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Direct-to-consumer platforms like Hims, Keeps, and Ro have introduced millions of patients to compounded finasteride and minoxidilbut the clinical oversight on those platforms varies enormously, and the compounding pharmacies behind them are not always transparent about their accreditation or testing protocols

At the molecular level, upregulation of hypoxia-inducible factor-1 (HIF-1) has been observed in active MS plaques by immunohistochemistry [130, 131], and the upregulation of genes associated with ischemic preconditioning, including HIF-1, has been observed in NAWM in patients with MS [132]

Moreover, neuropathological examination of MS tissue indicates that degeneration, CNS atrophy, and myelin loss are most prominent in the progressive stage, when lymphocytic inflammation paradoxically wanes

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Again, there is a small risk of infection if the bursa is drained with a needle