The only nonchemical option offered up by the dermatologists I spoke with — short of a surgical hair transplant or platelet-rich plasma therapy, which is like Kim Kardashian’s vampire facial but for your scalp — was the laser comb. First cleared by the FDA in 2009, the HairMax LaserComb is a handheld laser device that is designed to promote hair growth. As the manufacturer explains in a letter to the FDA, “The device provides distributed laser light to the scalp while the comb teeth simultaneously part the user’s hair to ensure the laser light reaches the user’s scalp,” which, in turn, stimulates the hair follicles.
Dr. Curtis says genes and hormones are the leading causes of hair loss.  And it's not just something we face as we age.  She says, "I've seen patients as young as 14-15 years old start having hair loss. It's all dependent on your genetics. Unfortunately the earlier it starts, the more likely it's going to be more severe in nature and the faster it can progress."

The tricheologist advised me to take four (4) fish oil -1000 (blackmores brand) – this also helped sooth the scalp can reduced the itchiness down further. Using the B Complex and the fish oil daily I also saw more hair growth over the period of eight months and am continuing on this regime. I try aim at 300 minutes of walking a week and drinking water. I don’t drink soft drinks nor have sweets and try to avoid processed food.

As much as 30 percent of women will experience some sort of hair thinning, usually first noticed with age as a skinnier ponytail or a little more visible scalp peeking out. Thick hair screams “youth,” which makes thinning a tough pill to swallow. But there are many ways you can help slow down thinning and hair loss, from eating the right foods to cutting back on stress, even strategically styling your locks. Here, seven ways to stave off hair loss and keep your ‘do looking young and healthy for longer. 
decrease in your blood Prostate Specific Antigen (PSA) levels. Finasteride can affect a blood test called PSA (Prostate-Specific Antigen) for the screening of prostate cancer. If you have a PSA test done you should tell your healthcare provider that you are taking Finasteride because Finasteride decreases PSA levels. Changes in PSA levels will need to be evaluated by your healthcare provider. Any increase in follow-up PSA levels from their lowest point may signal the presence of prostate cancer and should be evaluated, even if the test results are still within the normal range for men not taking Finasteride. You should also tell your healthcare provider if you have not been taking Finasteride as prescribed because this may affect the PSA test results. For more information, talk to your healthcare provider.

I’m 42 and I noticed my front top and sides thinning about a year ago – a lot coming out when brushing after washing. I went to the doctor who happened to be African-American (I’m caucasion) and she actually asked me if I wore “corn rows” a lot! Needless to say, she was worthless and just prescribed me something for dandruff, which I do not have! I went to an endocrinologist to see if my thyroid or menopause was the problem – tests turned out honky dorie! Now I can see through the top of my head when the sun shines on it (scar-y) and I’m having to cover over the temple areas with sweeps of hair from the other side (interesting, the right side is much thinner). I will say that I’ve gone through hell and back with a mentally ill young adult but if it was stress, wouldn’t it have come out quicker than just in the last year (I’ve been dealing with his illness for 7 years now)?? I’ve heard that sometimes it takes 2 or 3 blood tests and doctors to finally see that one has thyroid problems. Is this the experience of others, and would I be throwing my money away by seeing my general practitioner?

I would like to encourage you to join the Network if you have not already. There are so many wonderful women in this beloved Network that would love to hear your stories. The emotional toll that hair loss can have on women can be devestating and knowing that we are not alone helps to set us on a firmer foundation as we walk this journey called “hairloss.” 

