This phase gathers essential health information to determine eligibility and identify any risk factors that could affect the safe use of hair loss treatments.

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Male
Female
Transmale (Born a female)
Transfemale (Born a male)


Yes
No
Occasionally

If yes, please specify.

Severe liver disease
Rare hereditary problems of galactose intolerance, Lapp lactase deficiency, or glucose-galactose malabsorption
History of prostate issues (e.g., benign prostatic hyperplasia)
Breast tissue changes (e.g., lumps, pain, gynaecomastia, nipple discharge)
Any other significant medical conditions not listed
Not applicable


Other 5-alpha reductase inhibitors
Medications affecting testosterone levels
Any treatment for hair loss not listed
Not applicable

If yes, did you experience any side effects?

If yes, please provide further information.



This phase assesses the severity and nature of hair loss, symptoms, and any contraindications for treatment.

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Please take the time to carefully read the Agreement and Consent statements during our online consultation process. Understanding these statements is essential for your safety and for ensuring that you are fully informed about the treatment you will receive. The Agreement and Consent sections outline important information about the risks, benefits, and responsibilities associated with your medication. By reading and agreeing to these terms, you help us ensure that you are aware of and comfortable with the treatment plan. Your informed consent is crucial for providing you with the best possible care.

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  • I confirm that the information I have provided in this form is accurate to the best of my knowledge.
  • I understand that providing false or incomplete information may affect the safety of my treatment.

  • I understand that finasteride is only licensed for the treatment of male pattern baldness and is not suitable for all forms of hair loss.
  • I confirm that I do not have any medical conditions that would prevent me from safely taking this medication.
  • I understand that finasteride must be taken continuously to maintain its benefits.

  • I agree to report any severe or prolonged side effects to my GP or pharmacist.
  • I understand that common side effects may include decreased libido and erectile dysfunction.
  • I understand that I must seek medical attention if I experience breast tissue changes such as lumps, pain, gynaecomastia, or nipple discharge.
  • I am aware that finasteride should not be handled by women who are pregnant or may become pregnant due to potential risks to a male foetus.

  • I am requesting medication for the treatment of male pattern baldness.
  • I have had the opportunity to ask questions and understand the risks and benefits.
  • I accept full responsibility for taking this medication as advised.