What's in my prescription?
What is anastrozole?
Anastrazole is a prescription treatment that works by blocking the aromatase enzyme. This enzyme converts testosterone to estradiol (the primary form of estrogen). Anastrozole is not FDA-approved for low testosterone treatment but is used “off-label” by physicians. Off-label prescribing is the term used when a physician prescribes a medication for a specific condition different than the condition the medication was originally approved for. Off-label prescribing is common and approximately 20% of all prescriptions are done off-label. We only use medications off-label when there is high-quality safety and efficacy evidence available.
Why is anastrozole part of my treatment regimen?
Your Nimbus Hormone test indicated that estradiol levels were elevated due to increased aromatase activity. Aromatase activity and thus estradiol levels increase as we age and as our body adipose tissue percent increases.1
Is anastrozole effective for restoring normal testosterone levels?
Anastrazole affects testosterone levels in two distinct ways. By lowering circulating estrogen levels, anastrozole causes an increase in LH (Luteinizing Hormone) which is the hormone responsible for telling the testes to produce testosterone.
The second effect is by suppressing the conversion of testosterone to estrogen. Anastrazole will decrease the estradiol/testosterone ratio by approximately 77%, meaning more testosterone is available to the cells in the body.2
Are there potential side effects from using anastrozole?
The adverse effects of anastrozole therapy occur when estrogen levels are too suppressed. Estrogen has several different effects in men, including maintaining bone density and several aspects of sexual health, prostate health, and metabolism.3 At Nimbus, we monitor estradiol levels during therapy and adjust anastrozole dosage if estradiol levels are too low. Other adverse effects that have been reported include stomach upset, bone pains, mood disturbances, and fluid retention.
References
Hammes SR, Levin ER. Impact of estrogens in males and androgens in females. J Clin Invest. 2019;129(5):1818-1826. doi:10
What is Pregnyl (HCG)?
Pregnyl or HCG (Human Chorionic Gonadotropin) is a prescription medication to treat low testosterone levels. Pregnyl works in the body like the natural hormone LH (Luteinizing Hormone), which tells the testes to produce testosterone. Pregnyl is not FDA approved for increasing testosterone but is prescribed “off-label”. Off-label prescribing is the term used when a physician prescribes a medication for a specific condition different than the condition the medication was originally approved for. Off-label prescribing is common and approximately 20% of all prescriptions are done off-label. We only use medications off-label when there is high-quality safety and efficacy evidence available.
Why is Pregnyl part of my treatment regimen?
Pregnyl was identified as a viable treatment option based on your age and Nimbus hormone testing. Pregnyl can help restore normal testosterone levels in men who produce enough LH, but the testes are not responding to that signal. Pregnyl is also used in men on testosterone who desire to maintain fertility.1
Is Pregnyl effective for restoring normal testosterone levels?
Pregnyl effectively restored normal testosterone levels in testosterone deficient men while also persevering fertility. Studies show similar improvement in metabolic markers, blood sugars, and lean muscle mass compared to testosterone therapy.2 Pregnyl is also associated with a lower rate of adverse effects when compared to testosterone therapy.3
Are there potential adverse effects from using Pregnyl?
Pregnyl is well-tolerated, but adverse effects have been reported in clinical trials. Headache, restlessness, fatigue, ankle/feet swelling, mood changes, and breast tenderness have been reported.4
References
What is clomiphene?
Clomiphene is a prescription treatment that increases testosterone levels by causing the brain to release more FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) by interfering with the ability of estrogen to block signals to release these hormones. FSH and LH are essential for normal testicle function and testosterone production.1 Clomiphene is not FDA-approved as a treatment for low testosterone levels but is used “off-label” by physicians. Off-label prescribing is the term used when a physician prescribes a medication for a specific condition different than the condition the medication was originally approved for. Off-label prescribing is common and approximately 20% of all prescriptions are done off-label. We only use medications off-label when there is high-quality safety and efficacy evidence available.
Why is clomiphene part of my treatment regimen?
Your Nimbus testing indicated clomiphene is an effective option for restoring normal testosterone levels because of suboptimal LH levels. Clomiphene is an alternative treatment option that is effective in men younger than 55 who have low levels of LH. LH is the hormone responsible for the production of testosterone in the testes. Clomiphene effectively restores normal testosterone levels, especially in men younger than 55 who do not have diabetes, heart disease, or hypertension.2
Is clomiphene effective for restoring normal testosterone levels?
A retrospective study looked at clomiphene treatment for 400 men with low testosterone levels who had been on therapy for up to 3 years. It found that clomiphene treatment restored normal testosterone levels in 88% of the men treated, and 77% reporting improvement in symptoms.3 Another study compared testosterone injections to clomiphene and found nearly equivalent levels of symptom improvement and satisfaction.4 Clomiphene is recognized as a viable alternative treatment to testosterone-based therapies.
Are there potential adverse effects from taking clomiphene?
Adverse effects have been reported in 8-11% of men taking clomiphene in clinical trials; however, these are all minor incidents. Those trials reported fluid retention, breast tenderness, nausea, dizziness, fatigue, visual disturbances, and changes in mood as the adverse effects.3-5
References
What is DHEA-S
Dehydroepiandrosterone (DHEA) is a hormone made by the adrenal glands, ovaries, testes, and brain cells. DHEAS levels peak around age 20 and then decline as we age. The sulfated form (DHEA-S) is the most abundant steroid hormone in the body. 98% of circulating DHEA is in the sulfated form. DHEAS is a more stable measure of this hormone as it has a slower clearance from the circulation and does not experience day-to-day fluctuations.[1],[2] DHEA is a precursor to other sex hormones, including testosterone. Low levels of DHEA are associated with heart disease, endothelial dysfunction, atherosclerosis (the root cause behind strokes and heart attacks), bone loss, inflammatory diseases, and sexual dysfunction.[3] DHEA modulates the immune system, and in the elderly, use has been associated with increased muscle strength, bone density, and reduced body fat.[4] Low levels of DHEAS were associated with increased all-cause mortality in elderly men in a meta-analysis.[5] A 2020 meta-analysis of randomized controlled trials found that DHEA did not change blood pressure or body weight but increased lean mass and decreased fat mass.[6]
Why is DHEA-S part of my treatment protocol?
Your laboratory tests indicate that your testosterone, DHEAS, or both are outside of the optimal range, and your questionnaire indicated that the symptoms you are experiencing could benefit by supplementation. DHEA supplementation has been shown to increase testosterone levels in men.[7]
Is DHEA-S effective for restoring normal DHEA-S levels?
A 1-year double blind placebo controlled RCT of DHEA 100 mg per day found that supplementation increased levels from baseline by threefold in men.[8] Another 1 year RCT of 50 mg per day of DHEA in men 60 to 79 years old found that serum DHEAS levels returned to young adult values after 6 months of supplementation.[9] Other trials have found similar results in that DHEA supplementation effectively increased blood levels.4
Are there potential side effects from using DHEA-S?
Oral DHEA and DHEAS supplementation is usually well tolerated. Reported adverse effects include hirsutism, abdominal pain, acne, nausea, urinary urgency, testicular wasting, aggression, breast tenderness or enlargement (gynecomastia) have been reported.4
[1] Kamin HS, Kertes DA: Cortisol and DHEA in Development and Psychopathology. Horm Behav 2016.
[2] Starka L, Duskova M, Hill M: Dehydroepiandrosterone: a neuroactive steroid. J Steroid Biochem Mol Biol 2015;145:254-260.
[3] Traish AM, Kang HP, Saad F, Guay AT. Dehydroepiandrosterone (DHEA)--a precursor steroid or an active hormone in human physiology. J Sex Med. 2011;8(11):2960-2983. doi:10.1111/j.1743-6109.2011.02523.x
[4] Rutkowski K, Sowa P, Rutkowska-Talipska J, Kuryliszyn-Moskal A, Rutkowski R. Dehydroepiandrosterone (DHEA): hypes and hopes. Drugs. 2014;74(11):1195-1207. doi:10.1007/s40265-014-0259-8
[5] Li R, E L, Zha N. Circulating dehydroepiandrosterone sulfate level and cardiovascular or all-cause mortality in the elderly population: a meta-analysis. Ann Palliat Med. 2020;9(5):3537-3545. doi:10.21037/apm-20-441
[6] Wang F, He Y, O Santos H, Sathian B, C Price J, Diao J. The effects of dehydroepiandrosterone (DHEA) supplementation on body composition and blood pressure: A meta-analysis of randomized clinical trials. Steroids. 2020;163:108710. doi:10.1016/j.steroids.2020.108710
[7] Li Y, Ren J, Li N, et al. A dose-response and meta-analysis of dehydroepiandrosterone (DHEA) supplementation on testosterone levels: perinatal prediction of randomized clinical trials. Exp Gerontol. 2020;141:111110. doi:10.1016/j.exger.2020.111110
[8]Morales AJ, Haubrich RH, Hwang JY, et al. The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age-advanced men and women. Clin Endocrinol (Oxf). 1998;49:421–32.
