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Online Consultation

Please answer all questions honestly and completely so our health professional can ensure suitability and prevent any delays in supplying your medication

Are you purchasing this medication for yourself?
Are you male and over 18?
Do you currrently have or suffer with male pattern baldness?
Have you tried hair loss treatments before?
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 have or ever have suffered from depression, low mood or suicidal thoughts?
Do you currently take any treatment for benign prostate hyperplasia?
Have you previously developed sexual dysfunction after taking 5-alpha-reductase Inhibitors (such as finasteride or dutasteride)?
Do you have any of the following:
  • have a history of sensitivity to minoxidil, ketoconazole, ethanol or propylene glycol
  • suffer from treated or untreated high blood pressure, arrythmia or any other cardiovascular disease
  • suffer from Phaeochromocytoma
  • suffer from any current scalp issues including but not limited to infection, psoriasis, eczema, sunburn, broken skin or unspecified scalp pain, irritation, or inflammation
  • have a shaved scalp
  • have a condition where you use occlusive dressings.
Do you have any medical conditions or take any other medications including creams, ointments or any other skin preparations? (If you use skin preparations, please state where)
Do you use any recreational drugs?
Do you have any allergies?
Do you have a hereditary intolerance to galactose, lapp lactase deficiency or glucose-galactose malabsorption?
Have you previously tried finasteride 1mg for hair loss with unsatisfactory results, or taken dutasteride 0.5mg capsules for hair loss?
Is there anything else about your health you would like to tell us?
I will read the patient information leaflet before using any provided treatments.
I agree that
  • I will stop taking finasteride and contact my GP if develop depression, low mood or suicidal thoughts.
  • I agree to inform my prescriber or my GP about any reduced sexual function such as inability to get and maintain an erection or a decrease in sex drive.
  • I understand that 5-alpha-reductase Inhibitors (such as finasteride or dutasteride) has been reported to affect semen characteristics (reduction in sperm count, semen volume, and sperm motility) in healthy men. The possibility of reduced male fertility cannot be excluded. Dutasteride and finasteride are excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant. If you are planning a pregnancy we advise stopping finasteride or dutasteride at least 6 months before conception.
  • I will inform my doctor I am taking finasteride or dutasteride in advance of any prostrate specific antigens tests (PSA test).
Would you like us to inform your GP of any treatment provided (Optional)?
I agree that
  • All questions have been answered to the best of my knowledge.
  • I understand that I should regularly have my blood pressure, glucose and cholesterol levels checked regularly with my GP.
  • I am happy for pharmacists to review my consultation and prescribe the items requested, if it is clinically suitable for myself.
  • I understand my treatment request may be rejected due to clinical or other reasons.
  • The treatment is solely for my own use and not for the use of others.
  • I consent for SPK Pharma Ltd to undertake an ID check to confirm my age and identity. (This will be done using a credit check agency, no record will be put on your credit rating).
  • If you have used the requested medication before, you confirm it is working as intended.
I understand that Menschem will not inform my GP of this consultation, unless specifically requested via emailing [email protected] (please include GP name, address, and email address).