Are you male and aged between 18-65?

Do you agree to the following?

You understand that research suggests a possible link between finasteride and depressive symptoms, suicidal thoughts, and sexual problems (such as reduced sex drive, erectile dysfunction, and ejaculation issues), although this connection is still being studied. You understand that if you develop depression, suicidal thoughts, or sexual dysfunction, you must stop treatment and seek urgent medical advice. You understand that sexual dysfunction may in rare cases persist in some people even after stopping finasteride. You will seek medical review if you notice changes in your breast tissue including lumps, pain or nipple discharge. You understand that finasteride can affect Prostate Specific Antigen (PSA) test results, so you will tell your doctor you are taking this medication before having this test. You will read the patient information leaflet supplied with your medication You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment. The treatment is solely for your own use. You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.

Do you understand that if prescribed finasteride:

You must take steps to avoid conception while using this medication, such as always using a condom during sex. If your partner is pregnant or could become pregnant, they must not handle crushed or broken tablets, as this could harm the pregnancy.

Have you ever been diagnosed with one of the following conditions:

Prostate problems (prostate enlargement, prostatitis, prostate cancer) Male breast cancer Heart Disease (including chest pain, angina, heart attack or any history of cardiovascular event) High Blood Pressure Chronic liver disease (including liver cirrhosis) Pheochromocytoma (cancer of the adrenal glands) Acute Porphyria (a rare hereditary disease affecting haemoglobin)

Are you allergic/hypersensitive to minoxidil, finasteride/propecia, caffeine, ethanol, propylene glycol or lactose?

Have you ever had or are you currently experiencing low mood, depression or suicidal thoughts?

Do you currently have any sexual health concerns including low libido (sexual desire) or erectile dysfunction?

Are you currently taking any medications like finasteride e.g. dutasteride (Avodart)?

Are you suffering from hair loss?

Do you have hair loss in patches, or have an itchy or sore scalp?

Do you have a healthy scalp?

no inflammation on the scalp no redness no medical dressings unshaven

Do you have sudden unexplained hair loss or complete hair loss?

Could your hair loss be explained by any medication or illness (e.g. chemotherapy)?