[9] Baulieu EE, Thomas G, Legrain S, et al. Dehydroepiandrosterone (DHEA),DHEAsulfate,andaging:contributionoftheDHEAgeStudy to a sociobiomedical issue. Proc Natl Acad Sci. 2000;97:4279–84.
Progesterone supports healthy menstrual cycles and pregnancy. It balances estrogen, decreasing the risk of endometrial and perhaps breast cancer. It also helps support thyroid function, blood sugar, fluid and mineral balance, as well as helping build bone. Progesterone has a calming effect and enhances mood and sleep. Low progesterone levels can lead to anxiety, depression, irritability, insomnia, weight gain, heavy periods and decreased libido.
Progesterone levels drop during menopause, leaving estrogen unbalanced. Unfortunately levels can also drop with increased stress levels (high cortisol). Cortisol also blocks progesterone receptors and prevents progesterone from being used effectively in the body. This means that you can be in your early 20s and end up with hormone imbalances that resemble early menopause.
Compounded bioidentical progesterone is the optimal replacement for low levels. Synthetic progestins do not produce the same effect as natural progesterone and stay in the body longer (up to 6 months). This leads to an imbalance with estrogen and also interferes with the body’s own production. Progesterone can be compounded as a cream or as a slow release capsule. Taking progesterone orally is more effective if insomnia is one of the symptoms.
Testosterone in women is part of hormonal balance - we don’t need much but we do need some! Testosterone strengthens bone and muscle, decreases excess body fat, prevents skin from sagging, increases energy and libido and enhances our overall sense of well-being. Low levels can lead to fatigue, weight gain, anxiety, loss of muscle mass, loss of skin elasticity and decreased libido.
Testosterone levels in women drop in menopause since it is not involved in reproductive health. Unfortunately testosterone can also be affected by stress, meaning young women can experience low levels too. Birth control pills are another negative influence on testosterone levels.
If testosterone levels are elevated in a young woman, she should be evaluated for polycystic ovary syndrome. PCOS can lead to irregular menstrual cycles, lack of ovulation, infertility and miscarriages. Symptoms include acne, excess dark hair (hirsutism) and weight gain (high insulin and insulin resistance).
Testosterone replacement should always be bioidentical and transdermal, rotating sites where you apply the cream. Synthetic testosterone has been associated with an increase in liver cancer. If estrogen levels are not optimized, testosterone cannot attach to brain receptors so it is important to balance all hormones.
The thyroid gland is a butterfly shaped organ located in the front of the neck. Its main job is to release hormones that control metabolism and how energy is used in the body. The things controlled by the thyroid include heart rate, breathing, body weight, muscle strength, body temperature and fertility. The two most important hormones that the thyroid makes are T4 (inactive) and T3 (active after conversion from T4 in the liver and kidneys). The brain (hypothalamus and pituitary) control how much thyroid hormone is made by the gland through feedback loops.
Thyroid disease affects an estimated 20 million people in the US. Women are 5-8x more likely to be diagnosed with thyroid condition. Hypothyroidism (underactive thyroid) happens when the body doesn’t produce and release enough thyroid hormone. Common signs of hypothyroidism include hair loss, fatigue, depression, weight gain, constipation, dry skin and brittle nails. Nutritional deficiencies that contribute to low thyroid function are low levels of iodine, iron, ferritin, zinc, magnesium, selenium and vitamins A, C, B2, B6 and B12.
Stress can lead to hypothyroidism when high cortisol interferes with the conversion of T4 to T3, our active thyroid hormone. Estrogen dominance (estrogen not balanced by enough progesterone) can also lower thyroid function by causing the liver to increase thyroid binding globulin (TBG) thereby lowering available thyroid hormone.
Hashimoto’s thyroiditis is type of thyroid failure caused by autoimmune disease. Antibodies are formed by the immune system that attack thyroid cells as if they were an infection, causing cell death of the thyroid’s hormone-producing cells. Testing for TPO (thyroid peroxidase) and ATA (antithyroglobulin) antibodies are the way to diagnose this autoimmune thyroid disease.
Treatment of thyroid failure involves replacing T4 and T3. The best way to do this is with desiccated thyroid hormone (natural glandular extract) such as Armour or NP thyroid. Treating with synthetic T4 (Synthroid, Levothyroxine) and T3 (Cytomel) should only be done if the patient has Hashimoto’s disease. Taking supplements containing vitamins and nutrients essential for healthy thyroid function can also help optimize thyroid hormone production.
Cortisol is a steroid hormone that is made by the adrenal glands which sit on top of the kidneys. It is the only hormone that can increase with age. When one is stressed, cortisol levels increase (fight or flight response) to handle the situation. Levels are supposed to come back down to normal once the stress has passed. Unfortunately in modern day society this does not always happen. When we live in survival mode instead of thriving, the adrenal glands divert production of hormones from the reproductive system to fuel survival. This leads to hormonal imbalances and low hormone levels. The symptoms include anxiety, depression, fatigue, irritability, mood swings and brain fog.
The adrenal glands are part of the HPA axis (hypothalamus-pituitary-adrenal). The adrenal glands help control more than 50 hormones necessary for life, including epinephrine, cortisol, DHEA, progesterone, and testosterone. The hypothalamus and pituitary gland are found in the brain and together with adrenal glands control body functions by interacting with and signaling each other. Together these three regulate your stress response, mood, metabolism, energy levels, immune system, hormones and thyroid.
Cortisol is responsible for regulating the immune system, mainly by reducing inflammation. Cortisol also normalizes blood sugar, regulates metabolism, helps with memory formation, regulates blood pressure and electrolyte balance. Cortisol is responsible for our circadian rhythm, peaking between 7 and 9 am as we get our day started and lowest at bedtime so we can have healthy sleep cycles.
Adrenal hyperfunction (too much cortisol) weakens the immune system, leading to increased susceptibility to infections and cancer. High cortisol robs the body of hormones because the body has to choose survival over reproductive health. Cortisol also competes with
progesterone for common receptors, leading to lower levels of active progesterone. High levels of cortisol also disrupt blood sugar balance, causing low energy, sugar cravings and abdominal weight gain. Over time this can lead to insulin resistance. Excessive cortisol interferes with thyroid function and can eventually cause to thyroid failure.
Adrenal burnout or adrenal fatigue happens over time from prolonged exposure to chronic stress. The body cannot sustain the high cortisol levels indefinitely and so the brain shuts down cortisol production in an effort to protect itself. Low cortisol symptoms include fatigue, insomnia, loss of libido, brain fog, and emotional instability. Too little cortisol leads to an overactive immune system (allergies) and autoimmune disease.
Treatment of adrenal dysfunction must include stress management techniques such as meditation, yoga, massage, mindfulness exercises and deep breathing exercises. Healing adrenal glands takes time and is best achieved with targeted supplements (pharmaceutical grade). Herbal adaptogens are natural compounds that help the body resist an extreme response to stress by normalizing the HPA axis. Adaptogenic herbs are able to both tone down overactive adrenal glands and boost underactive adrenals. For high cortisol, Ashwaganda, Skullcap, Rhodiola rosea and Eleuthera root are excellent herbs. Adrenal hyperfunction also benefits from taking calming brain supplements such as phosphatidylserine and L-theanine. For low cortisol, Shisandra, ginseng and licorice root extract are helpful. Low cortisol can also be treated with adrenal extracts (natural compounds) but should not be treated with synthetic steroids.
DHEA (dehydroepiandrosterone) is a hormone made mainly by the adrenal glands. It is converted by the body into estrogen and testosterone. DHEA is an anti-aging hormone that peaks in the late twenties. It supports the immune system, decreases allergic reactions, lowers cholesterol and trigylcerides and promotes weight loss and mental health. One of the most important functions of DHEA is to buffer the hormone system from stress (cortisol “steal”).
DHEA levels declining is a normal part of aging and menopause. However, stress can cause an accelerated drop in levels in young women as well. Since DHEA is part of the hormone pathway and used make estrogen and testosterone, this can lead to hormone imbalances.
DHEA supplementation is best done with a pharmaceutical grade product. It does not require a prescription. The dose for replacement in women is much lower than for men since women are more sensitive to the effects of DHEA and need less as well. If DHEA levels are low and not fixed, it is harder to balance hormones (estrogen, progesterone and testosterone).
Estrogen is a chemical messenger with over 400 functions in the body. This hormone controls sexual and reproductive health. Estrogen receptors are located throughout the body because estrogen also has many non-reproductive functions - in the skeletal, cardiovascular and central nervous systems. Estrogen affects cholesterol levels, blood sugar levels, muscle and bone mass, circulation and blood flow, collagen production and skin moisture, and brain function, including focus and memory. Estrogen also helps with serotonin formation, decreasing depression, irritability, anxiety and pain sensitivity.
The body makes 3 types of estrogen - estrone (E1), estradiol (E2) and estriol (E3). E1 is the main estrogen made after menopause. E2 is the most potent estrogen, protecting bone, heart and brain health. E3 helps maintain pregnancy and controls symptoms of menopause.