Side effects and concerns: Minoxidil is safe, but it can have unpleasant side effects even apart from the alcohol-related skin irritation. Sometimes the new hair differs in color and texture from surrounding hair. Another risk is hypertrichosis — excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)
Laser devices: Brushes, combs, and other hand-held devices that emit laser light might stimulate hair growth. These devices might make hair look more youthful in some people. Because the FDA classifies these products as medical devices, the products do not undergo the rigorous testing that medicines undergo. The long-term effectiveness and safety for these devices are not known.
Alopecia areata occurs when your immune system attacks your hair follicles, causing varying degrees of hair loss. Alopecia areata usually starts with one or more small, round, smooth bald patches on your head, and can eventually cause complete hair loss on your scalp or even on your entire body. Full body hair loss is known as alopecia universalis.
Dermatologist: The short answer is a doctor who specializes in the diagnosis and treatment of problems related to the skin, its structure, functions, and diseases, as well as its appendages (nails, hair, sweat glands). The longer definition (as defined by wikipedia) Dermatologists are physicians (Medical Doctors, M.D.) or Doctors of Osteopathy (D.O.) specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages. There are medical and surgical sides to the specialty. Dermatologic surgeons practice skin cancer surgery (including Mohs’ micrographic surgery), laser surgery, photodynamic therapy (PDT) and cosmetic procedures using botulinum toxin (‘Botox’), soft tissue fillers, sclerotherapy and liposuction. Dermatopathologists interpret tissue under the microscope (histopathology). Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases like pemphigus. In addition, there is a wide range of congenital syndromes managed by dermatologists. 

Most people naturally shed about 50 to 100 hairs a day, but sometimes men and women can shed much more, leading to thinning hair, hair loss, and over time, baldness. The causes of this hair loss can be a result of hormones, underlying medical conditions, and even certain medications like antidepressants, high-blood pressure medications, and NSAIDS (non-steroidal anti-inflammatory medications). Sometimes, hair loss is purely genetic and can run in families.
The condition affects 0.1%–0.2% of the population,[26] and occurs equally in both males and females. Alopecia areata occurs in people who are otherwise healthy and have no other skin disorders.[7] Initial presentation most commonly occurs in the late teenage years, early childhood, or young adulthood, but can happen at any ages.[9] Patients also tend to have a slightly higher incidence of conditions related to the immune system, such as asthma, allergies, atopic dermatitis, and hypothyroidism.
Though we think our hair is super important, our bodies consider it nonessential (read: we don’t need it to stay conscious). Other bodily functions, like breathing, are more pressing and get first access to the nutrients in our diet. Our hair gets the leftovers. Protein is your hair's best friend, so reach for healthy protein such as eggs and fish and avoid fasting or yoyo dieting. These can deprive your body of these essential building blocks for a healthy scalp and hair. Wild salmon, tuna and trout are packed with omega-3 fatty acids that help provide moisture and prevent dry and brittle hair. Foods rich in B vitamins also help keep hair follicles healthy, decreasing the risk for hair loss. Fruits and vegetables, and beans and lean meat sources, such as chicken or turkey breast, are all great sources for vitamin B.
The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases.
So far, I’ve only been on the Propecia for about three weeks. I don’t notice any side-effects thus far. I am taking 2.5 mg of Proscar, to be exact. I feel good and have not noticed any difference in my hair. I continue to lose about 20 hairs when I shower and brush it each day. That may not sound like a lot but I have already lost so much of my hair, that I think that represents more hair loss than it sounds. At least it is stable for now…I thank GOD that it is not getting worse. I DO have re-growth but it is fine and “wispy” as you said. It is not the same as the rest of my “normal” hair but hey, at least some of it is growing back in. Slowly and finer. That seems to support the AGA diagnosis. The thing that really drives me crazy is that I still don’t know WHY the TE started in the first place. The TE unmasked the AGA, but why the damn TE and what from here? Anyway….I digress and obsses!
If you’re a lady and can remember the one difference in directions (or just scope out the instructions online) we recommend saving the cash. Similarly, you could go generic with Equate Hair Regrowth Treatment for Men or Costco’s Kirkland Signature Hair Regrowth Treatment Minoxidil Foam for Men. These alternatives offer the same percentage of active minoxidil and near-identical inactive ingredients for as little as half the price — a great option for both genders.
Hair transplantation involves harvesting follicles from the back of the head that are DHT resistant and transplanting them to bald areas. A surgeon will remove minuscule plugs of skin that contain a few hairs and implant the plugs where the follicles are inactive. Around 15 percent of hairs emerge from the follicle as a single hair, and 15 percent grow in groups of four or five hairs.
My story is little different it seems. My fiancé was dionosed with Rocky Mountain Spotted Fever from a tick bite. And after test after test almost losing her and so many blood drawings then blood transfusions along with dialysis. Fighting depression trying to stay possitive is getting harder everyday. We ask all her doctors about why her nails break so easy, skin changing and hair falling out handfulls at a time…..then being looked at like we’re crazy has took my faith out of their hands.

