Update on Nutrafol, a Good Article on Testosterone

Long COVID and Menopause, and more health potpourri

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It’s time for some potpourri!

No, not like a bag of herbs or anything remotely related to vaginal steaming (as if!), but a collection of shorter posts that don’t really have a unifying theme beyond women’s health. Think of these posts as what I might chat about if we were seated next to each other at a dinner party and you asked me to share some things that have recently piqued my interest.

1. I cannot verify that Nutrafol is tested by an independent third party.

I recently wrote about Nutrafol in this post. I noted that I could not verify who was conducting their third-party testing. Many supplements are adulterated or don’t contain what they claim, so independent and publicly available third-party testing is essential to ensure the product contains what the manufacturer claims.

I have now emailed the company multiple times. I received a couple of “contact this other person” replies, and when I did, crickets. Maybe I am just small beans as far as they are concerned. Still, if you have your supplement tested by a recognized independent third party to ensure it contains what it claims, it takes 30 seconds to send me the information to shut me up instead of passing me off to someone else. Color me unimpressed.

Add this to the many other reasons I don’t recommend Nutrafol’s hair growth “neutraceutical” (which is a marketing term, not a medical one, hence the quotations). Among the other reasons you couldn't pay me to take it are:

• It contains two “proprietary” blends, which means you can’t know the exact amount of each ingredient, and proprietary blends are linked with liver injury.

• It contains turmeric, which in supplements is also associated with liver injury.

• It has excessive amounts of vitamin A

• It contains biotin, and no quality studies support biotin for treating or preventing hair loss outside of treating people with a biotin deficiency. According to the NIH Office of Dietary Supplements, “Biotin deficiency is rare, and severe biotin deficiency in healthy individuals eating a normal mixed diet has never been reported.” Also, biotin supplements can interfere with some blood tests, including those for thyroid conditions and a troponin test, which is used to help diagnose a heart attack.

• No quality study shows Nutrafol works. Honestly, what they pass off as supporting studies on their website is the medical equivalent of “My mom likes my product.”

2. The New York Times Writes a Balanced Article on Testosterone and Menopause

Here is a gift link (I hope it works) for those who want to read it. It’s pretty short and to the point. I’ve seen other good work by the author, Danielle Friedman, so I also think of her as a trusted source.

Nothing here will surprise you if you have read this previous article of mine on testosterone. The main takeaways from the NYT piece are:

• Transdermal testosterone can help about 50% of women in menopause with libido issues, but the benefits are modest at best. This is not a wonder drug.

• We do not have the data to support it for other reasons, such as mood well-being, muscle strength, or heart health.

• There is a reasonably robust placebo effect.

• Pellets are never recommended.

And I’ll add that the placebo effect is higher when people pay more for medication. Now, think of how the loudest voices about testosterone on social media charge $1500 or more an hour to see patients. Cash only.

I know some doctors are regularly over-promoting testosterone on social media, and those videos get a lot of attention. Recently, I saw an account making a big deal about a pilot study showing testosterone improved mood and claimed that we’ve known this for years (it’s an older study). The implication was, “Duh, we have proof it helps mood,” and I guess doctors like me are stuck in the dark ages. One of the study’s authors actually commented that the person posting had failed to mention this was a pilot study and that larger studies later disproved its findings. This is a good lesson in why we don’t change clinical practice based on a single small study; instead, science is a body of evidence. Small studies help inform us for bigger, more robust studies. We have consensus statements that have reviewed the entire body of evidence. Women deserve robust data, not cherry-picked studies in video.

I recommend following Professor Sue Davis, one of the foremost (if not the foremost) experts on testosterone for women, as she is now on Instagram! Here’s the link to her profile.

3. Robert F. Kennedy Jr. will be the next Secretary of Health and Human Services.

It’s all but a done deal. He is the quintessential example of a mediocre (and in his case, saying he is mediocre is being kind) white man failing upwards.

He is a uniquely unqualified anti-science grifter who will use his power to profit while endangering the health of millions personally, if not billions, of people.

