HOW TO REQUEST A PHYSICIAN CONSULTATION FOR A MINOXIDIL PRESCRIPTION:

1. 1. Read about low-dose ORAL Minoxidil for hair loss to learn more about its indications and contraindications.
   2. Read and Agree to the Waiver of Liability.
   3. Accurately and truthfully complete and submit a medical consultation questionnaire
   4. Your medical consultation will be reviewed by one of our Physicians, and if approved you will be prescribed low-dose ORAL Minoxidil which will be forwarded directly to your local pharmacy.
   5. This consultation is RISK-FREE, if the physician determines oral Minoxidil  is not appropriate for you, then there is no charge.
   6. You can select either “regular” service (3-7 days to process) or “express” 24 hour processing for an express service fee.
   7. If approved you will receive an email confirmation from Medical Wellness Center after your prescription has been forwarded to your selected pharmacy.
   8. The initial consultation fee for the physician evaluation is only $49.95 for plus either Regular or Express 24 hour Service for a 90 day prescription, if you are approved for treatment, otherwise it’s free. If you find low-dose oral Minoxidil is working for you, refill consultations are only $49.95 plus processing for SIX months of refills.
      
   9. Unlike other medications we prescribe for hair loss, low-dose oral minoxidil requires more frequent monitoring since it can have systemic effects on your blood pressure.  Therefore the initial consult is for only three months.  Afterwards, since cardiovascular status can change, we require refill consultations every six months.
      
   10. If you have any health concerns in any way, you should contact your own physician for further advice

  General Male Pattern Hair Loss : FAQ

WHAT IS MALE PATTERN HAIR LOSS?

Male pattern baldness, androgenetic alopecia, is a very common condition in which men begin to experience thinning of the hair on the scalp. These changes often start slowly in men in their 20’s and often progress to a receding hairline and/or balding on the top of the head. Male pattern baldness is believed to be hereditary and dependent on hormonal effects. The primary cause of Male Pattern hair loss and baldness is due to Dihydrotestosterone (DHT) which is produced by 5-alpha reductase conversion of testosterone to DHT.

HOW LONG BEFORE I SEE RESULTS?

Hair grows only about ½ inch per month, therefore patients start to notice results after first 3 months of treatment. It takes time to see improvement. Also, for those just starting to have hair thinning, using the BIG THREE in the early stages can prevent or dramatically slow further hair loss.

HOW LONG DO I HAVE TO USE MEDICATION FOR HAIR LOSS?

The underlying predisposition to baldness is always present. Therefore, if a patient discontinues use of hair loss treatment, he will gradually lose the new hair that grew and the underlying predisposition to baldness progresses

HOW LONG BEFORE I SEE RESULTS?

Hair grows only about ½ inch per month, therefore patients start to notice results after the first 3 months of treatment. It takes time to see improvement. Initially one may start to notice very fine, soft, colorless hairs. With further use, the new hairs will gradually become thicker and the same color as the other hairs on your scalp. Up to 12 months of use may be needed to see your best results from Minoxidil. Also, for those just starting to have hair thinning, using Minoxidil in the early stages will yield the most dramatic results.

DOES MINOXIDIL CURE HAIR LOSS?

Because male pattern hair loss is a progressive condition, both oral and topical minoxidil slow the progression of hair loss. But, if you stop taking or using the medication, the hair regrowth stops and reverses.  Therefore, as long as you want to maintain the hair thickening and regrowth, you have to continue to the treatment.

HOW LONG DO I HAVE TO USE MINOXIDIL?

The underlying predisposition to baldness is always present. Therefore, if a patient discontinues the use of Minoxidil, he will gradually lose the new hair that grew in response to Minoxidil treatment and will experience the progression of his underlying predisposition to baldness.  Newly regrown hairs will probably be lost in 3 – 4  months after stopping medication use.

 PROPECIA and AVODART: FAQ

WHAT IS THE DIFFERENCE BETWEEN PROPECIA (FINASTERIDE) AND AVODART (DUTASTERIDE)?

Men with male pattern baldness have increased levels of the hormone dihydrotestosterone( DHT), the main culprit in male pattern hair loss.  As a result, the hair follicles in the balding areas of the scalp become miniaturized.  Both Propecia and Avodart inhibit 5-alpha reductase enzymes that converts testosterone to DHT.

Propecia (finasteride), the first oral drug for hair loss approved by the  FDA, only inhibits Type II 5-alpha reductase enzyme.  In contrast, Avodart (dutatseride),  blocks both Type I and Type II 5-alpha reductase enzymes.  Avodart at a daily dosage of 0.5mg/day has been shown to reduce serum levels of DHT by over 90%.  Preliminary Phase 2 studies by GlaxoSmithKline have shown Avodart to be as SAFE as Propecia but significantly more effective in decreasing DHT levels and treating Male Pattern Baldness.

HOW DOES ONE DECIDE WHETHER TO TAKE FINASTERIDE OR DUTASTERIDE?

