Prescription topicals, answered in order.

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What are they, actually?

Hair

Hair grows, sheds and regrows in cycles. With certain kinds of thinning, follicles gradually start producing thinner and weaker hairs. These formulations go after several parts of that process at once rather than just one.

Skin

Pain

Supplements — no prescription needed

These skip the provider review entirely. They’re here because people on the weight-loss program ask about them.

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Why do people use them?

Short versionBecause thinning, aging skin and nagging pain each have more than one cause, and a single-ingredient product only pulls one lever.

Hair. Pattern thinning has a hormonal driver (DHT), a growth-cycle driver, and often a scalp-inflammation driver. Minoxidil alone works on one of those. Combining an anti-androgen with minoxidil and something for the scalp is an attempt to work on all of them, in a single daily application instead of three.

Skin. Tretinoin is the best-evidenced ingredient there is for fine lines and texture; glycolic acid exfoliates, niacinamide evens tone, hyaluronic acid holds water. One serum, four jobs.

Pain. A sore knee or back is inflammation plus muscle guarding plus the pain signal. Ortharex puts an anti-inflammatory, a muscle relaxant and a local anaesthetic on the spot, which is a different proposition from swallowing an ibuprofen for your whole body.

Why topical. Applying something where the problem is means more of it gets to the target and less circulates through the rest of you. Less is not none — topical medications are still absorbed — which is why a provider still reviews your history.

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How do they work?

Hair

• Finasteride blocks the enzyme that converts testosterone into DHT, the hormone that shrinks follicles in pattern hair loss.
• Spironolactone does the anti-androgen job by a different route, and is the choice for women.
• Minoxidil increases blood flow to the follicle and extends the growth phase of the hair cycle.
• Tretinoin speeds skin turnover and helps minoxidil penetrate.
• Fluocinolone / hydrocortisone calm scalp inflammation.

Skin

• Tretinoin speeds cell turnover and stimulates collagen — the reason it’s the reference ingredient for lines and texture.
• Glycolic acid exfoliates the surface layer.
• Niacinamide evens tone and supports the skin barrier.
• Hyaluronic acid holds water in the skin so the actives don’t leave it stripped.

Pain

• Diclofenac and meloxicam are NSAIDs — they reduce inflammation at the site.
• Baclofen relaxes muscle.
• Lidocaine numbs the pain signal locally.

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When do you use them — and when will you notice?

Short versionHair: once daily, judge it at six months. Skin: at night, start slow, results in 8–12 weeks. Pain: two to four times a day, relief in minutes to days.

• Hair · dailyCapilyn or Minoxalune

  Once a day on a clean, dry scalp. Consistency beats quantity.

• Weeks 2–8Possible shedding

  Minoxidil can cause a shedding phase first as weak hairs make way for new growth. It’s alarming and it’s normal. Don’t stop.

• Months 3–6Judge the hair

  New growth takes months. Six months is the fair checkpoint; photos in the same light help.

• Skin · nightlyElastira

  A pea-sized amount at night. Start with a few nights a week per the label, then build to daily. Sunscreen every morning, no exceptions.

• Weeks 1–4Adjustment

  Some dryness, flaking or redness while your skin adapts to tretinoin is expected. Slow down, don’t stop.

• Weeks 8–12Judge the skin

  Texture and tone first; lines take longer.

• Pain · 2–4x dailyOrtharex

  A nickel-sized amount rubbed into the area. Lidocaine works in minutes; the anti-inflammatory effect builds over days.

• SupplementsBefore or with meals

  Calocurb before meals, SatiaLean and Citradine once daily in the morning.

The pharmacy label and the clinical team give you the specifics for your prescription.

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Who are they for? Who aren’t they for?

Short versionAdults with pattern thinning, aging skin, or localised pain who’ve been cleared by a provider. Not for anyone pregnant with the hair or skin products, and not for anyone with an NSAID or lidocaine allergy with the pain cream.

Hair

For pattern thinning in men and women. Capilyn is not for women who could become pregnant — finasteride can harm a developing baby, even absorbed through skin. Minoxalune exists for exactly that reason. Sudden or patchy hair loss is a different problem and should see a doctor first.

Skin

For fine lines, texture, tone and dullness. Not during pregnancy or breastfeeding, not alongside another retinoid, and not for anyone who won’t wear sunscreen — tretinoin makes skin more sun-sensitive and you’ll undo the benefit.

Pain

For joint and muscle pain in a specific area. Not for anyone with an NSAID or lidocaine allergy, NSAID-induced asthma, or broken skin at the site. Kidney problems, stomach ulcers, heart conditions and blood thinners all need the provider’s eyes.

Supplements

No prescription. None of the three are for under-18s, pregnancy or breastfeeding, and Citradine is caffeine-free despite what you may have read elsewhere.

Side effects

• Hair: scalp irritation, dryness, initial shedding. Topical finasteride reaches the bloodstream at much lower levels than the pill, but not zero — tell the provider about any change in mood or sexual function.
• Skin: dryness, peeling, redness, sun sensitivity, especially in the first month.
• Pain: skin irritation at the site; rarely, the systemic effects of NSAIDs.

