “problems feeling emotions” as in “feeling these emotions is a problem for me”.

    It is most commonly used to refer to “having difficulty identifying and expressing emotions”.

    There are a lot of very poor quality pop-science articles out there about it, but here’s a decent one with good examples and minimal sensationalist pathologization:

    Alexithymia Might Be the Reason It’s Hard to Label Your Emotions

    A somatic start

    Because a good level of self-awareness is critical for healthy emotional regulation, let’s start there. We’ll write this in the first person, but you can use it to help a loved one too, just switching to second person:

    Simplest level first:

    Are my most basic needs met right now? Is this room a good temperature? Am I comfortable dressed the way I am? Am I in good physical health? Am I well-rested? Have I been fed and watered recently? Does my body feel clean? Have I taken any meds I should be taking?

    Note: If the answer is “no”, then maybe there’s something you can do to fix that first. If the answer is “no” and also you can’t fix the thing for some reason, then that’s unfortunate, but just recognize it anyway for now. It doesn’t mean the thing in question is necessarily responsible for how you feel, but it’s good to check off this list as a matter of good practice.

    Bonus question: it’s cliché, but if applicable… What time of the month is it? Because while hormonal mood swings won’t create moods out of nothing, they sure aren’t irrelevant either and should be listened to too.

    Bodyscanning next

    What do you feel in each part of your body? Are you clenching your jaw? Are your shoulders tense? Do you have a knot in your stomach? What are your hands doing? How’s your posture? What’s your breathing like? How about your heart? What are your eyes doing?

    Your observations at this point should be neutral, by the way. Not “my posture is terrible”, but “my posture is stooped”, etc. Much like in mindfulness meditation, this is a time for observing, not for judging.

    Narrowing it down

    Now, like a good scientist, you have assembled data. But what does the data mean for your emotions? You may have to conduct some experiments to find out.

    Thought experiments: what calls to you? What do you feel like doing? Do you feel like curling up in a ball? Breaking something? Taking a bath? Crying?

    Maybe what calls to you, or what you feel like doing, isn’t something that’s possible for you to do. This is often the case with anxiety, for example, and perhaps also guilt. But whatever calls to you, notice it, reflect on it, and if it’s something that your conscious mind considers reasonable and safe for you to do, you can even try doing it.

    Your body is trying to help you here, by the way! It will try (and usually succeed) to give you a little dopamine spike when you anticipate doing the thing it wants you to do. Warning: it won’t always be right about what’s best for you, so do still make your own decisions about whether it is a good idea to safely do it.

    Practical experiments: whether you have a theory or just a hypothesis (if you have neither make up a hypothesis; that is also what scientists do), you can also test it:

    If in the previous step you identified something you’d like to do and are able to safely do it, now is the time to try it. If not…

    • Find something that is likely to (safely) tip you into emotional expression, ideally, in a cathartic way. But, whatever you can get is good.
      • Music is great for this. What songs (or even non-lyrical musical works) make you sad, happy, angry, energized? Try them.
      • Literature and film can be good too, albeit they take more time. Grab that tear-jerker or angsty rage-fest, and see if it feels right.
      • Other media, again, can be completely unrelated to the situation at hand, but if it evokes the same emotion, it’ll help you figure out “yes, this is it”.
        • It could be a love letter or a tax letter, it could be an outrage-provoking news piece or some nostalgic thing you own.

    Ride it out, wherever it takes you (safely)

    Feelings feel better felt. It doesn’t always seem that way! But, really, they are.

    Emotions, just like physical sensations, are messengers. And when a feeling/sensation is troublesome, one of the best ways to get past it is to first fully listen to it and respond accordingly.

    • If your body tells you something, then it’s good to acknowledge that and give it some reassurance by taking some action to appease it.
    • If your emotions are telling you something, then it’s good to acknowledge that and similarly take some action to appease it.

    There is a reason people feel better after “having a good cry”, or “pounding it out” against a punchbag. Even stress can be dealt with by physically deliberately tensing up and then relaxing that tension, so the body thinks that you had a fight and won and can relax now.