I would just like to spare anyone else In Los Angeles thinking about going to see the dermatologist who supposedly specializes in hair lossat UCLA (Dr Strick or something like that I think is his name) He is the most insensitive and uncaring Dr. I have ever met. After waiting close to 2 hours after my scheduled appt to see him. He gave me some xeroxed copy of an article on T E that was out of Glamour or Cosmopolitan or some Fashion magazine like that. He asked no questions. I wasnt even there for 10minutes but when I showed him a big bag of hair which I saved, that had fallen out in the past several weeks. He just very insensitively told me it was T E and it would grow back-basically like just get over it, then he gave me the bums rush out the door.
The trick about all of these hair-loss products and treatments is that they’ll stop working as soon as you stop using them. “They have to be ready for a lifetime commitment,” says Rieder. But, just like brushing your teeth, as long you keep on keeping on with the scientifically proven preventative treatments, those hairs on your head should be just fine.
During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of tiny grafts, each containing just a few hairs. Each graft is planted in a slit in the scalp created by a blade or needle in the area of missing hair. Hair grows naturally this way, in small clusters of one to four follicles, called follicular units. As a result, the graft looks better than the larger "plugs" associated with hair transplants of yesteryear.
About 2 years ago my hair started thinning. I thought it was because I was in college and stressed. At that point I started going what is known as “CG” in the curly hair world. I no longer color, flat iron, use sulfates and I rarely blow-dry and use silicones. I use shampoos and conditioners with beneficial ingredients, not fillers. After 1.5 years on this Curly Girl routine, I experienced some relief and noticed my hair getting thicker. That lasted a couple months and now I’m back to losing a ton of hair. One day I counted 160 hairs…that was on a decent day. I’m sure I’ve lost 2x that amount before. My hair is noticeably thinner, drier, and it knots. It NEVER use to knot. I think my hair has become finer too, but I’m not positive. It just feels more fragile.

I heard about DR. REDMOND from a couple support sites, but thought his prices were outrageous…until I had the breakdown and confronted the truth of my many bald spots and the way it had controlled my self-esteem/psyche for so long. I went. I continue to go. It is THE BEST investment for yourself. As females, we equivocate taking care of ourselves with selfishness. This is simply not true. THINK ABOUT IT. if your mother/daughter/best friend/lover/sister had this problem, would you call her selfish if she wanted to fix it?!?!?! INVEST in YOURSELF. Please, go to DR. REDMOND. He CAN HELP!!!!


Telogen effluvium is the second most common type of hair loss. It is predominantly seen in women between the ages of 40-70, but may occur at any age. Its symptoms include excessive thinning, shedding, and balding and it may happen abruptly. Common causes of sudden hair loss include changes in hormone levels such as with child birth, menopause, poor nutrition, medical conditions such as iron deficiency anemia and hypothyroidism, medications, severe illness or infection, major surgery, and even extreme levels of stress.
again, she found my testosterone level a tad high, in the 50’s. she initially wanted me to start on both metformin and spironolactone. i am not a diabetic, but apparently the metformin stops testosterone production and the spironolactone inhibits testosterone from absorbing…or something to that nature. she didn’t come out and say that my elevated level was the cause of my hair loss, but she did say elevated levels “could” be the culprit, but that either way she wanted my levels to normalize. makes sense. she listened to me patiently and spent a good amount of time, medically, with me. she ordered labs: not anemic, good iron, good protein, no thyroid problems. the metformin made me sick. she told me to start slowly with each med and that she’d increase it with time, based on my body’s reaction. with spiro you need to have your potassium checked within two weeks of starting it. sadly, i didn’t follow through with the meds because they made me feel so sick and i couldn’t go back to her since i lost my insurance. but after reading all of these posts, i have scheduled another appt with her in a few weeks and will ask her to put me on spiro only and will see if this helps.