Menopause typically happens between ages 35 and 55. Unfortunately it is unpredictable and varies individually. It can happen over months in some and years in others. Hormones tend to fluctuate and can leave one feeling like they are on a rollercoaster. It usually starts with drops in levels of testosterone and progesterone, with estrogen being preserved. Unfortunately this can lead to a relative estrogen dominance (not being balanced by progesterone) which causes weight gain, mood swings, poor sleep, breast tenderness and heavy cycles. It can also lead to hypothyroidism and increase the risk of breast cancer. Other symptoms of menopause include night sweats, loss of libido, vaginal dryness, panic attacks and urinary symptoms.
Bioidentical hormone replacement is the best way to treat menopause. These compounds are custom created in a pharmacy with natural hormones that the body produces and recognizes. Synthetic hormones don’t produce optimal signals to the body and should be avoided. Estrogen should not be taken orally as it can increase blood pressure, elevate liver enzymes, cause gallstones, decrease testosterone and cause blood clots. Replacement of estrogen is best with a mixture of E2 and E3 that is compounded in a base cream applied to skin (upper inner thigh) daily. Taking hormones through the skin means they go directly to the target organs and avoid liver metabolism. This allows optimal results with lower doses of hormones.
What is Minoxidil?
Minoxidil is an FDA-approved treatment available over the counter and by prescription. The prescription-strength minoxidil is 5% or greater, while the over-the-counter treatment is 2%. Minoxidil increases the anagen phase (hair growth) and shortens the telogen phase (hair loss). It also enlarges maturing hair follicles.
Minoxidil also enlarges maturing hair follicles which places them back in action sooner. It is thought that Minoxidil does this by increasing blood flow to the skin and hair follicles and increasing prostaglandin (hair growth factors) levels.1
Why is minoxidil part of my treatment plan?
Your genetic profile indicates efficacy with the use of minoxidil. Minoxidil must be activated in the body by a class of enzymes called sulfotransferases. Specific genetic changes make it so minoxidil is not activated by the body and will not be effective. Your genetic profile has enough sulfotransferase activity for minoxidil to be effective, but it may require higher doses.
Is topical minoxidil effective for alopecia?
Clinical trials have shown that Minoxidil 5% is more effective than 2%. This is why some men do not see improvement with treatment with over-the-counter strength minoxidil products.
Treatment with topical minoxidil in clinical trials is associated with increased hair counts, patient ratings of scalp coverage and treatment benefit, and researcher ratings of scalp coverage. Treatment is also associated with an improvement in psychological perceptions of hair loss as well.2,3
Are there adverse effects when using topical minoxidil?
Topical minoxidil is well tolerated, and adverse effects are infrequent. Topical therapy reduces the risk of systemic side effects because only a tiny portion of the dose is absorbed from the skin to reach the systemic circulation. Dermatitis, itching, irritation, and excessive facial hair growth in men have been reported. Minoxidil was initially used as a blood pressure medication; however, topical therapy is not associated with changes in blood pressure, pulse, or body weight.4 Some people experience an initial increase in hair shedding when starting minoxidil therapy.
Low-dose oral minoxidil carries the potential for serious adverse effects. It has a black box warning for the potential to cause severe pericardial effusions, increased heart rate, and worsen preexisting ischemic cardiac disease. Other adverse effects of oral minoxidil include low blood pressure, fluid retention, hair growth on different parts of the body, headache, insomnia, lightheadedness, and swelling around the eyes..5
Why do I need to keep taking minoxidil for hair loss?
Minoxidil should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Minoxidil is not a cure for hair loss; it is a treatment.
Medication Summary: Minoxidil
References
1) Messenger AG, Rundegren J. Minoxidil: mechanisms of action on hair growth. Br J Dermatol. 2004;150(2):186-194. doi:10.1111/j.1365-2133.2004.05785.x
2) Olsen EA, Dunlap FE, Funicella T, et al. A randomized clinical trial of 5% topical minoxidil versus 2% topical minoxidil and placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2002;47(3):377-385. doi:10.1067/mjd.2002.124088
3) Olsen EA, Whiting D, Bergfeld W, et al. A multicenter, randomized, placebo-controlled, double-blind clinical trial of a novel formulation of 5% minoxidil topical foam versus placebo in the treatment of androgenetic alopecia in men. J Am Acad Dermatol. 2007;57(5):767-774. doi:10.1016/j.jaad.2007.04.012
4) Rogaine extra strength for men (5 percent minoxidil topical solution): for nonprescription use. Summary volume, Pharmacia & Upjohn, Kalamazoo, MI 1997.
5) Vañó-Galván S, Pirmez R, Hermosa-Gelbard A, et al. Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patients. J Am Acad Dermatol. 2021;84(6):1644-1651. doi:10.1016/j.jaad.2021.02.054
What is tretinoin?
Tretinoin (all-trans retinoic acid) is a prescription treatment closely related to vitamin A.
Why is tretinoin part of my treatment regimen?
Your genetic profile indicates a change in the cRABP2 gene, which oversees the transport of vitamin A into the cells. Higher levels of vitamin A are necessary when this genetic change is present. Trentoin has been shown to increase the cRABP2 protein increasing Vitamin A availability to the hair follicle.1
Is topical tretinoin effective in alopeica?
Tretinoin has been shown to increase hair growth, anagen hair amount, hair diameter, and total hair count, especially when combined with minoxidil.1-3
Are there adverse effects while using topical tretinoin?
The application of tretinoin can cause redness, hyperpigmentation, hypopigmentation, burning, pain, peeling, irritation, and dryness of the skin or scalp. Tretinoin is pregnancy category C and should not be used by reproductive-eligible females without reliable contraceptive use.
Why do I need to keep taking Tretinoin?
Tretinoin should be used once a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Tretinoin is not a cure for hair loss; it is a treatment.
Active Ingredient Monograph: Tretinoin
References
What is dutasteride?
Dutasteride is a prescription treatment that blocks the enzyme 5-alpha reductase type I and II. 5-alpha reductase turns testosterone into dihydrotestosterone (DHT).
Why is dutasteride part of my treatment plan?
Your genetics indicate that your steroid-reductase type I or type II activity is high. This will lead to increased levels of DHT, which impairs hair growth.
Are topical and oral dutasteride effective for alopecia?
Dutasteride has proven to increase hair counts, density, and personal assessment of hair growth. One study found that dutasteride is more effective for hair growth than finasteride. This is likely because finasteride only blocks type I of the steroid-reductase enzyme, while dutasteride blocks type I and type II. Dutasteride is three times more effective at blocking type II and 100 times more effective at blocking type I steroid-reductase enzymes.1 Topical dutasteride combined with microneedling was found to improve hair density and patient assessment of hair growth.2 Another study found significant hair growth with a topical product containing dutasteride, minoxidil, and finasteride.3
Why does Nimbus use low doses of oral dutasteride?
Oral dutasteride has the potential to cause significant side effects. By lowering systemic levels of DHT, you reduce the level of the most active form of testosterone. Unfortunately, this can lead to decreased libido, erectile dysfunction, adverse sexual experiences, nipple discharge, prostate cancer, and male breast cancer. Dutasteride is also associated with changes in mental health, such as depression, anxiety, and brain fog. Side effects usually resolve after medication discontinuation but may persist in rare cases. Stop taking dutasteride immediately and contact your physician if you experience any of these side effects.
Dutasteride is category X in pregnancy as it causes birth defects in a male fetus. The use of dutasteride in pregnancy-eligible women is contraindicated unless reliable forms of contraception are used in conjunction. The risk of adverse effects can be lessened by using topical dutasteride. Blood DHT levels declined slightly in one trial, but the difference was not significant, and none of the participants reported adverse sexual issues.2
Are there any adverse effects while using dutasteride?
Topical dutasteride is well tolerated. Itching has been reported at the application site.2 Other adverse events include low blood pressure, breast tenderness/enlargement, high-grade prostate cancer, allergic reactions, and leg swelling.
Why do I need to keep taking dutasteride?
Dutasteride should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Dutasteride is not a cure for hair loss; it is a treatment.
Drug Summary: Dutasteride
References
1) Zhou, Z., Song, S., Gao, Z., Wu, J., Ma, J., & Cui, Y. (2019). The efficacy and safety of dutasteride compared with finasteride in treating men with androgenetic alopecia: A systematic review and meta-analysis. Clinical Interventions in Aging, Volume 14, 399-406. doi:10.2147/cia.s192435
2) Nada, Essam & Sharkawy, Reham & Abd Elmaged, Wafaa & Elmagd, Marwa. (2018). Topical dutasteride with microneedling in treatment of male androgenetic alopecia. Sohag Medical Journal. 22. 387-400. 10.21608/smj.2018.42083.
3) Rafi AW, Katz RM. Pilot Study of 15 Patients Receiving a New Treatment Regimen for Androgenic Alopecia: The Effects of Atopy on AGA. ISRN Dermatol. 2011;2011:241953. doi:10.5402/2011/241953
What is latanoprost?
Latanoprost is a prescription treatment that functions similarly to the hair growth factor prostaglandin F2.
Why is latanoprost part of my treatment plan?
Your genetic profile indicates that the ability of the prostaglandin F2 receptors would benefit from the application of latanoprost to stimulate the receptors and improve hair growth. The PTGFR-1 receptors are the three prostaglandin F2 receptors we measure in the Nimbus Hair DNA Test.