    And when someone is in a certain (not happy) mood and takes (sometimes baffling!) actions to stay in that mood rather than “snap out of it”, it’s probably because there’s more feeling to be done before the body feels heard. Hence the “ride it out if you safely can” idea.

    How much feeling is too much?

    While this is in large part a subjective matter, clinically speaking the key question is generally: is it adversely affecting daily life to the point of being a problem?

    For example, if you have to spend half an hour every day actively managing a certain emotion, that’s probably indicative of something unusual, but “unusual” is not inherently pathological. If you’re managing it safely and in a way that doesn’t negatively affect the rest of your life, then that is generally considered fine, unless you feel otherwise about it.

    If you do think “I would like to not think/feel this anymore”, then there are tools at your disposal too:

    Take care!

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  • LGBTQ+ People Relive Old Traumas as They Age on Their Own

    Judith Graham

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Bill Hall, 71, has been fighting for his life for 38 years. These days, he’s feeling worn out.

    Hall contracted HIV, the virus that can cause AIDS, in 1986. Since then, he’s battled depression, heart disease, diabetes, non-Hodgkin lymphoma, kidney cancer, and prostate cancer. This past year, Hall has been hospitalized five times with dangerous infections and life-threatening internal bleeding.

    But that’s only part of what Hall, a gay man, has dealt with. Hall was born into the Tlingit tribe in a small fishing village in Alaska. He was separated from his family at age 9 and sent to a government boarding school. There, he told me, he endured years of bullying and sexual abuse that “killed my spirit.”

    Because of the trauma, Hall said, he’s never been able to form an intimate relationship. He contracted HIV from anonymous sex at bath houses he used to visit. He lives alone in Seattle and has been on his own throughout his adult life.

    “It’s really difficult to maintain a positive attitude when you’re going through so much,” said Hall, who works with Native American community organizations. “You become mentally exhausted.”

    It’s a sentiment shared by many older LGBTQ+ adults — most of whom, like Hall, are trying to manage on their own.

    Of the 3 million Americans over age 50 who identify as gay, bisexual, or transgender, about twice as many are single and living alone when compared with their heterosexual counterparts, according to the National Resource Center on LGBTQ+ Aging.

    This slice of the older population is expanding rapidly. By 2030, the number of LGBTQ+ seniors is expected to double. Many won’t have partners and most won’t have children or grandchildren to help care for them, AARP research indicates.

    They face a daunting array of problems, including higher-than-usual rates of anxiety and depression, chronic stress, disability, and chronic illnesses such as heart disease, according to numerous research studies. High rates of smoking, alcohol use, and drug use — all ways people try to cope with stress — contribute to poor health.

    Keep in mind, this generation grew up at a time when every state outlawed same-sex relations and when the American Psychiatric Association identified homosexuality as a psychiatric disorder. Many were rejected by their families and their churches when they came out. Then, they endured the horrifying impact of the AIDS crisis.

    “Dozens of people were dying every day,” Hall said. “Your life becomes going to support groups, going to visit friends in the hospital, going to funerals.”

    It’s no wonder that LGBTQ+ seniors often withdraw socially and experience isolation more commonly than other older adults. “There was too much grief, too much anger, too much trauma — too many people were dying,” said Vincent Crisostomo, director of aging services for the San Francisco AIDS Foundation. “It was just too much to bear.”

    In an AARP survey of 2,200 LGBTQ+ adults 45 or older this year, 48% said they felt isolated from others and 45% reported lacking companionship. Almost 80% reported being concerned about having adequate social support as they grow older.

    Embracing aging isn’t easy for anyone, but it can be especially difficult for LGBTQ+ seniors who are long-term HIV survivors like Hall.

    Related Links

    Of 1.2 million people living with HIV in the United States, about half are over age 50. By 2030, that’s estimated to rise to 70%.

    Christopher Christensen, 72, of Palm Springs, California, has been HIV-positive since May 1981 and is deeply involved with local organizations serving HIV survivors. “A lot of people living with HIV never thought they’d grow old — or planned for it — because they thought they would die quickly,” Christensen said.