Ironically, taking the hormone levothyroxine to treat an underactive thyroid can contribute to some hair loss, among other side effects, but this seems to be more common within the first month of treatment and more often in children than adults. This hair loss is only temporary and will go away as treatment is continued and thyroid hormone levels stabilize.

"This is an oral, prescription-only medication with the brand name Propecia that’s also FDA approved to treat hair loss," says Spencer. Male pattern hair loss occurs when a hormone called dihydrotestosterone (DHT) prevents hair follicles from getting the nutrients they need. Finasteride works by blocking the production of DHT, which protects the follicles.


I am relieved to find out that I am not the only female going through this problem. Don’t get me wrong. I am sorry that you are all going through this, but I was beginning to think I was the only female with this problem. I am 22 years old and I have been experiencing hair loss for the last two years. At first, it didn’t really bother me and I imagined it wouldn’t last. Then, it progressively got worse and has continued for the last two years. I have seen my PCP, GYN as well as various Endocrinologists and ENT’s to try and get to the source of my hair loss. They have all laughed at me and told me not to worry about it. I feel like they’ve all blown me off because I’m so young; However, no one understands how emotionally and physically destructive this is! I used to have tons of hair! I was even named “Best Hair” my senior year in high school and now I am ashamed to go out in public or even look at myself. I have very little hair left and it’s ruining my life, my relationship with my boyfriend, and my ability to maintain other relationships. I am now suffering from a lot of anxiety, depression and low self esteem. I’m all out of ideas and hope! My mother suggested that I go see a dermatologist, but I wouldn’t even know who to trust with this issue. The last thing I need is another doctor looking at me like I’m crazy and thinking that because I’m so young I should just ignore it. I can’t ignore it! It has been going on for far too long and all I want is someone who will listen to me and try to help me. I live in Arizona. Do any of you know of a good dermatologist that I can go see? I hate that this is happening to me and the negative impact it has been having and will continue to have on my life. I’m afraid that it’s only going to get worse and I will wake up one day completely bald! If any of you have advice or suggestions, I would be glad to hear them!
Alopecia areata is a disease that attacks your hair follicles (the part of your skin that makes hair). In most cases, hair falls out in small, round patches about the size of a quarter. This causes only a few bare patches. Some people may lose more hair. In only a few people, the disease causes total loss of hair on the head or loss of all body hair.
Mistakenly thought of as a male disease, around 40% percent of women will suffer from some form of hair loss by the age of 50. A woman’s hair is an important part of her aesthetic make-up. It represents her style and taste, and frames her face while accentuating her best features. Unfortunately, most physicians don’t have answers or solutions for women who begin to lose their hair.  Plano, TX hair restoration surgeon, Dr. Joseph Yaker, understands that this can be extremely catastrophic to a woman’s self-confidence, body image and quality of life. Clinical studies have shown that psychiatric disorders such as depression and anxiety are more common in people with hair loss, especially women.
Leprosy (Hansen's disease) is a disfiguring disease caused by infection with Mycobacterium leprae bacteria. The disease is spread from person to person through nasal secretions or droplets. Symptoms and signs of leprosy include numbness, loss of temperature sensation, painless ulcers, eye damage, loss of digits, and facial disfigurement. Leprosy is treated with antibiotics and the dosage and length of time of administration depends upon which form of leprosy the patient has.
I just came across this website, I thought by chance but I think not! I have been having scalp pain, like my skull wanted to crack open. Then the tendersness of my hair folicals when the wind would blow. I started to loose lots of hair so went to my family doctor. All the test were done for Thyroid problems…all turned out what they call “normal”. Have you seen the wide range which is considered normal? How can this be when everyone is so different? I am loosing hair as I sit and write this message. The hair just gently falling onto my shoulder. I need to color my hair as it is time from the length of my silver roots but the last time I had my hair touched up, I thought I was going to die from the pain when the stylist tried to just shampoo the color off. Oh my God! Painful, painful. I used to be a stylist so you can imagine my shock when I was told it wasn’t my Tyroid!
Hair transplants will likely lead to better results in the long run (you are introducing new hairs to the balding areas), but you’ll still need to use minoxidil or finasteride after surgery to maintain the results. Like all hair loss treatments, hair transplants are best when combined with other methods, and you’ll want to speak with your doctor to see what combination is best for you.
How many of us are out there… feeling alone and pretending to not be ashamed. As a child, I had so much hair that my mother used a thinning shears on my locks. In high school I had a glorious mane, cut into a ‘Gypsy’… what great pictures. By my mid-20’s I had to cut my hair short because it was so thin that it wouldn’t hold a style. Was diagnosed with PCOS and told that this syndrome, combined with heredity, caused my hair loss.
decrease in your blood Prostate Specific Antigen (PSA) levels. Finasteride can affect a blood test called PSA (Prostate-Specific Antigen) for the screening of prostate cancer. If you have a PSA test done you should tell your healthcare provider that you are taking Finasteride because Finasteride decreases PSA levels. Changes in PSA levels will need to be evaluated by your healthcare provider. Any increase in follow-up PSA levels from their lowest point may signal the presence of prostate cancer and should be evaluated, even if the test results are still within the normal range for men not taking Finasteride. You should also tell your healthcare provider if you have not been taking Finasteride as prescribed because this may affect the PSA test results. For more information, talk to your healthcare provider.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
