PATIENT CONSENT FORM

FINASTERIDE and PROPCIA FOR TREATING HAIR LOSS

 Patient Name: __________________________________________________

Address: __________________________________________________

__________________________________________________

__________________________________________________

_______________________ Post Code _________________

Date of Birth: _______________________ Age: ____________________

I consent to undergo treatment with Finasteride or Propcia daily oral or equivalent for Androgenetic Alopecia .

I understand that Finasteride/Propcia suppresses an enzyme in the scalp which is responsible for promoting hair loss.

I understand that like Minoxidil, the treatment does not guarantee hair growth in all patients, although research has shown that it is effective and safe in over 60% of patients and can be enhanced further if used together with Minoxidil. The response to treatment is effective if medication is uninterrupted and cannot be assessed fully before six months.

Side Effects :

These are minimal and include impotence and decreased libido (less than 1%). If present, the effect will reverse after cessation of treatment.

Warning :

Finasteride/Propcia should not be given to women who might become pregnant as it could affect the development of the foetus.

For this reason patients taking Finesteride/Propcia should not donate blood in case a pregnant woman were to receive it.

If you are over 50, we would recommend that you have a PSA level check by your GP re prostate, before starting a course of Finesteride.

Signed......................................