Is topical latanoprost effective in Alopecia?
Topical therapy with latanoprost 0.05% to 0.1% has increased hair thickness, length, and pigmentation. Latanoprost is thought to recruit hairs to enter and maintain the growth (anagen) phase.1-3
Are there adverse effects while using topical latanoprost?
Topical latanoprost is well tolerated. Adverse events associated with therapy include redness at the application site, skin pigmentation, burning, and hair follicle irritation.1-3 The absorption of latanoprost from the skin to the bloodstream is unknown. Data from administration to the eye shows minimal systemic absorption with quick clearance from the blood, and many of those who chronically use latanoprost for glaucoma have undetectable blood levels.4
Why do I need to keep taking latanoprost?
Latanoprost should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Latanoprost is not a cure for hair loss; it is a treatment.
Medication Summary: Latanoprost
References
1) Blume-Peytavi U, Lönnfors S, Hillmann K, Garcia Bartels N. A randomized double-blind placebo-controlled pilot study to assess the efficacy of a 24-week topical treatment by latanoprost 0.1% on hair growth and pigmentation in healthy volunteers with androgenetic alopecia. J Am Acad Dermatol. 2012;66(5):794-800. doi:10.1016/j.jaad.2011.05.026
2) Amal Ahmad El-Ashmawy, Iman Hamed El-Maadawy & Gamal Mohamed El-Maghraby (2018) Efficacy of topical latanoprost versus minoxidil and betamethasone valerate on the treatment of alopecia areata, Journal of Dermatological Treatment, 29:1, 55-64, DOI: 10.1080/09546634.2017.1330527
3) Bhat S, Handa S, De D. A randomized comparative study of the efficacy of topical latanoprost versus topical betamethasone diproprionate lotion in the treatment of localized alopecia areata. Indian J Dermatol Venereol Leprol. 2021;87(1):42-48. doi:10.25259/IJDVL_787_19
4) Sjöquist B, Stjernschantz J. Ocular and systemic pharmacokinetics of latanoprost in humans. Surv Ophthalmol. 2002 Aug;47 Suppl 1:S6-12. doi: 10.1016/s0039-6257(02)00302-8. PMID: 12204697.
What is spironolactone?
Spironolactone is a prescription treatment that blocks androgen receptors. By preventing testosterone from binding to its receptor, it prevents the conversion of testosterone to DHT. The net result is inhibition of hair loss, thinning, and shrinking of the hair follicle.
Why is spironolactone part of my treatment plan?
Your genetic testing indicates one or both of your SR5DA genes is more active. This enzyme turns testosterone into DHT, which promotes hair loss. By blocking the androgen receptor with spironolactone, less testosterone is converted to DHT, encouraging hair growth.
Is topical spironolactone effective in Alopecia?
Clinical studies with topical spironolactone 1% to 5% have shown increased hair diameter, growth, and density.1-4
Are there adverse effects while using topical spironolactone?
Treatment with topical spironolactone is well tolerated. It does not appear to affect systemic testosterone or DHT levels.3 Contact dermatitis manifested by itching, burning, and scaling has been reported.4 Topical therapy reduces the risk of systemic side adverse effects. Oral spironolactone can cause low blood pressure, electrolyte abnormalities, dizziness/fainting, changes in menstrual periods, breast tenderness/enlargement in women, and gynecomastia (growth of breast tissue) in men. Topical therapy reduces the risk of systemic adverse effects.
Why do I need to keep taking spironolactone?
Spironolactone should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Spironolactone is not a cure for hair loss; it is a treatment.
Drug Summary: Spironolactone
References
What is ketoconazole?
Ketoconazole is a prescription treatment that is a potent antifungal agent. Ketoconazole blocks testosterone synthesis, which decreases DHT while also being anti-inflammatory through its actions on 5-lipoxygenase. Blocking 5-lipoxygenase decreases the production of pro-inflammatory leukotrienes.
Why is ketoconazole part of my treatment plan?
Your genetic testing indicated that your steroid-reductase type I and/or type II were more active than usual. This will lead to increased DHT levels and impair hair follicle development. Ketoconazole blocks this by decreasing testosterone availability for steroid-reductase to turn testosterone into DHT. Ketoconazole is used for seborrheic dermatitis, a risk factor for hair loss. Seborrheic dermatitis can cause a very itchy, dry scalp. Frequently this leads to scratching, which can damage hair follicles leading to hair loss. A common cause of this condition is the yeast Malassezia which is associated with hair shedding due to inflammation.1 Ketoconazole has anti-inflammatory properties.
Is topical ketoconazole effective for alopecia?
Treatment with 2% ketoconazole is associated with improved hair growth, density, and proportion of hair in the growth (anagen) phase.2,3
Are there adverse effects from topical ketoconazole?
The topical application of ketoconazole is well tolerated, and adverse events are rare. Reported adverse events, including itching, stinging, allergic reaction, and local irritation.
Why do I need to keep taking ketoconazole?
Ketoconazole should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Ketoconazole is not a cure for hair loss; it is a treatment.
Drug Summary: Ketoconazole
References
What is caffeine?
Caffeine is everywhere in modern society. Many of us take it for the cognitive boost and alertness we feel after ingesting caffeine, but did you know that caffeine also has anti-inflammatory and antioxidant effects?1 Caffeine has also been shown to improve how our blood vessels function.2 Caffeine directly stimulates cell metabolism due to increasing the availability of energy by freeing fat from fat stores.3 These mechanisms are thought to be how caffeine positively affects hair growth.
Why is caffeine part of my treatment plan?
Your genetic pattern indicated that strategies to increase IGF-1 might benefit hair regrowth.4 Caffeine application has been shown to increase IGF-1 and improve hair growth.5
Is topical caffeine effective for alopecia?
Caffeine has been studied in androgenic alopecia in men, women, and women with telogen effluvium. Those studies revealed that caffeine helped strengthen hair, decrease hair shedding, and decrease the progression of balding.5 A 2017 study compared a topical 0.2% caffeine solution with minoxidil 5% and found similar results regarding hair growth between caffeine and minoxidil.6
Are there adverse effects when using caffeine?
Systemic absorption with topical caffeine is low. A study using a more concentrated topical caffeine solution showed minimal blood levels after administration, much lower than one would see after drinking coffee.7,8 Topical caffeine is well tolerated with few reported adverse effects.
Why do I need to keep using caffeine for hair loss?
Topical caffeine should be used once or twice a day as your physician prescribes. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Topical caffeine is not a cure for hair loss; it is a treatment.
References:
What are corticosteroids?
Corticosteroids or steroids, for short, are a class of prescription and over-the-counter medications that are used for conditions where the immune system is overactive. Steroids work by decreasing the release of several pro-inflammatory mediators such as prostaglandin and leukotrienes.
Why are corticosteroids part of my treatment plan?
Topical steroids are first-line therapy for patchy limited hair loss with alopecia areata. Your genetic profile indicated that your GR-alpha gene is normal. This gene encodes for the steroid receptor, and abnormalities in the gene make steroid therapy less effective. In these cases, we may have to use higher doses which increase the risk of side effects.
Are topical corticosteroids effective for alopecia areata (AA)?
Topical therapy with high potency corticosteroids have shown efficacy in clinical trials for alopecia areata. A trial of 70 patients with desoximetasone had 58% regrow their hair entirely after 12 weeks.1 Another 12-week trial compared betamethasone vs. triamcinolone injections vs. tacrolimus and found that more than 75% of people using betamethasone (the steroid) regrow their hair.2
Are there any adverse effects to using topical corticosteroids?
Adverse reactions can occur when using steroids and are more likely with longer durations and higher potency formulations. Adverse effects include local skin atrophy, hypo or hyperpigmentation, acne, redness, burning, stretch marks, telangiectasias, swelling, itching, pain, skin infections, and rarely adrenal suppression.3
How long is the treatment course for Alopecia areata?
Treatment for AA needs to be individualized based upon the response to therapy. In general, therapy is tapered within three to six months of starting therapy. If there is no response to initial therapy within three months, another agent will need to be initiated.
References
What is collagen?
Collagen refers to proteins that are crucial components of skin, connective tissue, bones, ligaments, cartilage, muscles, hair, and nails. The collagen protein is intertwined like a rope, giving it the strength and flexibility to be part of numerous structures in our body.
Why is collagen part of my treatment plan?
Your genetics identified a change in the Col1A1 gene, which regulates the production of collagen. Your body does not produce as much collagen as usual, which can directly impact the health of your skin and hair. Oral collagen supplementation improves collagen end products in the body.1,2 One clinical study showed a supplement containing collagen improved hair growth, hair quality, hair volume, and thickness.3 Collagen peptides were found to have a positive effect on hair thickness.4 Another with collagen supplementation showed collagen might improve skin hydration, elasticity, and overall appearance.5
What are the food sources of collagen?
Animal proteins like chicken, fish, beef are high in collagen. Bone broth is also a great source of collagen. Plant-based sources can improve collagen production by providing essential cofactors like vitamin C and vitamin A. These include berries, garlic, leafy greens, tomatoes, citrus fruits, brussel sprouts, carrots, and sweet potatoes.
