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Chronic poor sleep (less than 7-8 hours per night for most adults) and high stress levels can increase the production of the stress hormone cortisol

MDMA, like fenfluramine, is an indirect serotonergic agonist that elevates 5HT levels via SERT reversal, and therefore the drug effects are broad and not selective with respect to any one 5HT receptor subtype

While these mechanisms are well-documented in general skin-brightening studies, the application for those with localized depigmentation is more complex

In theory, that could also feed hidden cancers though this has not been shown in people

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