Clinical studies that Propecia stops further hair loss and/or causes significant hair regrowth filling in thin or balding areas in over 80% of men with male pattern baldness.  Therefore, all men should initially start with finasteride 1mg daily.  If one does not respond to at least six months of finasteride or finasteride loses effectiveness, then men should upgrade to the stronger dual-acting 5-alpha reductase inhibitor, dutasteride.  Most men who don’t respond or stop responding to finasteride, respond extremely well to dutasteride.

 Medical Wellness Center has been compiling patients responses to Avodart (dutasteride). Click here to read unedited patient responses to Avodart.

WHEN & HOW DO I TAKE AVODART OR PROPECIA?

One takes either one 0.5mg dutasteride capsule daily or one 1mg finasteride pill daily.  Do not combine or alternate between the two.  Doing so increases risk of irreversible side effects. If you miss adose, take the missed dose as soon as you remember during the SAME day.  However, if you don’t remember until the next day, skip the dose you missed and take only the next regularly scheduled dose. DO NOT take a double dose of the medication.

• • Dutasteride or finasteride is for use by MEN only.
  • Take each dose with a full glass of water
  • Swallow the capsule or pill whole. Do NOT chew or crush or break the capsule.
  • Dutasteride or finasteride can be taken with or without food
  • Always discuss any new medications with your primary care physician first before taking.
  • Do NOT combine Avodart with finasteride – Proscar or Propecia

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT ABOUT DUTASTERIDE OR FINASTERIDE?

• Avodart and Propecia are for MEN only
• Avodart is a more potent and effective 5 alpha reductase inhibitor than Propecia.  Avodart, FDA-approved for BPH only, has been shown to be more effective than Propecia and is  prescribed off-label for male pattern hair loss
• Pregnant women or women who may become pregnant MUST NOT handle Avodart or Propecia as the active ingredient can be absorbed via the skin and cause external genital abnormalities in the male fetus.
• Do not donate blood for at least 6 months after your last dose of Avodart or Propecia to prevent pregnant woman receiving dutasteride via blood transfusion.
• Store Avodart or Propecia at room temperature away from moisture and heat.
• Avodart or Propecia reduces the serum level of the Prostate cancer marker PSA by approximately 40% after 3 months of treatment and by 50% after 6 months of treatment.  Therefore, if taking Avodart or Propecia one must inform all treating physicians and adjustments need to be made in baseline measurements and interpretation of PSA levels for monitoring cancer-related changes. To interpret PSA testing for a man on alpha-reductase inhibitor treatment for 6 months or longer, one must double the PSA value for Prostate cancer detection.
  

IS AVODART or Propecia COVERED BY INSURANCE?

Since both are being prescribed for cosmetic hair loss, insurance usually does not cover it. But, some insurance companies may cover it.  Unfortunately, Medical Wellness Center can not call any health insurance provider for a prior authorization.  In order to do this, the prescribing physician has to confirm that the medication is being prescribed for a medically necessary condition, Benign Prostate Hypertrophy (BPH).  Dutsateride or finasteride prescribed for BPH needs direct physician monitoring. Therefore, we do not prescribe dutasteride or finasteride for BPH.

WHAT ARE THE SIDE EFFECTS OF AVODART?

Avodart has shown a similar safety profile as Propecia and most men, as with Propecia, experience no side effects. A small percentage of men experience the following side effects most of which decrease or disappear with continued usage: impotence (4.7%), decreased libido (3%), breast tenderness and breast enlargement (0.5%) and ejaculation disorders (1.4%). These possible side effects disappeared in most men who continued to take Avodart  and completely disappeared in men who stopped taking Avodart.

Stop taking Avodart and seek emergency medical attention if you experience an allergic reaction such as difficulty breathing, closing of the throat, swelling of the lips, tongue or face.

WHO SHOULD NOT TAKE AVODART?

• Avodart is for Men over age 18 only.
• Do NOT take Avodart if you are a female or under age 18.
• Do NOT take Avodart if you have LIVER disease as Avodart is metabolized by the liver.
• Do NOT take Avodart if you are  taking Protease inhibitors such as Agenerase (amprenavir), Crixivan (indinavir), Viracept(nelfinavir), Novir (ritonavir) or Invirase, Fortovase (saquinavir)
• Do NOT take Avodart if you are taking oral Nizoral (ketaconazole) or Sporanox (itraconazole).
• Women who are pregnant or planning to become pregnant must NOT touch Avodart capsules as dutasteride can be absorbed through the skin and cause harm to developing male fetus.

Minoxidil: FAQ

WHAT IS MINOXIDIL AND HOW DOES IT WORK?

Minoxidil is the active ingredient in Rogaine and it works at the level of the dermal papilla.  Minoxidil increases blood flow and works by gradually enlarging miniaturized follicles that have shrunk.  Also, Minoxidil appears to extend the hair’s growth phase thus giving the hairs an opportunity to reach a longer length before falling out.  With more follicles in the growth stage, it is possible to see improved coverage of the scalp.