How do deficiencies in collagen occur?
Collagen levels decline as we age. Malnourishment, specifically a protein deficit, can cause collagen deficiencies as well. There are several diseases associated with genes that are involved with collagen production and metabolism. Smoking, UV damage to the skin, stress, and excess sugar can also lower collagen levels.5
What are the symptoms of collagen deficiency?
Collagen deficiencies are associated with joint pains, decreased joint mobility, impaired skin integrity, dry skin, brittle nails, and wrinkled skin.
What does collagen do in the body?
Collagen maintains the skin’s structure and supports water retention, firm, smooth, and strong skin. Proline is a major component of collagen and also keratin. Keratin makes up approximately 95% of our hair. The middle layer of our skin is called the dermis. This layer holds our hair roots in place and is 70% collagen. During the growth phase of hair, collagen levels surround the hair follicle and thicken, which supports hair follicles entering and maintaining the anagen phase.6
Does collagen have any adverse effects?
Oral administration of collagen is well tolerated. One clinical trial reported stomach upset/dyspepsia and a lingering aftertaste in some people taking collagen.7
References
What is Vitamin A?
Vitamin A is a fat-soluble vitamin that exists in several forms, including retinol, retinoic acid, and retinal. All-trans retinol is the most active form and is the form that is present in foods. Carotenoids are precursors to retinol (a provitamin), and approximately 50% of the Vitamin A consumed in America comes from plant carotenoids.1
Why is vitamin A part of my treatment plan?
Your genetic profile indicates a change in the CRABP2 gene, which oversees the transport of vitamin A into the cells. Higher levels of vitamin A are necessary when this genetic change is present. Retinol increases collagen production, the hair growth factor IGF.2
Vitamin A is used topically to enhance skin cell health and reduce skin inflammation.3
Retinol is associated with hair growth and improvement in scalp skin conditions. It is a crucial vitamin for the growth, maturation, and maintenance of hair follicles.4
What are the food sources of vitamin A?
Eggs, milk, butter, fish, other animal proteins, & liver are sources of all-trans retinoic acid. Plant sources of carotenoids include kale, spinach, squash, avocado, sweet potatoes, and carrots.
How do deficiencies in vitamin A occur?
Malnutrition, liver disease, malabsorptive diseases, and pancreatic insufficiency are causes of vitamin A deficiency.5
Hodge C, Taylor C. Vitamin A Deficiency. [Updated 2021 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567744/
What are the symptoms of vitamin A deficiency?
Symptoms of vitamin A deficiency include vision loss, night blindness, increased infections, impaired immunity, dry skin, acne, and poor wound healing.5
What does vitamin A do in the body?
Vitamin A is an essential vitamin for the regulation of vision, cell growth and differentiation, immune cell function, bone development, skin integrity, cholesterol and steroid metabolism, and signaling between nerves in the brain.6
Does vitamin A have adverse effects?
Vitamin A is well tolerated up to doses of 10,000 IU daily. Amounts above this are associated with hair loss, liver toxicity, coma, and death. Other adverse effects of high amounts of Vitamin A include skin redness, hyperpigmentation, skin peeling, diarrhea, nausea, and vomiting.7
References
What is arginine?
Arginine is a conditional amino acid used to make proteins. Conditional amino acids are a class of amino acids that the body can make 100% of what it needs to function under normal circumstances. Under periods of stress or critical injury, additional amino acids are required from food intake.
Why is arginine part of my treatment plan?
Your Nimbus DNA Test discovered a mutation in the ACE gene that increases the amount of ACE-II, which constricts blood vessels.1,2 Poor blood flow has been linked to alopecia. Arginine works to increase nitric oxide, which improves blood flow and the delivery of nutrients to hair follicles.3 Topicals containing 2-6% arginine have been used to improve blood flow.
What are the food sources of arginine?
Animal protein is the primary dietary source of arginine.
How do deficiencies in arginine occur?
Arginine deficiencies are rare but can occur from severe illness, severe calorie restriction, and rare genetic mutations that increase arginine turnover or decrease its absorption. Sickle cell disease, malaria, cystic fibrosis, and liver transplantation have been associated with lower arginine levels.4
What are the symptoms of arginine deficiency?
Symptoms of arginine deficiency can include increased blood pressure and increased susceptibility to infections.4
What does arginine do in the body?
Arginine is an essential regulator of blood flow for our circulatory system. It is a precursor to nitric oxide, which is the principal regulator of blood flow. Arginine also has an anti-inflammatory, antioxidant and participates in the regulation of several hormones.5
Does arginine have adverse effects?
Topical use of arginine is very well tolerated without reported adverse events. Reports of abdominal pain, bloating, nausea, diarrhea, headache, insomnia, and flushing have been reported.5
Resources
What is melatonin?
Melatonin is a hormone produced by the pineal gland in the brain and our skin.1
Why is melatonin part of my treatment plan?
Your genetic testing and questionnaire indicate you could benefit from melatonin therapy. Melatonin can decrease the activity of the androgen receptor, which neutralizes the impact of DHT and results in improved hair growth/retention. Melatonin also reduces the activity of aromatase, decreasing the conversion of testosterone to estrogen. Clinical research shows that melatonin therapy can improve hair density, hair counts, hair texture, decrease hair loss, and reduce inflammation and oil production in seborrheic dermatitis.1-3
What are the food sources of melatonin?
Eggs, fish, grains (wheat, barley, oats), black rice, grapes, strawberries, cherries, tomatoes, peppers, pistachios, mustard seeds, and mushrooms are food sources with abundant melatonin. Oral melatonin is not very well absorbed, but studies show that eating melatonin-rich foods does increase blood melatonin levels.4
How do deficiencies in melatonin occur?
Melatonin deficiencies occur in diabetes, fibromyalgia, migraines, critical illnesses, and shift work disorders. Genetics and age can also influence melatonin levels.
What are the symptoms of melatonin deficiency?
Chronic insomnia, depression, memory and learning issues, inflammation, recurrent infections, premature aging, increased visceral body fat and blood sugars, and hair loss is associated with a melatonin deficiency.5
What does melatonin do in the body?
Melatonin has various functions inside the body, but its primary role is to regulate the circadian rhythm for light-dark cycles. Melatonin also serves as an antioxidant, regulates the immune system, helps fight inflammation, slows aging, has anti-cancer properties, and helps regulate blood sugar, lipid metabolism, mood, and body temperature. Melatonin is an essential hormone!4
Our skin has melatonin receptors, and melatonin in the skin helps protect skin cells from damage. It also positively influences the aging processes in the skin. Melatonin also has a role in the normal growth of our skin cells and hair follicles. Melatonin accelerates hair growth and stimulates hair cells to enter the anagen (growth) phase.1
Does melatonin have adverse effects?
In clinical trials, topical melatonin was well tolerated. Topical melatonin is slightly absorbed into the bloodstream, but the effect was not significant in clinical trials. There was no change in vitals or neurocognitive effects. One clinical study had a few patients experience temporary reddening, itching, and burning, but none discontinued the medication. No systemic symptoms were reported.1
Resources
What is D-panthenol?
D-Panthenol is what we call a provitamin. Provitamins are compounds that must be activated by the body to become a vitamin that can be used by our cells. In this case, D-Panthenol is turned into vitamin B5, also known as pantothenic acid.
Why is D-panthenol part of my treatment plan?
Your answers to the questionnaire and genetic testing indicate that you would benefit from therapy with D-panthenol. Another function of this crucial vitamin is the formation of Coenzyme A. Coenzyme A is essential for making the fatty acids that are a part of the skin’s natural lubricants. Topical preparations using 1-5% D-panthenol have been shown to improve skin moisturization, enhance collagen production, enhance skin barrier function, reduce dryness and irritation of the skin, prevent early hair greying, aid in the restoration of normal hair color, and supports normal hair growth.1-3
What are the food sources of D-panthenol?
Food sources of vitamin B5 include broccoli, sweet potatoes, mushrooms, eggs, nuts, chicken, legumes, nuts, and cabbage.4
How do deficiencies in D-panthenol occur?
Deficiencies of vitamin B5 are very rare. A rare genetic condition named pantothenate kinase-associated neurodegeneration is associated with deficiency.
What are the symptoms of D-panthenol deficiency?
Deficiencies in vitamin B5 are rare. Symptoms of a deficiency include fatigue, insomnia, depression, burning in the feet, vomiting, and frequent upper respiratory infections.
What does D-panthenol do in the body?
Vitamin B5 is necessary for the normal functioning of our digestive system and nervous system, metabolism of proteins, carbohydrates, and fats, and the production of red blood cells, sex hormones, and stress hormones. It also has a role in keeping our skin and hair healthy. Pantothenic Acid.4
Does D-panthenol have adverse effects?
Topical therapy with D-panthenol is well tolerated. There are reports of itching, dermatitis, burning, and eczema with topical therapy.4
References
What is Biotin?
Vitamin B7, also known as Biotin, is an essential water-soluble B vitamin.
Why is Biotin part of my treatment regimen?
