Are you purchasing this medication for yourself?
Are you male and over 18?
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Do you currently have or suffer with male pattern baldness?
Have you tried hair loss treatments before?
Please specify which treatments and for how long
Have you previously tried finasteride 1mg for hair loss with unsatisfactory results, or taken dutasteride 0.5mg capsules for hair loss?
Do you have, or have you ever suffered from heart failure, any form of liver disease, prostate cancer (or are undergoing investigations for prostate cancer), benign prostate hyperplasia, difficulty urinating (obstructive uropathy), male breast enlargement (gynecomastia) or breast cancer?
Do you currently take any treatment for benign prostate hyperplasia?
Please specify any treatment(s) you are taking
Do you have or ever have suffered from depression, low mood or suicidal thoughts?
Have you previously developed sexual dysfunction after taking 5-alpha-reductase Inhibitors (such as finasteride or dutasteride)?
Do you have any of the following:
Do you have any medical conditions or take any other medications including creams, ointments or any other skin preparations?
Please specify any medication you are currently taking
If you use skin preparations, please state where.
Do you use any recreational drugs?
Please specify any recreational drugs you are currently taking
Do you have any allergies?
Please specify any allergies
Do you have a hereditary intolerance to galactose, lapp lactase deficiency or glucose-galactose malabsorption?
Is there anything else about your health you would like to tell us?
Please enter any further information you'd like to provide
I will read the patient information leaflet before using any provided treatments.
I agree that
Would you like us to inform your GP of any treatment provided?
Please provide the email address for your GP
I understand that Menschem will not inform my GP of this consultation, unless specifically requested via emailing info@menschem.co.uk (please include GP name, address, and email address).
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