I haven’t heard of many one pillers who have full blown PAS but this in no way breaks a theory. Just reverting to one pillers can break this theory, on that logic one pillers could break every plausible theory. Can you think of a single theory which would make sense in the light of supposed one pillers? Does that mean all theories are not legit? There is certainly a theory which is correct and works in spite of one pillers.
I imagine one pillers who develop full blown PAS are very much an exception to the rule (a rarity), I am sure these individuals do exist but they are likely to have some kind of extreme sensitivity to the effects of PAS. They may have multiple gene variants, each of which makes them more sensitive to developing PAS than the average person. Thus the combination of these gene variants together makes these individuals hypersensitive, so that they develop full blown PAS very quickly. In this light, these individuals do not disprove this theory.
What if a person has multiple gene variants such as:
- A variant which greatly reduces the ability to eliminate Isotretinoin metabolites from the body.
- A variant which greatly increases progesterone receptor expression or binding capacity.
- A variant which greatly increases progesterone production in response to isotretinoin metabolites.
If you imagine all three of these in a single individual, it becomes possible for just a few pills to lead to PAS. Again though, these individuals would be very much rare cases and from what I have read, they do appear very rare as I haven’t heard of any, I have only heard of PFS people who took a single pill.
Again how do you explain why PAS can develop after a single pill in some people but it can also develop only in a second course of isotretinoin, meaning individuals take an entire course of isotretinoin but do not develop PAS.