Here is my prediction for some of the havoc he will bring in the first three months:

“Review” *cough* the “safety” of mifepristone (abortion pill), which could mean removing the ruling that allows it to be dispensed by telemedicine or even reversing approval of the drug altogether. I suspect he will reverse the telemedicine ruling first to give him time to “review” the data. The implication that he is qualified to review the data is, of course, absurd. Kennedy promised to focus on mifepristone, so we should take him at his word. He is chomping at the bit to get to vaccines and raw milk, so I am sure he promised every forced birther Republican that he would enact their anti-abortion wet dreams. He doesn’t care about science, so he will rely on some bullshit report based on retracted studies (almost certainly, this report has already been written by Project 2025), instead of using the wealth of data that we already have. Mifepristone is safer than Viagra. It’s safer than pregnancy. It’s safer than acetaminophen. It’s safer than every supplement that contains turmeric. But science is inconvenient for dictatorships.

Almost certainly, Kennedy will also target childhood vaccines, and this will include the HPV vaccine. He can remove a vaccine from the schedule, meaning insurers would no longer have to pay for it, which would cause vaccination rates to plummet. He can stack the Advisory Committee on Immunization Practices (ACIP) with anti-vaccine activists, halting the development and approval of new vaccines. He could even get a vaccine’s approval reversed. And that’s only a few ways he could cause harm. To read about the many ways that RFK. Jr. could cause havoc by screwing with vaccines, I recommend this article.

If you or your family are not current on your vaccines, I’d strongly consider rectifying that in the next week or so. And I do mean in the next week or so. At the pace at which the Trump administration is moving to dismantle our overall scientific infrastructure, you should assume the worst-case scenario in your planning.

4. Promising Early Results for a Vaccine to Treat High-grade Cervical Intraepithelial Neoplasia or Precancer

We need some good news. Here is a “Go science!” moment and a testimony to the promise of vaccines.

Most cervical cancer is caused by infection with Human Papilloma Virus (HPV). While the vaccine is highly protective against infection (and at preventing cancer), it isn't very effective at clearing the virus when it has already resulted in high-grade cervical intraepithelial neoplasia, which is a pre-cancer. Many women with this pre-cancer go through years of painful and stressful testing and treatment, so a better option is very much needed. Given the tragically low update of the HPV vaccine and the number of people already infected before the vaccine became available, we still need more strategies to treat these pre-cancers.

Researchers have reported on a phase II study looking at a vaccine for HPV 16, the most common of the cancer-causing types of HPV, designed to target infections associated with pre-cancers. Women with pre-cancers due to HPV16 were given the study vaccine and closely followed to see if their cervical lesions cleared up or reduced in size, and biopsies were also taken to see how the tissues responded. This is a small study; only 18 patients were included, but for 17 of them, or 94%, the vaccine reduced the lesion size. When the tissues were biopsied, 50% cleared the precancer, and 63% cleared their HPV16 infection! While this study has a small number of patients and relatively short-term follow-up (20 or so months), it’s very exciting. Maybe we will one day be at a place where we can treat pre-cancer of the cervix with a vaccine, which would be of great help to those who never had the chance to get vaccinated.

Also, if you are wondering about getting vaccinated but are outside the age limits, I wrote about that here. I was vaccinated when I was 52!

5. White Blood Cell Count (WBC) and Severity of Long COVID for Women in Menopause.

File this under interesting.

Long COVID is partly believed to be due to dysregulated inflammation. To help evaluate this hypothesis, researchers mined the Women’s Health Initiative (WHI), looking specifically at white blood cell counts and high-sensitivity C-reactive protein results measured 25 or so years before infection with COVID-19. The researchers then compared these results with the 1,237 women in the WHI who subsequently had COVID-19 and completed a COVID-19 survey, which allowed the researchers to determine who had long COVID. A white blood cell count ≥ 5.5 × 1,000 cells/µL (normal is typically 4.5-11) was associated with more severe symptoms of long COVID symptoms, although not with the risk of developing long COVID. Interestingly, several studies have shown a link between a higher baseline white blood cell count and the later development of several health conditions, such as heart disease and several cancers, including breast, colon, and endometrial cancer.

Considering the normal range for a white blood cell count for women is 4.5-11, we can’t call a level of 5.5 abnormally high. Still, with more research, we may one day be able to use a white blood cell count and other markers to help predict the risk of infectious complications like long COVID and possibly understand why they occur. Considering the nature of the study, it’s impossible to use white blood cell count today as a predictive tool, although this is precisely the kind of study that unscrupulous providers might use to sell some scammy anti-inflammatory miracle cure!

I wanted to share this information because so many interesting articles don't offer grand proclamations; they are hopefully pieces of a larger puzzle that has yet to be assembled. This is the slow, meandering path of research. Also, this study shows how researchers continue to mine the WHI for other data.