    Jeff Berry is executive director of the Reunion Project, an alliance of long-term HIV survivors. “Here people are who survived the AIDS epidemic, and all these years later their health issues are getting worse and they’re losing their peers again,” Berry said. “And it’s triggering this post-traumatic stress that’s been underlying for many, many years. Yes, it’s part of getting older. But it’s very, very hard.”

    Being on their own, without people who understand how the past is informing current challenges, can magnify those difficulties.

    “Not having access to supports and services that are both LGBTQ-friendly and age-friendly is a real hardship for many,” said Christina DaCosta, chief experience officer at SAGE, the nation’s largest and oldest organization for older LGBTQ+ adults.

    Diedra Nottingham, a 74-year-old gay woman, lives alone in a one-bedroom apartment in Stonewall House, an LGBTQ+-friendly elder housing complex in New York City. “I just don’t trust people,“ she said. “And I don’t want to get hurt, either, by the way people attack gay people.”

    When I first spoke to Nottingham in 2022, she described a post-traumatic-stress-type reaction to so many people dying of covid-19 and the fear of becoming infected. This was a common reaction among older people who are gay, bisexual, or transgender and who bear psychological scars from the AIDS epidemic.

    Nottingham was kicked out of her house by her mother at age 14 and spent the next four years on the streets. The only sibling she talks with regularly lives across the country in Seattle. Four partners whom she’d remained close with died in short order in 1999 and 2000, and her last partner passed away in 2003.

    When I talked to her in September, Nottingham said she was benefiting from weekly therapy sessions and time spent with a volunteer “friendly visitor” arranged by SAGE. Yet she acknowledged: “I don’t like being by myself all the time the way I am. I’m lonely.”

    Donald Bell, a 74-year-old gay Black man who is co-chair of the Illinois Commission on LGBTQ Aging, lives alone in a studio apartment in subsidized LGBTQ+-friendly senior housing in Chicago. He spent 30 years caring for two elderly parents who had serious health issues, while he was also a single father, raising two sons he adopted from a niece.

    Bell has very little money, he said, because he left work as a higher-education administrator to care for his parents. “The cost of health care bankrupted us,” he said. (According to SAGE, one-third of older LGBTQ+ adults live at or below 200% of the federal poverty level.) He has hypertension, diabetes, heart disease, and nerve damage in his feet. These days, he walks with a cane.

    To his great regret, Bell told me, he’s never had a long-term relationship. But he has several good friends in his building and in the city.

    “Of course I experience loneliness,” Bell said when we spoke in June. “But the fact that I am a Black man who has lived to 74, that I have not been destroyed, that I have the sanctity of my own life and my own person is a victory and something for which I am grateful.”

    Now he wants to be a model to younger gay men and accept aging rather than feeling stuck in the past. “My past is over,” Bell said, “and I must move on.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    This article first appeared on KFF Health News and is republished here under a Creative Commons license.

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  • Dating apps could have negative effects on body image and mental health, our research shows

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Zac Bowman – Flinders University

    Around 350 million people globally use dating apps, and they amass an estimated annual revenue of more than US$5 billion. In Australia, 49% of adults report using at least one online dating app or website, with a further 27% having done so in the past.

    But while dating apps have helped many people find romantic partners, they’re not all good news.

    In a recent review, my colleagues and I found using dating apps may be linked to poorer body image, mental health and wellbeing.

    Dikushin Dmitry/Shutterstock

    We collated the evidence

    Our study was a systematic review, where we collated the results of 45 studies that looked at dating app use and how this was linked to body image, mental health or wellbeing.

    Body image refers to the perceptions or feelings a person has towards their own appearance, often relating to body size, shape and attractiveness.

    Most of the studies we included were published in 2020 onwards. The majority were carried out in Western countries (such as the United States, the United Kingdom and Australia). Just under half of studies included participants of all genders. Interestingly, 44% of studies observed men exclusively, while only 7% included just women.

    Of the 45 studies, 29 looked at the impact of dating apps on mental health and wellbeing and 22 considered the impact on body image (some looked at both). Some studies examined differences between users and non-users of dating apps, while others looked at whether intensity of dating app use (how often they’re used, how many apps are used, and so on) makes a difference.

