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Most healthcare and mental health specialists think that HRT should be the first therapy choice for trichotillomania, as per a 2011 review

in vitro experiments demonstrated that SGK1 knockdown attenuated erastin-induced downregulation of Slc7a11, GPX4, GSH, and oxidized glutathione (GSSG), while reducing lipid peroxidation, iron accumulation, and mitochondrial damage upregulation, suggesting SGK1's critical role in CHD-associated ferroptosis (44)

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The remaining vendors face stronger incentives to maintain high compliance standards, as another enforcement wave would eliminate those who cut corners

Each additional compound introduces its own side effect profile, interaction potential, and pharmacokinetic considerations