I’m not screening you. I’m telling you what the provider will be looking at so nothing catches you by surprise.

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Where do they come from, and where can they ship?

Short versionPrescribed by a licensed provider in your state, prepared by a licensed US compounding pharmacy, shipped to your door by FedEx.

Where they’re prescribed

By a licensed provider in DirectMeds’ network, licensed for your state. The supplements skip this step. Chapter 11 is all about the provider.

Where they’re made

A licensed, FDA-registered compounding pharmacy prepares your prescription under real quality standards. That isn’t the same as the product being FDA-approved — compounded medications aren’t.

Where they ship

To a street address, by FedEx, with tracking. No PO boxes.

Where they’re available

Availability and consult rules vary by state. Email me your state and I’ll check before you pay.

Where they live at home

Room temperature, per the label, away from anyone they aren’t prescribed to. Tretinoin degrades in light, so keep the cap on and the tube out of the sun.

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What does it cost — really?

Short versionFrom $89 a month for the hair serums, $100 for the skin and pain creams, and about $120 for the supplements — each sold on its own, 30- or 90-day supply, no membership. Under $4 a day for any of them.

Unlike the injectable programs, the topicals are sold individually, each with its own price and its own first-order offer. These are the “as low as” numbers from each product page; the exact figure depends on the supply length you choose.

No membership fee, no consultation fee. The number you see is the medication. The provider review is part of it.

No long-term contract. It renews until you cancel, and you can cancel future shipments any time after your first order. The first-order price and the recurring price are printed side by side above, because you should see both before you decide.

Your recurring price is locked. I’m authorized to guarantee that the recurring price you start at will not go up.

First-order discounts come and go. If today’s number is better than what’s printed here, I’ll tell you when you email me. If it’s worse, I’ll tell you that too.

My link is cheaper than the shop price. The DirectMeds shop lists the standard price; my link carries the telesales pricing, which is the best I’m authorized to offer.

The per-day number is there on purpose. A monthly figure and a daily figure are the same money and feel very different. Both are honest; use whichever one helps you decide clearly.

And the disclosure, because it belongs on the page with the prices: I earn a commission when you order through my link. It doesn’t change what you pay — the pricing on my link is the best available — but you should weigh everything I say against it.

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How do I order?

Short versionTap the product’s link, create a login, pay, then fill in the health intake for the prescription products. Supplements skip the intake. About ten minutes.

The whole thing takes about ten minutes, and you do it yourself, on your phone, at whatever pace you like. Here’s each step so nothing surprises you.

1. Tap my link1 min

   It opens the DirectMeds order page for the topicals. My name rides along inside the link — that’s what attaches me to your account as your account manager. The link is in chapter 14, and in the button at the bottom of your screen.

   These open in the DirectMeds shop rather than a “Welcome back” page: a product page with the ingredients, the “as low as” price, and a supply-length option. No countdown timer here.

2. Pick your option1 min

   Each product has its own order page — the buttons in chapter 1 and chapter 14 go straight to them. Prescription products go through the intake and provider review; the three supplements don’t.

3. Create your login and pay2 min

   Your email becomes your username for the DirectMeds patient portal, and payment is by card. Nothing on the checkout is a consultation or membership fee; the number is the medication.

4. Complete the health intake10 min

   In your portal, right after checkout. This is the medical part, and it’s what the provider uses to decide. It includes a quick ID check — a photo of you and a photo of your ID, taken with your phone camera (a QR code opens it) or a webcam. Nothing ships until the intake is submitted. The next chapter walks through every question on it.

5. Wait — briefly, and usually quietly1–3 days

   A licensed provider reviews your intake. Chapter 10 tells you exactly what that wait looks like, including the part where nobody calls and that’s normal.

If anything at all goes sideways — a page won’t load, a card gets declined, you’re not sure it submitted — email me. Fixing it is my actual job, and it usually takes two minutes.

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What’s on the health intake form?

Short versionAbout ten minutes. A photo of you, a photo of your ID, your basics, and your medical history — answered honestly, because it’s the only thing the provider has to go on.

Right after you pay, you complete the health intake. It replaces the office visit: it’s everything a provider would ask you across a desk, and it’s the only thing they have to go on. So it’s worth doing carefully.

What it asks for

• A photo of you — a clear, well-lit selfie. It’s an identity check, not a beauty contest.
• A photo of your government ID — driver’s license or passport. This is the upload that trips people up most; good light, flat surface, no glare.
• Date of birth, height and weight, and your state.
• Your medical history — conditions, past surgeries, allergies, and every medication and supplement you take. Yes, every one.

What to make sure is on it for the topicals

These are the things the provider specifically looks at for this program. None of them are automatic disqualifiers unless I say so — but leaving one off is the one way to make this go badly.