    More than 85% of studies (19 of 22) looking at body image found significant negative relationships between dating app use and body image. Just under half of studies (14 of 29) observed negative relationships with mental health and wellbeing.

    The studies noted links with problems including body dissatisfaction, disordered eating, depression, anxiety and low self-esteem.

    A man leaning against large windows of an apartment.
    Dating apps are becoming increasingly common. But could their use harm mental health? Rachata Teyparsit/Shutterstock

    It’s important to note our research has a few limitations. For example, almost all studies included in the review were cross-sectional – studies that analyse data at a particular point in time.

    This means researchers were unable to discern whether dating apps actually cause body image, mental health and wellbeing concerns over time, or whether there is simply a correlation. They can’t rule out that in some cases the relationship may go the other way, meaning poor mental health or body image increases a person’s likelihood of using dating apps.

    Also, the studies included in the review were mostly conducted in Western regions with predominantly white participants, limiting our ability to generalise the findings to all populations.

    Why are dating apps linked to poor body image and mental health?

    Despite these limitations, there are plausible reasons to expect there may be a link between dating apps and poorer body image, mental health and wellbeing.

    Like a lot of social media, dating apps are overwhelmingly image-centric, meaning they have an emphasis on pictures or videos. Dating app users are initially exposed primarily to photos when browsing, with information such as interests or hobbies accessible only after manually clicking through to profiles.

    Because of this, users often evaluate profiles based primarily on the photos attached. Even when a user does click through to another person’s profile, whether or not they “like” someone may still often be determined primarily on the basis of physical appearance.

    This emphasis on visual content on dating apps can, in turn, cause users to view their appearance as more important than who they are as a person. This process is called self-objectification.

    People who experience self-objectification are more likely to scrutinise their appearance, potentially leading to body dissatisfaction, body shame, or other issues pertaining to body image.

    A woman using a dating app.
    Dating apps are overwhelmingly image-centric. Studio Romantic/Shutterstock

    There could be several reasons why mental health and wellbeing may be impacted by dating apps, many of which may centre around rejection.

    Rejection can come in many forms on dating apps. It can be implied, such as having a lack of matches, or it can be explicit, such as discrimination or abuse. Users who encounter rejection frequently on dating apps may be more likely to experience poorer self-esteem, depressive symptoms or anxiety.

    And if rejection is perceived to be based on appearance, this could lead again to body image concerns.

    What’s more, the convenience and game-like nature of dating apps may lead people who could benefit from taking a break to keep swiping.

    What can app developers do? What can you do?

    Developers of dating apps should be seeking ways to protect users against these possible harms. This could, for example, include reducing the prominence of photos on user profiles, and increasing the moderation of discrimination and abuse on their platforms.

    The Australian government has developed a code of conduct – to be enforced from April 1 this year – to help moderate and reduce discrimination and abuse on online dating platforms. This is a positive step.

    Despite the possible negatives, research has also found dating apps can help build confidence and help users meet new people.

    If you use dating apps, my colleagues and I recommend choosing profile images you feel display your personality or interests, or photos with friends, rather than semi-clothed images and selfies. Engage in positive conversations with other users, and block and report anyone who is abusive or discriminatory.

    It’s also sensible to take breaks from the apps, particularly if you’re feeling overwhelmed or dejected.

    If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. The Butterfly Foundation provides support for eating disorders and body image issues, and can be reached on 1800 334 673.

    Zac Bowman, PhD Candidate, College of Education, Psychology & Social Work, Flinders University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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    Learn to Age Gracefully

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  • Hair-Loss Remedies, By Science

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The 10almonds Team

    10almonds Gets Hairy

    Hair loss is a thing that at some point affects most men and a large minority of women. It can be a source of considerable dysphoria for both, as it’s often seen as a loss of virility/femininity respectively, and is societally stigmatized in various ways.

    Today we’re going to focus on the most common kind: androgenic alopecia, which is called “male pattern baldness” in men and “female pattern baldness” in women, despite being the same thing.

    We won’t spend a lot of time on the science of why this happens (we’re going to focus on the remedies instead), but suffice it to say that genes and hormones both play a role, with dihydrogen testosterone (DHT) being the primary villain in this case.