Your genetic testing indicated you have a gene alteration in the enzyme Biotinidase. Biotinidase frees up Biotin from the proteins it is bound to in foods.1 Supplementation of Biotin in deficient individuals is associated with improvements in hair loss.2
What are the food sources of Biotin?
Biotin is found in egg yolks, legumes, liver, nuts, mushrooms, sweet potatoes, avocados, broccoli, & bananas.
How do deficiencies in Biotin occur?
Biotin deficiencies are associated with pregnancy, bariatric surgery, malabsorption diseases, genetics, and diabetes.3
What are the symptoms of Biotin deficiency?
Biotin deficiency is associated with fatigue, hair loss, hair color loss, red scaly facial rashes, depression, and numbness and tingling in the extremities.4,5
What does Biotin do in the body?
Enzymes use Biotin in the body involved with the metabolism of carbohydrates, proteins, and fats.
Does Biotin have adverse effects?
Biotin is well tolerated when given orally. One study of patients taking high dose Biotin had a few participants experience mild diarrhea.6
Resources:
What is Zinc?
Zinc is a mineral found in the earth that is an essential nutrient for animals and plants, Zinc including humans. It is the second most abundant trace mineral in the body behind iron. The average person has between 1.5g and 2.5g of Zinc present.1 The body does not have a reservoir of Zinc stored; thus, we must continuously consume Zinc from food.
Why is Zinc part of my treatment plan?
Studies have shown that Zinc can improve hair growth in Alopecia2 and that low Zinc levels are associated with poor treatment response.3
What are the food sources of Zinc?
Zinc is most abundant in animal sources like fish, poultry, and beef. Approximately 186% more Zinc is found in animal sources versus plant sources.1 Plant sources of Zinc are not absorbed as well because of anti-nutrients such as phytates.
How does one become Zinc deficient?
Deficiencies in Zinc are common amongst vegetarians or those who are heavily plant-based. Other reasons include genetics, excess iron or copper intake (compete for absorption), chronic diarrhea, medications (ace inhibitors, antacids, diuretics), excess alcohol intake, and bariatric surgery.
What are the symptoms associated with Zinc deficiency?
Erectile dysfunction, diarrhea, alopecia, nail discoloration/distortion, low testosterone, & decreased immunity are associated with deficiencies in Zinc.4
What does Zinc do in the body?
Zinc has several different functions inside the body. It is a necessary co-factor for over 300 different reactions in the body. Zinc is essential for our immune system, hair growth, protein metabolism, synthesis of red blood cells (heme), DNA synthesis, gene expression (30% of Zinc is in the nucleus), growth and development, reproductive hormones, digestion, antioxidant function, detoxification, the transport of Vitamin A, the communication between nerve cells, carbohydrate metabolism through proper insulin signaling, moderating inflammation, lipid balance, and bone health.5
Does Zinc have adverse effects?
Zinc is well tolerated at doses below 40 mg daily. Reported adverse events include abdominal cramps, diarrhea, nausea & vomiting, and a metallic taste.6
Resources:
Institute of Medicine (U.S.). DRI: Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press; 2001.
What is levocetirizine?
Levocetirizine is an antihistamine that also has anti-inflammatory properties. Levocetirizine is the purified and concentrated active version of cetirizine. Cetirizine is comprised of 50% levocetirizine. Levocetirizine blocks prostaglandin D2 and increases the release of prostaglandin E2. Prostaglandin E2 stimulates hair growth, while prostaglandin D2 inhibits hair growth.1
Why is levocetirizine part of my treatment regimen?
Your genetic profile indicates you have normal activity of the prostaglandin D2 receptor, which promotes hair loss. Inhibiting this and increasing prostaglandin E2 will favor hair growth.
Is topical levocetirizine effective for alopecia?
1% topical cetirizine has been evaluated in clinical trials for alopecia. These trials found improved hair density, hair diameter with cetirizine, and self-reported symptom severity.1-3
Are there adverse effects when using topical levocetirizine?
Topical cetirizine is well tolerated. One clinical study showed no adverse effects with topical treatment, however, topical therapy with any agent can result in skin reactions such as redness, rash, irritation, or hives.1
Why do I need to keep taking cetirizine?
Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Cetirizine is not a cure for hair loss; it is a treatment.
References
What is finasteride?
Finasteride is a prescription treatment that blocks the enzyme 5-alpha reductase type II. 5-alpha reductase turns testosterone into dihydrotestosterone (DHT).
Why is finasteride part of my treatment plan?
Your genetics indicate that your steroid-reductase type II activity is high. This will lead to increased levels of DHT, which impairs hair growth.
Are topical and oral finasteride effective for alopecia?Oral finasteride is FDA-approved to treat androgenic alopecia. Finasteride has proven to be effective in increasing hair counts and density compared to placebo. The placebo treatment arms had worsened hair loss. Patients in trials reported improved appearance of their hair as well.1,2
Why does Nimbus use low doses of oral finasteride?
Oral finasteride has the potential to cause significant side effects. By lowering systemic levels of DHT, you reduce the level of the most potent forms of testosterone. Unfortunately, this can lead to decreased libido, erectile dysfunction, adverse sexual experiences, nipple discharge, prostate cancer, and male breast cancer. Finasteride is also associated with changes in mental health, such as depression, anxiety, and brain fog. Side effects usually resolve after medication discontinuation but may persist in rare cases. Stop taking finasteride immediately and contact your physician if you experience any of these side effects.
Finasteride is category X in pregnancy as it causes birth defects in a male fetus. The use of finasteride in pregnancy-eligible women is contraindicated unless reliable forms of contraception are used in conjunction. The risk of adverse effects can be lessened by using topical finasteride.2 One study compared topical finasteride 1% with 1 mg finasteride tablets and found no difference in the therapeutic effect.3 We believe in using low doses of oral finasteride to reduce the likelihood of systemic side effects that can occur. Topical therapy is our preferred choice, given the improved safety profile.
Are there any adverse effects while using topical finasteride?
Topical finasteride is well tolerated. Redness and irritation have been reported at the application site.2 Other rare adverse events include low blood pressure, breast tenderness/enlargement, high-grade prostate cancer, allergic reactions, and leg swelling.4 Why do I need to keep taking finasteride?Finasteride should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Finasteride is not a cure for hair loss; it is a treatment.
Drug Summary: Finasteride
References
1) Kaufman KD, Olsen EA, Whiting D, et al. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998;39(4 Pt 1):578-589. doi:10.1016/s0190-9622(98)70007-6
2) Shapiro J, Kaufman KD. Use of finasteride in the treatment of men with androgenetic alopecia (male pattern hair loss). J Investig Dermatol Symp Proc. 2003;8(1):20-23. doi:10.1046/j.1523-1747.2003.12167.x
3) Caserini M, Radicioni M, Leuratti C, Terragni E, Iorizzo M, Palmieri R. Effects of a novel finasteride 0.25% topical solution on scalp and serum dihydrotestosterone in healthy men with androgenetic alopecia. Int J Clin Pharmacol Ther. 2016;54(1):19-27. doi:10.5414/CP202467
4) Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol. 2009;75(1):47-51. doi:10.4103/0378-6323.45220
What is triamcinolone?
Triamcinolone belongs to a class of medications called corticosteroids, a class of prescription and over-the-counter drugs used for conditions where the immune system is overactive. Steroids decrease the release of several pro-inflammatory mediators, such as prostaglandin and leukotrienes.
Why is triamcinolone part of my treatment plan?
Topical corticosteroids are first-line therapy for the patchy limited hair loss seen with alopecia areata. Your genetic profile indicated that your GR-alpha gene is normal. This gene encodes for the corticosteroid receptor, and abnormalities in the gene make steroid therapy less effective. Alternative medications are recommended for changes in the GR-alpha gene that make steroids less effective.
Are topical corticosteroids effective for alopecia areata (AA)?
Topical therapy with corticosteroids has shown efficacy in clinical trials for alopecia areata. In a trial of 70 patients with desoximetasone, 58% regrow their hair entirely after 12 weeks.1 Another 12-week trial compared betamethasone vs. triamcinolone injections vs. tacrolimus and found that more than 75% of people using betamethasone (the steroid) regrow their hair.2
Are there any adverse effects to using topical corticosteroids?
Adverse reactions can occur when using steroids and are more likely with longer durations and higher potency formulations. Adverse effects include local skin atrophy, hypo or hyperpigmentation, acne, redness, burning, stretch marks, telangiectasias, swelling, itching, pain, skin infections, and rarely adrenal suppression.3
How long is the treatment course for AA
Treatment for AA needs to be individualized based on the response to therapy. Therapy is generally tapered within three to six months. If there is no response to treatment within three months, another agent should be initiated.
Drug Summary: Triamcinolone
References
What is semaglutide?
Semaglutide is a peptide medication that belongs to a class called glucagon-like peptide-1 receptor (GLP-1) agonists. GLP-1 is a hormone released by the intestines in response to food to aid in glucose metabolism and satiety (feeling full after a meal). GLP-1 decreases the rate at which food empties from the stomach, which reduces calorie intake and promotes weight loss.^1 The body clears GLP-1 made by the intestinal cells within minutes.^2 Semaglutide is given as a weekly injection and maintains elevated levels of GLP-1 for seven days.^3
How is semaglutide different than Ozempic or Wegovy?
