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    Do you understand that this treatment is only suitable for men?(those whose registered sex at birth was male)

    YesNo

    This treatment is only suitable and safe for us to prescribe for men. Please see your GP for further advice.

    Have you had this problem diagnosed by a healthcare professional before?

    YesNoOther

    Why do you need treatment today?

    I’ve had this problem before and need a REPEAT prescriptionI’ve had this problem before but want to try a NEW medicationI’ve NOT had this problem before and want to try a medication to helpOther

    0%

    Which type of hairloss do you think you have? If you are not sure please select ‘I don’t know’

    Classic male pattern hair loss
    - Gradual thinning on the top of the head or a receding hairline. Often happens as you get older or can run in families.

    Alopecia
    - Sudden, round patches of hair loss on the scalp, beard or other parts of the body.

    Unfortunately, this treatment is not suitable for this condition. However, we do offer some treatments for Alopecia so we advise you to use our ‘Express Consultation Service’ - alternatively see your own GP for further advice.

    Telogen effluvium
    - General hair thinning all over the scalp, often after stress, illness, or a major life event.

    Unfortunately, this treatment is not suitable for this condition. We advise you to see your own GP for further advice.

    Traction alopecia
    - Hair loss caused by tight hairstyles (e.g., ponytails, braids) or repeated pulling on the hair.

    Unfortunately, this treatment is not suitable for this condition. We advise you to see your own GP for further advice.

    Scarring alopecia
    - Permanent hair loss where hair follicles are destroyed, often with inflammation, scaling, or redness on the scalp

    Unfortunately, this treatment is not suitable for this condition. We advise you to see your own GP for further advice.

    Hair loss due to medication or illness
    - Permanent hair loss where hair follicles are destroyed, often with inflammation, scaling, or redness on the scalp

    Unfortunately, this treatment is not suitable for this condition. We advise you to see your own GP for further advice.

    Other

    I don’t know

    14%

    What areas of your head are losing hair? Please select all that apply

    Top of the head (crown)
    - thinning or balding at the top of your head

    Front of the scalp (hairline)
    - receding hairline or thinning at the front of the scalp

    Sides of the head (temples)
    - hair loss or thinning around the temples

    Back of the head
    - thinning or bald spots on the back of your head

    All over the scalp
    - general thinning or shedding all over the head

    Patches of hair loss (anywhere on the scalp)
    - round or irregular patches of hair loss on the scalp

    Other

    I don’t know

    Do you have any of the following additional symptoms?

    Generalised hair thinning (thinning across the scalp)Hair loss in single or multiple patchesItchy or flakey scalpDryness, scaling, or crusting on the scalpPainful or sensitive scalpGreasy or oily scalpRedness on the scalpBlistering or sores on the scalpScaling or flakey skin affecting eyebrows, sides of the nose, or earsRash in the center of the faceYellowish crusting on the skinNone of the aboveOtherI don’t know

    28%

    When did the problems start?

    How quickly did the problem start?

    Suddenly (minutes)Quickly (hours)Gradually (days)Slowly (weeks)Very slowly (months)Over several yearsOtherI don't know

    Is it getting worse?

    NoYesOtherI don’t know

    How does the problem behave?

    It's always thereIt comes and goesOtherI don’t know

    How long does it last?

    MinutesHoursDaysWeeksMonthsYears

    Please explain:

    42%

    Has anyone in your close family also had a similar pattern of hair loss?

    NoYes, other people in my family have suffered with this problem tooI don’t know

    Have you been unwell in any other way recently or experienced any of the following symptoms?