    We’ve talked before about the science of 5α-reductase inhibitors to block the conversion of regular testosterone* to DHT, its more potent form:

    One Man’s Saw Palmetto Is Another Woman’s Serenoa Repens…

    *We all make this to a greater or lesser degree, unless we have had our ovaries/testes removed.

    Finasteride

    Finasteride is a 5α-reductase inhibitor that performs similarly to saw palmetto, but comes in tiny pills instead of needing to take a much higher dose of supplement (5mg of finasteride is comparable in efficacy to a little over 300mg of saw palmetto).

    Does it work? Yes!

    Any drawbacks? A few:

    • It’ll take 3–6 months to start seeing effects. This is because of the hormonal life-cycle of human hairs.
    • Common side-effects include ED.
    • It is popularly labelled/prescribed as “only for men”

    On that latter point: the warnings about this are severe, detailing how women must not take it, must not even touch it if it has been cut up or crushed.

    However… That’s because it can carry a big risk to our unborn fetuses. So, if we are confident we definitely don’t have one of those, it’s not actually applicable to us.

    That said, finasteride’s results in women aren’t nearly so clear-cut as in men (though also, there has been less research, largely because of the above). Here’s an interesting breakdown in more words than we have room for here:

    Finasteride for Women: Everything You Need to Know

    Spironolactone

    This one’s generally prescribed to women, not men, largely because it’s the drug sometimes popularly known as a “chemical castration” drug, which isn’t typically great marketing for men (although it can be applied topically, which will have less of an effect on the rest of the body). For women, this risk is simply not an issue.

    We’ll be brief on this one, but we’ll just drop this, so that you know it’s an option that works:

    ❝Spironolactone is an effective and safe treatment of androgenic alopecia which can enhance the efficacy when combined with other conventional treatments such as minoxidil.

    Topical spironolactone is safer than oral administration and is suitable for both male and female patients, and is expected to become a common drug for those who do not have a good response to minoxidil❞

    Read more: The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review

    Minoxidil

    This one is available (to men and women) without prescription. It’s applied topically, and works by shortcutting the hair’s hormonal growth cycle, to reduce the resting phase and kick it into a growth phase.

    Does it work? Yes!

    Any drawbacks? A few:

    • Whereas you’ll remember finasteride takes 3–6 months to see any effect, this one will have an effect very quickly
      • Specifically, the immediate effect is: your rate of hair loss will appear to dramatically speed up
      • This happens because when hairs are kicked into their growth phase if they were in a resting phase, the first part of that growth phase is to shed each old hair to make room for the new one
    • You’ll then need the same 3–6 months as with finasteride, to see the regrowth effects
    • If you stop using it, you will immediately shed whatever hair you gained by this method

    Why do people choose this over finasteride? For one of three reasons, mainly:

    • They are women, and not offered finasteride
    • They are men, and do not want the side effects of finasteride
    • They just saw an ad and tried it

    As to how it works:

    Minoxidil upregulates the expression of vascular endothelial growth factor in human hair dermal papilla cells

    Some final notes:

    There are some other contraindications and warnings with each of these drugs by the way, so do speak with your doctor/pharmacist. For example:

    There are other hair loss remedies and practices, but the above three are the heavy-hitters, so that’s what we spent our time/space on today. We’ll perhaps cover the less powerful (but less risky) options one of these days.

    Meanwhile, take care!

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  • Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Gemma Sharp – Monash University

    People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.

    The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.

    The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.

    It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.

    Why do people want cosmetic surgery?

    Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.

    The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.

    The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.

    The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.

    People don’t always get the results they expect

    Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.

    However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.

    People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.

    What’s changing?

    According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.

    For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.

    It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.

    It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.

    What about the mental health assessment?

    The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.

    According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.

    While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.

    So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.

    Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.

    Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.

    Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.

    In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.

    If you’re considering cosmetic surgery

    The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:

    1. have an independent physical and mental health assessment before you commit to cosmetic surgery

    2. make an informed decision knowing the risks

    3. choose your practitioner, knowing their training and qualifications

    4. discuss your care after your operation and where you can go for support.

    My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.The Conversation

    Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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