Wegovy and Ozempic are brand-name medications that utilize semaglutide for different reasons. The FDA approved Ozempic for the management of Type 2 diabetes. Clinical studies revealed that patients with diabetes who took Ozempic lost weight. Subsequent trials in overweight and obese adults demonstrated efficacy as a weight loss agent, and Wegovy was approved for this indication by the FDA.^4 The semaglutide that Nimbus uses is compounded in a specialty pharmacy because semaglutide is on the FDA shortage list. The FDA shortage list lists medications where demand exceeds the available supply. Compounding pharmacies can compound a therapeutically equivalent semaglutide and distribute that to patients with a legitimate prescription.^5
How effective is semaglutide for weight loss?
Semaglutide can be a very effective agent for weight loss; however, patients with diabetes lose less weight than patients without diabetes.^6 In a recent two-year trial of semaglutide vs. placebo, the participants in the semaglutide group lost an average of 15.2% of their initial body weight compared to 2.6% for placebo.^7 However, once semaglutide is stopped, significant weight regain can occur. One year after stopping semaglutide and lifestyle interventions, participants regained 11.6% of their body weight for a net loss of 5.6% of initial body weight. A regression was also seen in cardiometabolic markers that had improved while on semaglutide therapy.^8
For this reason, we do not believe in treating with semaglutide alone. Our Discover You program has robust information regarding the big five of lifestyle medicine (mindset, nutrition, exercise, stress management, and sleep). These are essential to creating a mindset shift to ensure long-term behavioral changes and sustainable weight loss. The STEP 3 trial showed a significant improvement in body weight (a loss of 5.7% of initial body weight) in the placebo group placed in an energy deficit and receiving behavioral counseling.^9
Who is not a good candidate for semaglutide?
Semaglutide can interact with medications used for diabetes. Patients on diabetes medications other than metformin are at a higher risk of developing low blood sugars. Also, patients with diabetes complications of the eye should not use semaglutide. Semaglutide should not be used in patients with a history of pancreatitis, acute kidney injury, or gallbladder disease, as semaglutide may worsen these conditions. Patients with a family or personal history of multiple endocrine neoplasia syndrome or medullary thyroid cancer are not candidates for semaglutide therapy.^3 Women who are pregnant or trying to become pregnant are not candidates for semaglutide therapy.
What are the adverse effects of semaglutide
In a two-year trial of semaglutide for weight loss, adverse effects leading to discontinuation of the medication occurred in 5.9% of the participants. The most common adverse effects were nausea (53.3%), diarrhea (34.9%), constipation (30.9%), vomiting (30.3%), abdominal pain (13.2%), allergic reactions (15.1%), dyspepsia (13.2%), flatulence (13.2%), gastroenteritis (13.2%), and belching (11.2%). Rare events included low blood sugar (2.6%), gallbladder disorders (2.6%), and injection site reactions (6.6%). No events of pancreatitis or acute renal failure were seen in this study, but pancreatitis (inflammation of the pancreas) and renal failure due to dehydration from vomiting, diarrhea, or inadequate hydration are possible adverse effects.^7,10
The gastrointestinal adverse effects of semaglutide are usually transient, mild, and resolve by the time the maintenance dose is reached. Persistent or severe nausea, vomiting, diarrhea, or abdominal pain is worrisome. Stop taking semaglutide if you experience persistent or severe nausea, vomiting, diarrhea, or abdominal pain, and seek immediate medical attention. Severe abdominal pain, nausea, or vomiting can be a sign of pancreatitis, which may require hospitalization for treatment. Do not “push through” repeated bouts of diarrhea, nausea, and vomiting, as this can lead to severe dehydration with serious consequences such as acute renal failure. Maintaining adequate hydration is essential for clinical success with semaglutide.
Using semaglutide without strength/resistance training and adequate protein intake may result in a significant loss of lean mass. In two trials utilizing semaglutide, the participants saw 39% and 40% of their total weight loss be loss of lean mass.^4,11
In September 2023, the FDA issued an alert for semaglutide due to reports of ileus (slowing or stopping flow through the intestines). This advisory is due to voluntary reports received by the FDA; however, at this time, the FDA can not estimate the frequency of ileus or whether the ileus was caused by semaglutide. Nimbus Healthcare will keep up with new information as it is released and update this page accordingly.
Are there any tips to minimize semaglutide adverse effects?
To prevent muscle loss, we recommend maintaining a protein intake of approximately 0.8 g /lb of body weight and performing resistance training two to three times a week for a total of 75 minutes a week. We suggest working with a personal trainer or fitness professional to fine-tune your workout regimens to your individual needs.^12 As we age, sarcopenia (loss of muscle mass) is associated with an increased risk of cardiovascular disease, falls, dementia, diabetes, kidney dysfunction, some cancers, and poor disease prognosis.^13
Semaglutide decreases the rate at which the stomach empties into the intestines, thus increasing satiety and fullness. Overeating can lead to nausea, vomiting, diarrhea, and abdominal pain. Tips to prevent overeating include eating slowly, eating smaller portions, limiting snacking and eating only when hungry, eating until you feel like you are 80% full, eating smaller, more frequent meals, avoiding using a straw to reduce swallowing air, limiting liquid intake during meals or 30 to 60 minutes before or after meals, limiting eating right before bed or eating and then lying down, and trying not to perform vigorous activity directly after a meal. Mint or ginger-based drinks and avoiding strong smells within 30 minutes of taking semaglutide may help to reduce nausea.
If an adverse effect persists at a specific dose but is not present at a lower dose, we recommend remaining at the lower dose.
Are there additional weight loss resources you recommend?
I recommend the book Fat Loss Forever by Dr. Layne Norton. It is an excellent book on creating sustainable habits with nutrition and exercise to lose weight and keep it off. The Carbon Diet App is a great app that provides calorie counting and coaching. As you lose weight and gain muscle, your calorie needs will change. The Carbon Diet app offers guidance on calories and macros to maintain muscle mass while eating a diet below maintenance calories (a calorie deficit). Another good book on nutrition is Flexible Dieting by Alan Aragon.
How do I use semaglutide?
Semaglutide is given as a subcutaneous (under the skin) injection once a week. Store semaglutide in the refrigerator away from light, heat, and moisture. Unused or expired medication should be thrown away and not flushed down the toilet or placed down the sink. The starting dose is 0.25 mg per week, which is increased as tolerated every month until the maximum dose of 2 mg per week is achieved. The maximum weight loss is achieved between six to twelve months of therapy.^7
How much medication to draw up in the syringe depends on your vial concentration and prescribed dose. See the instructions that come in your Nimbus package for accurate administration instructions.
1 Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in
diabetes and beyond. Drugs Context. 2015;4:212283. Published 2015 Jul 9.
doi:10.7573/dic.212283
2 Gupta V. Glucagon-like peptide-1 analogues: an overview. Indian J Endocrinol
Metab. 2013;17(3):413–21.
3 Ozempic (semaglutide) [prescribing information]. Plainsboro, NJ: Novo Nordisk Inc; October
2022.
4 Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with
Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
5 https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm
6 Jensterle M, Rizzo M, Haluzík M, Janež A. Efficacy of GLP-1 RA Approved for Weight
Management in Patients With or Without Diabetes: A Narrative Review. Adv Ther.
2022;39(6):2452-2467. doi:10.1007/s12325-022-02153-x
7 Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with
overweight or obesity: the STEP 5 trial. Nat Med. 2022;28(10):2083-2091. doi:10.1038/s41591-
022-02026-4
8 Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725
9 Wadden TA, Bailey TS, Billings LK, et al. Effect of Subcutaneous Semaglutide vs Placebo as an Adjunct to Intensive Behavioral Therapy on Body Weight in Adults With Overweight or Obesity: The STEP 3 Randomized Clinical Trial. JAMA. 2021;325(14):1403-1413. doi:10.1001/jama.2021.1831
10 Rubino DM, Greenway FL, Khalid U, et al. Effect of Weekly Subcutaneous Semaglutide vs
Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The
STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619
11 McCrimmon RJ, Catarig AM, Frias JP, et al. Effects of once-weekly semaglutide vs once-daily
canagliflozin on body composition in type 2 diabetes: a substudy of the SUSTAIN 8 randomised
controlled clinical trial. Diabetologia. 2020;63(3):473-485. doi:10.1007/s00125-019-05065-8
12 Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gómez J, et al. Clinical Recommendations
to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A
Multidisciplinary Expert Consensus. J Clin Med. 2022;12(1):145. Published 2022 Dec 24.
doi:10.3390/jcm12010145
13 He N, Zhang Y, Zhang L, Zhang S, Ye H. Relationship Between Sarcopenia and Cardiovascular Diseases in the Elderly: An Overview. Front Cardiovasc Med. 2021;8:743710. Published 2021 Dec 9. doi:10.3389/fcvm.2021.743710
What is tirzepatide?
