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Researchers were finding that unstable nutrient supply through intermittent fasting, which we can see mimicked in GLP-1 users, can cause a release of reactive oxidative species within your hair stem cell environment, which can actually cause cell death for your hair follicle stem cells. Follicular cell death is probably not something any of us had on our bingo cards for potential GLP-1 side effects

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Two downstream consequences are mechanistically central: nicotinamide is preserved for re-entry into the NAD+ salvage pathway (raising intracellular NAD+ availability), and SAM is preserved for other methylation reactions

Generic versions became available in 2022, reducing costs to $150-250 monthly depending on the pharmacy and dosage strength