• Pregnancy, breastfeeding, or any chance of becoming pregnant — this rules out Capilyn and Elastira
• Allergies to NSAIDs or lidocaine, and any asthma triggered by NSAIDs
• Kidney problems, stomach ulcers, or heart conditions, if you’re asking about Ortharex
• Blood thinners, if you’re asking about Ortharex
• Any other retinoid you use, if you’re asking about Elastira
• Blood-pressure medication, if you’re asking about Minoxalune
• Scalp or skin conditions at the site
• Every medication and supplement, including the ones that feel irrelevant

If you get stuck

Nine times out of ten it’s the ID photo. Email me. I’ll walk you through it or sort it from my side. Please don’t leave a paid order sitting because a photo upload wouldn’t cooperate.

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What happens, and when?

Short versionPay and do the intake today. Provider review in a day or three. Ships about five business days after approval. Pain relief is fast; skin takes 8–12 weeks; hair is a six-month judgement.

Here’s the whole thing laid end to end, from the moment you pay. Knowing the shape of it in advance is most of what makes the wait easy.

• Day 0You order and complete the intake

  Ten minutes for prescription products. Supplements skip straight to checkout.

• Days 1–3A licensed provider reviews it

  Usually silently. If something in your history needs a closer look, they reach out first.

• On approvalThe pharmacy compounds and ships it

  About five business days, by FedEx, with tracking.

• Week 1You start

  Per the label. For Elastira, a few nights a week to begin with.

• Weeks 2–8Adjustment

  Hair may shed first; skin may flake. Both are normal, and both are reasons to keep going, not stop.

• Weeks 8–12Skin results

  Texture and tone first.

• Month 3Refill

  On the subscription. A 50ml Ortharex pump runs about a month; hair and skin products vary by use.

• Month 6Hair checkpoint

  The fair point to judge new growth. Same-light photos help.

When you should actually get in touch

• You can’t finish the intake, or the site won’t take your ID photo
• You’re not sure whether the order went through
• Something on your card statement doesn’t look right
• It’s been longer than feels reasonable and you want a human to check

That last one is a completely legitimate reason to email me. You don’t need a better excuse than “where is this?”

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Who’s the provider, and what do they decide?

Short versionA licensed clinician in your state who reads your intake and makes the call. Often without a phone call — that’s the normal outcome, not a shortcut.

A licensed clinician in DirectMeds’ network, licensed for your state. They read your intake the way a doctor reads a chart, and they make the decision. I don’t.

What they decide

Whether the product you asked for is safe for you — pregnancy and the possibility of it for the hair and skin products, allergies and kidney, stomach and heart history for the pain cream — and whether anything you take alongside changes the answer.

Will you actually talk to them?

Maybe not, and that’s normal. In many states the provider can review your history and approve without ever speaking to you. If something in your history needs a closer look — or if your state requires a consult before prescribing — they reach out first. A call is not a rejection. It’s a clinician doing the job properly.

If they say no

You’re refunded in full, and I’d rather that happen than have you take something that isn’t right for you. You’re welcome to ask what the reason was, and to take it to your own doctor.

After approval

The clinical team takes over the medical side: how to take it, what to expect, side-effect questions, dose changes, and check-ins. If the provider orders bloodwork, that typically lands around the 90-day mark. You reach them through your account, and if you ever can’t find the door, I’ll walk you to it.

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What do I do as your account manager?

Short versionI’m the person who answers when something goes sideways with your order — intake, billing, “where is it.” Not a doctor, and I’ll say so when a question isn’t mine.

I’m a patient onboarding specialist at DirectMeds. Which is a long way of saying: I’m the person who explains this, and the person who picks up when something goes wrong with your order.

What I’m good for

• Explaining what the medication is and how the program works, in normal language
• Telling you what it costs today, including the renewal price
• Getting you through the intake form when it’s being difficult
• Finding out where your order is
• Billing and account problems — fixing them, or getting you to whoever can, without leaving you on hold
• Making sure you’re on the best price I’m authorized to offer, and that your recurring price stays put
• Setting up the six-month Affirm option, by email, if you want it

What I’m not

A doctor. Anything clinical — dosing, side effects, interactions, whether this is right for you — goes to the provider or the clinical team. I’ll tell you out loud when a question is above my pay grade rather than guess at it.

How to reach me

Email. Malcolm@DirectMeds.com. Tell me what you’re trying to do and I’ll give you a straight answer.

Cancelling or changing an existing order

That goes through Customer Service rather than through me — the company keeps new orders and account changes separate so they don’t tangle. Tell me what you need and I’ll get you to the right people. You won’t be left holding.

And how I’m paid, one more time: commission on orders through my link. It doesn’t change your price. It’s stated on every page so you can weigh everything else against it.

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What else do people ask?

Short versionThe things people actually ask, including the awkward ones — about the topicals, and about the whole setup.

Everything I get asked about the topicals that hasn’t already been covered, including the awkward ones. Tap a question to open it.

If your question isn’t here, email me and ask it. An unanswered question is the main reason people don’t start, and I’d rather spend ten minutes on it than have you guess.