When I was a teenager, I had severe nodular acne. Using Clearasil didn’t help, washing my face for what felt like hours each morning and evening with a hot rag (to open the pores) and various cleansers didn’t get even dint the oil, dirt, and painful boils and whiteheads that were seemingly permanent fixtures of my face. It was a point of extreme anxiety during the endless expanse of middle school; 1997-2000 felt like a fucking decade, since on top of all the usual changes of adolescence there was my red and often swollen visage.
Sometime in 1999, we went to a dermatologist to assess treatment options. After cycling through a few medication including the antibiotic tetracycline, the doctor prescribed Accutane, a synthetic Vitamin A* derivative that first hit the market in 1988 and was still on patent by the pharmaceutical giant Hoffmann La Roche at the time. Ovoid little yellow pills in a branded blister pack, Accutane was serious business; it contained black box warnings about pregnancy risks, which in the coming years (along with the drug’s alleged propensity to cause irritable bowel syndrome) would prompt Roche to pull it from the U.S. market not long after the patent expired and lawsuits began mounting.
Accutane’s side effects are considerable. Some of them have a frequency of > 1 in every 10 patients! For comparison: the potent prostate drugs Proscar and Avodart (more on both of these medications later) have been the subjects of enormous online controversy for precipating erectile dysfunction in literally fewer than 1 in a 100 men.
I took my first dose sometime in early 2000 – I’m not exactly sure the date. It was quickly apparent that something had changed. My lips began to dry out, and would almost blacken in the following months. I got random nose bleeds. My acne got much worse for the first couple of weeks, the pimples painful to the touch. A picture of me in May 2000, at my grandfather’s 90th birthday celebration in Kentucky, showed my early-phase red face with my then-platinum blonde hair.
And then, nothing. Within months my acne was eradicated, I finished the prescribed pills, and that was that. You would never know without asking me that I had previously struggled so much with it. Without Accutane, I would likely have continued to battle acne into adulthood and been left with signifcant scarring. I have never taken any drug that was so effective.
My experience with Accutane changed how I perceive drugs as both medical and recreational substances. It made my expectations just absurdly high – unmeetable.
I had high hopes for Prozac when I started taking it in 2004, making a long walk from my dorm to a psychiatrist’s office about a Myopic Books store, bumping into someone with whom I still talk to today along the way, listening to Joy Division’s “Shadowplay” in my discman for probably the last time ever, and camping out at a Starbucks since I was too early for my appointment. It might have stabilized my mood at best, if it did anything other than make it hard to get hard (in both men and women, Prozac causes sexual dysfunction in a staggering 3/4ths of patients). Wellbutrin, the alternative I began taking in 2005, was better but hardly life-changing.
Recreationally, marijuana reminded me of alcohol, albeit without the worse aspects of the latter like dehydration and hangovers. But like anything else of that ilk, the high is temporary. Being without it makes you want it more, and yet each experience someone feels diminished from the first one. Accutane doesn’t make one “high” per se, but its benefits are permanent, even years after cessation. There’s no moment to recapture, since it’s always with you.
As a cosmetic and anti-aging drug, with the ability to prevent the nearly inevitable scaring that comes with nodular acne, it has few peers, especially considering its immediate efficacy and lasting effects. I mentioned Proscar and Avodart earlier. Both drugs are also somewhat effective as acne cures since they dramatically reduce the serum levels of DHT in the body, which has the indicated effects of reducing benign prostatic hyperplasia and halting male pattern baldness. A doctor I spoke to once confessed that every male in his office – everyone from the guy with a solid Norwood V hair pattern, to the full-looking yet folicularly thin physician himself – was on Propecia (which is 1/5th a dose of Proscar, taken daily), which made me think if there were any reason not to take the drug if one were a healthy male with a predisposition to MPB. Its anti-aging effect in terms of reduction of prostate swelling and hormonal acne.
As an Avodart off-label user, I admit that my reasons are cosmetic and superficial, with health only a secondary concern. The need to constantly take the medicine, rather than finish a designated, shorter window of treatment a la Accutane, is admittedly a drawback, but also a reminder of the difficulty of halting some of the most obvious harbingers of aging, including MPB, BPH, and harder skin. It seems like there ought to be a more convenient form of treatment, and undoubtedly many new tries at anti-aging, from infusing the blood of younger people into older ones to the development of more sophisticated biologics, are coming. But the Accutane difference is what sticks with me.
That difference has remained with me whenever I think of what’s really satisfying, like creating something, or being moved by a certain visit or personal interaction. I mean, I still glow thinking of a life-sized self-portrait I scrawled out in a dormitory basement in 2005. The drive to keep “go back for more,” redo something in a similar way, doesn’t necessairly wash over me since I know the exact circumstances can’t be recreated and that I’ll always enjoy it in a particular way. Realizing that frees up mental space to pursue fresh thoughts and new adventures – and somehow, Accutane shares in the credit.
*: my father, whose acne was if anything far worse than mine, told me a story about once consuming cod liver oil as a treatment; cod liver oil is one of the richest natural sources of Vitamin A, indicating that speculation (this would have been in the 1960s) about a cure for acne was already on the right track.