Hi Everyone I thought I was the only person with major hairloss because everywhere I look all I see is beautiful heads of hair. I am 34 years old and my hair started thinning 7 months ago at first I thought it was just my ponytail getting thinner but my hair became horrible with split ends and dryness too (I have always had extremely healthy hair and never had split ends) – I thought I had burnt my hair using a straightener and that’s why it was thinning. However it has gotten worse and worse and I finally visited a doctor. I have had full blood tests for thyroid issues, hormone levels, cholesterol etc etc all were perfectly normal, I had a thyroid antibody test which was at the high end of normal but still within normal range, I had a thyroid function test which was within normal limits however he thought I did have some slight inflammation ie thyroiditis. My doctor said this isn’t causing the hair loss either. I have loads of energy, don’t get tired, eat well am normal weight range the only other thing I have noticed is my eyelashes seem stunted in growth (not thinned out though) and my eyebrows have thinned on the outer edges. My last two nails on both hands have a dark (looks like they have lifted slight) strip just below the white nail part. I am booked to have a stress test, pelvic ultrasound and to see an endocrinologist also to rule out all other possible reasons for hairloss. I am now getting to the point of embarrassment to go out it is soooo thin on top particularly on one side of temple and majorly down the centre where I used to part my hair. HELPPPPPP!!!!!
Onion - A study published in the Journal of Dermatology examined the results when onion juice was used in people with alopecia areata. Twenty-three people applied onion juice directly to the scalp twice daily for two months. Participants began to experience hair growth after just two weeks of treatment. At four weeks, hair regrowth was seen in 17 people and at six weeks, hair growth was apparent in 20 people.
Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. Anagen (A), the active growth phase, lasts two to seven years. Catagen (), the transition phase, lasts about two weeks. During this phase, the hair shaft moves upward toward the skin's surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle. Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.
I am 30 and am trying Rogaine and spironolactone but only stopped the loss and I want to try Propecia. I know about the side effects for a male fetus, but I have chosen myself that I do not ever want to create a child out of my body. I will adopt or foster, but have intense lockeophobia. I even agreed to sign a legal document saying such, but my doctor would still not prescribe me propecia unless I had had a hysterectomy. He said it was for safety reasons, but as far as I understand it the only safety issue would be to such a fetus that will not exist. So I am confused about his reservations.
Its been 1.5 years since my problem started. I noticed first the texture became course or wiry. Then I wore a hair net and hard hat for 8 years I don’t know if that helped with my condition or not. Then I went to got my hair highlighted within 1 week my hair broke off to 1/2″ just in front the rest was full. Since then I have tried all kinds of hair therapy. The texture changed to being normal but I have Nice shiny almost bald spot on my head. Nothing I tried helped in regrowth. Went over all my mess with my doctor she said no should damage my hair. Also it grows but as soon as it starts looking decent I have breakage. What to do what to do.
Why? Unwanted hair growth (sideburns, for example) is a reported side effect of minoxidil. The belief is that a higher concentration of minoxidil would result in more unwanted hair, which is why women are instructed to use it less often. However, the study in Skin Therapy Letter reports that unwanted hair was more common in 2 percent minoxidil solutions than 5 percent, and women are instructed to use Rogaine’s 2 percent solution twice daily — so what gives?
The main type of hair loss in women is the same as it is men. It's called androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss usually begins above the temples, and the receding hairline eventually forms a characteristic "M" shape; hair at the top of the head also thins, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman's hairline rarely recedes, and women rarely become bald.
Results from several small studies suggest that biotin supplements may improve thinning hair and brittle nails. Less commonly known as vitamin H, biotin is part of the B complex vitamins, which help your body metabolize fats and protein. Some experts even recommend a daily supplement for everyone since it’s generally safe and pretty hard to get too much of it.
Hello. Chris, I am so happy that you made an appt to see Dr. Redmond. How did it go? I really hope it helped. i have been on treatment now for almost 3 months. Dr. Redmond told me to be patient, that things could take a year to improve, but I do feel mostly that things have stabilized. In my work (i am a physician) I have seen alot of sad cases in the last few weeks. Young patients with major illnesses, some possibly incurable and fatal. It has made me really sad. It has also made me realize that regardless of what is happening to my hair, I have to try and be happy. I have to be thankful that I am healthy and have wonderful family and friends. Not that it is a consolation, but for us, our illness is on the surface and not life threatening…unless we make it by the psychological part. Thank you for everyone who has contributed to this website so that I can deal with the psychological part better. I am doing research into wigs now and will let all of you know when I have more info. Supposedly there is a soap opera star who was bald at 14 and has been wearing wigs for a long time. She has made a line of wig’s I think called Amy’s presence. It seems that she has led a happy life despite her hairloss. Once I found out more, I will let you know. I know its not a cure, but at least it is a remedy. One day at a time, I know we can all get through this. Be well.