Tirzepatide is a peptide medication that mimics the actions of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). GLP-1 is a hormone released by the intestines in response to food to aid in glucose metabolism and satiety (feeling full after a meal). GLP-1 decreases the rate at which food empties from the stomach, which reduces calorie intake and promotes weight loss.^1 The body clears GLP-1 made by the intestinal cells within minutes.^2 Tirzepatide is given as a weekly injection because it is slowly removed from the body.^3
GIP is another incretin hormone secreted by the intestines in response to nutrient intake. GIP is involved with insulin signaling, fat metabolism, and satiety. Tirzepatide is about five times more potent at mimicking GIP than GLP-1.^4
How is tirzepatide different from Mounjaro?
Mounjaro is a brand-name medication that contains tirzepatide. The FDA approved Mounjaro for the management of type 2 diabetes. Clinical studies revealed that patients with diabetes who took Mounjaro lost weight. Subsequent trials in overweight and obese adults demonstrated efficacy as a weight loss agent; however, FDA approval for weight loss is currently pending. The tirzepatide that Nimbus uses is compounded in a specialty pharmacy because tirzepatide is on the FDA shortage list. The FDA shortage list lists medications where demand exceeds the available supply. Compounding pharmacies can compound a therapeutically equivalent tirzepatide and distribute that to patients with a legitimate prescription.^5
How effective is tirzepatide for weight loss?
The SURMOUNT-1 trial was a 72-week study done in obese individuals without diabetes. Three doses were compared to placebo: 5 mg, 10 mg, and 15 mg. Weight loss was 15% of body weight with the 5 mg dose, 19.5% of body weight with the 10 mg dose, and 20.9% of body weight with the 15 mg dose compared to 3.1% with placebo.^6 The SURMOUNT-3 trial utilized a 12-week lifestyle intervention lead-in period followed by 72 weeks of tirzepatide or placebo. The tirzepatide group lost 26.6% of their body weight after 12 weeks of lifestyle intervention, followed by 72 weeks of treatment. ^7 However, participants in SURMOUNT-4 showed significant weight regain after stopping tirzepatide. After 36 weeks on the tirzepatide trial, participants lost 21.1% of their body weight. The participants randomized to placebo after that regained 14.8% of their body weight over the next 52 weeks. For this reason, we do not believe in treating with tirzepatide alone. Our Nimbus Health Club has robust information regarding the big five of lifestyle medicine (mindset, nutrition, exercise, stress management, and sleep). These are essential to creating a mindset shift to ensure long-term behavioral changes and sustainable weight loss.
Who is not a good candidate for tirzepatide^8?
Tirzepatide can interact with medications used for diabetes. Patients on diabetes medications other than metformin are at a higher risk of developing low blood sugars. Also, patients with diabetes complications of the eye should not use tirzepatide. Tirzepatide should not be used in patients with a history of pancreatitis, acute kidney injury, or gallbladder disease, as tirzepatide may worsen these conditions. Patients with a family or personal history of multiple endocrine neoplasia syndrome or medullary thyroid cancer are not candidates for tirzepatide therapy. Women who are pregnant or trying to become pregnant are not candidates for tirzepatide therapy. Patients with a history of gastroparesis or slowing of intestinal transit should be cautious when using GLP-1 medications, as tirzepatide may worsen these conditions.
What are the adverse effects of tirzepatide?
The most common adverse effects of tirzepatide are nausea, vomiting, abdominal pain and diarrhea. Serious adverse events leading to discontinuation of the medication were reported in 4.3% to 7.1% of participants in the SURMOUNT-1 trial. Serious adverse events were reported in 5.1% to 6.9% of participants. Seroius adverse events included pancreatitis, gallbladder and liver issues, allergic reactions, renal failure, and arrhythmias.
The gastrointestinal adverse effects of semaglutide are usually transient, mild, and resolve by the time the maintenance dose is reached. Persistent or severe nausea, vomiting, diarrhea, or abdominal pain is worrisome. Stop taking semaglutide if you experience persistent or severe nausea, vomiting, diarrhea, or abdominal pain, and seek immediate medical attention. Severe abdominal pain, nausea, or vomiting can be a sign of pancreatitis, which may require hospitalization for treatment. Do not “push through” repeated bouts of diarrhea, nausea, and vomiting, as this can lead to severe dehydration with serious consequences such as acute renal failure. Maintaining adequate hydration is essential for clinical success with semaglutide.
Using GLP-1 medications without strength/resistance training and adequate protein intake may result in a significant loss of lean mass. In two trials utilizing semaglutide, the participants saw 39% and 40% of their total weight loss be loss of lean mass. This effect has not been seen with tirzepatide in clinical trials yet. . ^9,10
In September 2023, the FDA issued an alert for semaglutide (a GLP-1 medication like tirzepatide) due to reports of ileus (slowing or stopping flow through the intestines). This advisory is due to voluntary reports received by the FDA; however, at this time, the FDA can not estimate the frequency of ileus or whether the ileus was caused by semaglutide. Nimbus Healthcare will keep up with new information as it is released and update this page accordingly.
Are there any tips to minimize tirzepatide adverse effects?
To prevent muscle loss, we recommend maintaining a protein intake of approximately 0.8 g /lb of body weight and performing resistance training two to three times a week for a total of 75 minutes a week. We suggest working with a personal trainer or fitness professional to fine-tune your workout regimens to your individual needs.^11 As we age, sarcopenia (loss of muscle mass) is associated with an increased risk of cardiovascular disease, falls, dementia, diabetes, kidney dysfunction, some cancers, and poor disease prognosis. ^12
Tirzepatide decreases the rate at which the stomach empties into the intestines, thus increasing satiety and fullness. Overeating can lead to nausea, vomiting, diarrhea, and abdominal pain. Tips to prevent overeating include eating slowly, eating smaller portions, limiting snacking and eating only when hungry, eating until you feel like you are 80% full, eating smaller, more frequent meals, avoiding using a straw to reduce swallowing air, limiting liquid intake during meals or 30 to 60 minutes before or after meals, limiting eating right before bed or eating and then lying down, and trying not to perform vigorous activity directly after a meal. Mint or ginger-based drinks and avoiding strong smells within 30 minutes of taking semaglutide may help to reduce nausea.
If an adverse effect persists at a specific dose but is not present at a lower dose, we recommend remaining at the lower dose.
Are there additional weight loss resources you recommend?
I recommend the book Fat Loss Forever by Dr. Layne Norton. It is an excellent book on creating sustainable habits with nutrition and exercise to lose weight and keep it off. The Carbon Diet App is a great app that provides calorie counting and coaching. As you lose weight and gain muscle, your calorie needs will change. The Carbon Diet app offers guidance on calories and macros to maintain muscle mass while eating a diet below maintenance calories (a calorie deficit). Another good book on nutrition is Flexible Dieting by Alan Aragon.
How do I use tirzepatide?
Tirzepatide is given as a subcutaneous (under the skin) injection once a week. Store tirzepatide in the refrigerator away from light, heat, and moisture. Unused or expired medication should be thrown away and not flushed down the toilet or placed down the sink. The starting dose is 2.5 mg per week, which is increased as tolerated every month until the maximum dose of 15 mg per week is achieved.
How much medication to draw up in the syringe depends on your vial concentration and prescribed dose. See the instructions that come in your Nimbus package for accurate administration instructions.
Citations
1) Prasad-Reddy L, Isaacs D. A clinical review of GLP-1 receptor agonists: efficacy and safety in diabetes and beyond. Drugs Context. 2015;4:212283. Published 2015 Jul 9. doi:10.7573/dic.212283
2) Gupta V. Glucagon-like peptide-1 analogues: an overview. Indian J Endocrinol Metab. 2013;17(3):413–21.
3) Mounjaro (tirzepatide) [prescribing information]. Indianapolis, IN: Eli Lilly; May 2022.
4) Fisman, E.Z., Tenenbaum, A. The dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide: a novel cardiometabolic therapeutic prospect. Cardiovasc Diabetol 20, 225 (2021). https://doi.org/10.1186/s12933-021-01412-5
5) https://www.accessdata.fda.gov/scripts/drugshortages/default.cfm
6) Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
7) le Roux CW, Zhang S, Aronne LJ, et al. Tirzepatide for the treatment of obesity: Rationale and design of the SURMOUNT clinical development program. Obesity (Silver Spring). 2023;31(1):96-110. doi:10.1002/oby.23612
8) Mounjaro (tirzepatide) [prescribing information]. Indianapolis, IN: Eli Lilly and Company; May 2022.
9) Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
10) McCrimmon RJ, Catarig AM, Frias JP, et al. Effects of once-weekly semaglutide vs once-daily canagliflozin on body composition in type 2 diabetes: a substudy of the SUSTAIN 8 randomised controlled clinical trial. Diabetologia. 2020;63(3):473-485. doi:10.1007/s00125-019-05065-8
11) Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gómez J, et al. Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus. J Clin Med. 2022;12(1):145. Published 2022 Dec 24. doi:10.3390/jcm12010145
12) He N, Zhang Y, Zhang L, Zhang S, Ye H. Relationship Between Sarcopenia and Cardiovascular Diseases in the Elderly: An Overview. Front Cardiovasc Med. 2021;8:743710. Published 2021 Dec 9. doi:10.3389/fcvm.2021.743710
