In the early 2010s, fecal transplantation began to attract attention far beyond medical circles. The topic left the confines of academic journals and quickly found an audience among forum users, social media communities, and journalists. There were several reasons for this surge of interest. On the one hand, studies were showing remarkable results in treating certain intestinal infections. On the other, the very nature of the procedure was so unconventional that it inevitably sparked curiosity. Finally, technical accessibility played a role: some enthusiasts attempted DIY "treatments" at home, using donor stool from acquaintances and standard enemas. What has become of this practice over the years?
Why Fecal Transplantation Can Be Therapeutic
Fecal transplantation, also known as fecal microbiota transplantation (FMT), involves transferring gut contents from a healthy donor into a patient’s digestive tract. The goal is to restore microbial balance when the recipient’s own intestinal ecosystem has been depleted and can no longer resist pathogenic bacteria.
Interest in the method surged more than a decade ago after a clinical study demonstrated its high effectiveness in treating recurrent infections caused by the bacterium Clostridioides difficile. This condition often arises after antibiotic use and is marked by persistent diarrhea and abdominal pain. Conventional drug treatments are not always successful; in some cases, the infection resists even last-line therapies. Mortality rates in such instances can reach 9%.
Can Fecal Transplantation Help With Alopecia, Depression, and Dementia?
Fecal transplantation modifies the composition of the gut microbiota, which in turn affects the functioning of multiple organs and systems. This has made it a subject of interest not only for researchers studying Clostridioides difficile infections but also for those investigating a wide range of other conditions. Attention to the method increased following reports of unexpected side effects.
In 2017, American doctors published a paper describing two patients with C. difficile infections and comorbid alopecia. Following microbiota transplantation, both saw their infections resolved—but something else happened: they began to regrow hair. For one, the regrowth occurred in scattered patches and was mostly an inconvenience, requiring regular shaving. For the other, hair returned in sufficient volume that he chose to keep it. While the observation could not be directly explained by the microbiota composition, it became a further impetus for research.
Interest in applying microbiota transplantation in other medical contexts has expanded rapidly. In 2024 alone, around 1,300 scientific papers were published on the topic; the total number now exceeds 7,500. Areas of investigation include treatments for allergies, Parkinson’s disease, cancer, multiple sclerosis, hypertension, Alzheimer’s disease, non-alcoholic fatty liver disease, dry eye syndrome, depression, and bipolar disorder. Researchers are also exploring its potential for managing autism, regulating body weight, and improving recovery after stroke. And this is only part of the list.
Although none of these applications have yet been incorporated into approved clinical protocols, the volume and breadth of research reflect a growing interest in the microbiota as a therapeutic tool—and fecal transplantation itself as a potentially universal method for influencing health through the gut ecosystem.
Outside of its established use in treating Clostridioides difficile infection, fecal transplantation has yet to gain recognition in clinical practice—even for other gastrointestinal conditions. Neither European nor American clinical guidelines recommend the procedure for obesity, depression, autism spectrum disorders (ASD), or other conditions widely discussed in scientific literature. The reason is a lack of sufficient evidence regarding its actual effectiveness or safety.
Despite the cautious stance of the medical community, some patients still pursue the procedure outside formal healthcare systems. In some cases, this takes place at home, using a self-selected donor. However, such an approach carries significant risks and cannot be considered a safe alternative to medical treatment.
How Are Stool Donors Selected?
One unresolved question is whether stool donors should be matched to each recipient individually. Research has yet to provide a clear answer on the so-called "donor effect"—that is, the impact of a specific microbiota profile on treatment success. Still, even without personalization, finding a suitable donor is extremely challenging.
International guidelines require each potential donor to undergo detailed questionnaires and medical screening. The U.S. Food and Drug Administration (FDA) has its own requirements. Russia has no official protocol yet, though a proposed framework has been published in the scientific literature.
Without laboratory testing, there is a risk of transferring not just beneficial bacteria but also infections—such as HIV, viral hepatitis, parasitic diseases, and others. In fact, the criteria for stool donors are stricter than those for blood donors.
"An ideal donor is someone who is not overweight, not underweight, does not smoke or drink excessively, has no immune disorders, and is generally in stable, moderate health," say gastroenterologists.
A donor’s physiological and metabolic characteristics directly affect the quality of their microbiota. In one early case—before rigorous criteria were in place—a patient received a transplant from an overweight donor. Within 16 months, the recipient gained 15 kilograms, despite having no prior history of obesity.
The strictness of the selection process is evident in the numbers. In a large U.S. study involving nearly 8,000 individuals who expressed interest in becoming donors:
⋅ 50% were excluded at the online questionnaire stage;
⋅ 80% of the remainder failed to appear for interviews;
⋅ among those who did show up, 63% were rejected;
⋅ some dropped out after lab testing, and
⋅ of those who remained, 26% were ultimately not approved.
⋅ 50% were excluded at the online questionnaire stage;
⋅ 80% of the remainder failed to appear for interviews;
⋅ among those who did show up, 63% were rejected;
⋅ some dropped out after lab testing, and
⋅ of those who remained, 26% were ultimately not approved.
As a result, only 1.7% of the original candidates were deemed suitable. In a comparable Chinese study, just 3.2% of 2,071 applicants were approved for donation.
These figures alone make a strong case against performing fecal transplantation at home. Beyond donor selection, precision in preparing the material is critical—any lapse in sterility or dosing can lead to serious consequences.
Even under ideal conditions and with a qualified donor, the procedure is not without risks. Side effects can range from mild issues like constipation to severe outcomes including sepsis. Fatal cases have been documented, despite adherence to clinical protocols in controlled settings.
Fecal transplantation is not a folk remedy—it is a serious medical intervention. And if it is to be performed, it should only be done under the supervision of a qualified physician.
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