Anagen effluvium is rapid hair loss resulting from medical treatment, such as chemotherapy. These potent and fast-acting medications kill cancer cells, but they may also shut down hair follicle production in the scalp and other parts of the body. After chemotherapy ends, hair usually grows back on its own. Dermatologists can offer medication to help hair grow back more quickly.
That said, there are products that don’t have FDA approval or clearance, but may help prevent hair loss. For example, shampoos with ketoconazole, a chemical with anti-DHT properties, is widely used to treat fungal infections but has become popular among consumers as a hair loss treatment. It makes sense — research shows that ketoconazole actually has beneficial effects on hair growth (especially for those with seborrheic dermatitis).

Sea salt has the ability to stabilize hormones, alkalize the body (which is SUPER important), and do a plethora of other beneficial things. Due to very weak experimentation by doctors, most people believe the stigma that salt causes high blood pressure and we should avoid salt. It’s true, TABLE (or refined) salt causes blood pressure to rise. Table salt is sucked dry of 80 minerals in order to make it look pure/white. Unrefined light grey salt (aka sea salt) contains 80 minerals our bodies need. It has the ability to LOWER blood pressure, stabilize hormones, correct pH levels, prevent acid reflux, detox, decrease hypertension, strengthen the immune system, helps with chronic fatique, etc, etc…

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