    No- I have been wellI have been unwell recently due to another condition, illness or circumstanceTemperatureFeverNauseaVomitingNight sweatsWeight lossExcessive tirednessJoint pain/ swellingOther concerning symptomsI don’t know

    Please tell us more

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    Does anything make it WORSE? Please select all that apply

    StressPoor diet or nutritional deficienciesWearing hats or helmets frequentlyTight hairstyles (e.g., ponytails, braids)Hair treatment e.g hot combing, using straightenersHeat (e.g., hot showers, hair dryers)Sun exposureSweatingHair products (e.g., gels, sprays)Certain medicationsLack of sleepWeather changes (e.g., dry or cold air)OtherNone of the aboveI don’t know

    Does anything make it BETTER? Please select all that apply

    Reducing stressA healthy, balanced dietUsing gentle or medicated shampoosAvoiding tight hairstylesAvoiding heat styling (e.g., hair dryers, straighteners)Taking hair growth supplements (e.g., biotin, zinc)Using hair loss treatments (e.g., minoxidil, finasteride)Keeping the scalp clean and moisturisedProtecting the scalp from sun exposureGetting enough sleepAvoiding harsh hair products (e.g., gels, sprays)OtherNone of the aboveI don’t know

    57%

    Have you already tried any of the following treatments?

    Hair Loss Shampoos/ Lotions/ Serums
    e.g. Regaine, Alpecin, Nioxin, Revita, Nanogen

    Hair Supplements & Vitamins
    e.g. Biotin, Collagen, Zinc, Vitamins, Iron

    Herbal/ alternative Supplements
    e.g Saw palmetto, Rosemary oil, Aloe vera, Ginseng. Horse tail extract

    Prescription Medications
    e.g. Finasteride (Propecia) tablets, Dutasteride (Avodart) /capsules

    Hair Transplants or Surgical Procedures
    e.g. FUE, Scalp MIcropigmentation

    PRP (Platelet-Rich Plasma) Therapy

    Laser Therapy
    e.g. Capillus, HairMax LaserComb, iRestore

    Cosmetic Camouflage Products
    e.g Toppik Hair Fibres, Caboki, DermMAtch

    Other

    None - I haven't tried any treatments.

    Is there anything else you feel is important for us to know that would prevent us from safely prescribing for you?

    NoYes

    71%

    Photo Upload

    • If this is a new problem then we require at least one photo of it (max 6 photos) using your phone or digital camera.

    • Take a "far away photo" (from 1 meter away) to show the location and size of the problem.

    • Take a close-up photo (10-12 cm away) to show the details.

    • If appropriate please include a size reference (e.g. a coin or ruler) in your photo for scale.

    Upload Photo 1





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    85%

    Do you understand and agree with the following?

    You are aware that finasteride (propecia) and dutasteride (avodart) are for men only. These medications will not work for females and can be harmful in pregnancy. Pregnant women should avoid touching broken or crushed tablets.

    You are aware that finasteride (Propecia) and dutasteride (Avodart) can sometimes cause reduced sex drive or erection difficulties- although this is uncommon and usually resolves over time.

    You are aware that there have been reports of depression and suicidal thoughts with finasteride (Propecia) and dutasteride (Avodart). If you have a history of depression or experience these symptoms, you should stop treatment immediately and consult your GP.

    You are aware and accept that you should consult your GP if you notice any changes in breast tissue, such as lumps, pain, or nipple discharge. While rare, breast cancer has been reported in men taking finasteride and dutasteride.

    You are aware and accept that if your hair loss does not improve after 6 months of treatment with finasteride or dutasteride, you should stop using the medication.You are aware that if you develop any worsening, new or severe symptoms, or you have any concerns or psychological distress then you should see your GP or seek urgent care as soon as possible.

    You will read the patient information leaflet supplied with any medication we send you and if you have any allergies to any of the ingredients or any contraindications, you will not take the medication and contact a DigiDerm clinician for further advice. You have informed us of any allergies you have by completing the general health questions.

    You have informed us of any current or previous medical conditions you have by completing the general health questions.

    You agree that if needed, a DigiDerm clinician may contact you via email, whatsapp or telephone in response to this consultation form to offer advice and suggest treatments where necessary, or if they feel they need more information to make an accurate diagnosis or assessment of your condition.

    You agree that if after reviewing your consultation, your skin problem is something we cannot treat or is not suitable for our service, then we will give you a full refund and suggest you visit your registered NHS GP for further advice.

    You are at least 16 years old and currently resident in the UK at the time of this consultation. This treatment is to be used only by you.

    You take responsibility to inform your own regular doctor/ NHS GP of this online consultation and any treatments supplied, or any changes in your circumstances.

    The answers provided to the above questions are true and accurate to the best of your knowledge.

    100%

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