WILL MINOXIDIL WORK FOR ME? ?

Minoxidil is prescribed online for MEN 18 years or older experiencing gradual thinning and hair loss on the top of the head, ANDROGENETIC Male Pattern Baldness. The response to Minoxidil varies greatly for each person and can not be predicted.  But topical minoxidil does not work for everyone.  Some men lack or have low levels of the sulfotransferase enzyme in their scalp that converts minoxidil to the active form.  Therefore, in these men physicians recommend low-dose oral minoxidil because the sulfotransferase enzyme in the liver converts the oral minoxidil to the active form.

HOW DOES ORAL MINOXIDIL COMPARE TO TOPICAL?

Most studies claim low-dose oral minoxidil is superior to topical minoxidil.  When applied topically, minoxidil needs to be activated by a sulfotransferase enzyme in the hair follicle.  Unfortunately, this scalp enzyme varies greatly and even missing in some men which makes topical minoxidil less effective.  When taken orally, the liver sulfotransferase enzyme activates the minoxidil, often yielding superior results.

WHAT IS THE DIFFERENCE BETWEEN ORAL MINOXIDIL DOSE FOR HIGH BLOOD PRESSURE AND HAIR LOSS?

Oral minoxidil is approved to treat high blood pressure. The usual dose for high blood pressure is between 10 -40 mg daily, much higher that for hair loss.  In contrast. Physicians typically prescribe up to 2.5mg oral minoxidil daily for hair loss.

WHAT IS THE MAXIMUM ORAL MINOXIDIL DOSE PRESCRIBED FOR MALE PATTERN HAIR LOSS?

Although you may be able to get higher doses elsewhere, our physicians prescribe a maximum of 2.5mg daily for male pattern hair loss.   Since even low doses can cause a decrease in blood pressure, lightheadedness and dizziness, this dose maximizes hair loss benefits and minimizes adverse systemic side effects.  Often it is best to start with 1.25mg daily for men.  If you tolerate this dose, after one week increase to 2.5mg daily dose.

CAN I USE BOTH TOPICAL AND ORAL MINOXIDIL?

Yes, but you have to start slowly and increase maximal topical minoxidil dose to only 15% not 30%.  Combining topical and low-dose oral minoxidil can increase unwanted hair growth and potentially increase side effects.    If on topical minoxidil and wanting to switch or add low-dose oral minoxidil, stop topical minoxidil.  Take oral minoxidil and make sure you do not have any low blood pressure effects such as light headedness or dizziness.  Then slow start with 5% minoxidil and increase to a maximum of 15% topical minoxidil.    WARNING:  Do not use multiple topical minoxidil formulas such as lotions, sprays and shampoos along with oral minoxidil.   If you choose to combine low-dose oral minoxidil with a topical minoxidil, select either a shampoo, spray or topical compounded lotion or cream only!

WHAT ABOUT ALCOHOL OR CAFFEINE CONSUMPTION WITH ORAL MINOXIDIL?

Since alcohol can lower blood pressure, cutting down on alcohol helps decrease and adverse low blood pressure effects.  In addition, excess caffeine consumption can cause rapid heart beat or palpitations. Therefore, decreasing caffein consumption minimizes side effects.

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT MINOXIDIL?

• Minoxidil is prescribed ONLINE for MEN only, although unlike Propecia or Avodart, it is often used for women who are experiencing male pattern hair loss.  Minoxidil is NEVER prescribed for women online because, in women, male pattern hair loss can be a sign of a serious or life-threatening underlying medical condition from hormonal problems to even cancer.
• Pregnant women should NOT use OTC Rogaine or prescription strength or oral Minoxidil.
• Low dose oral minoxidil or topical minoxidil is for treatment for male pattern hair loss which occurs gradually and runs in families.  If you experience sudden hair loss, or you are experiencing patchy areas or hair loss or hair loss from medication or after pregnancy Minoxidil is NOT for you.

WHAT ARE THE SIDE EFFECTS OF LOW-DOSE ORAL MINOXIDIL?

The most common side of low-dose oral minoxidil occurring in about 15% of men, is increased hair growth on face and body.  Stopping oral minoxidil reverses this side effect in one to six months.

Stop using the formulation and seek emergency medical attention if you experience an allergic reaction such as difficulty breathing, closing of the throat, swelling of the lips, tongue or face.

STOP USING MINOXIDIL AND SEE YOUR DOCTOR IF YOU GET:

• • Chest pain
  • Rapid heartbeat
  • Faintness and/or dizziness
  • Sudden, unexplained weight gain
  • Swollen hands or feet
  • Sudden changes to your vision or hearing

NIZORAL SHAMPOO: FAQ

WHAT IS 2% NIZORAL SHAMPOO?

Nizoral Shampoo is a clean pleasant fragrant shampoo that is PH balanced and leaves your hair soft, healthy and clean.  Ketoconazole, an anti-fungal agent, is the key ingredient. Nizoral is the #1 choice of doctors to treat dandruff and recent research has shown that prescription strength Nizoral Shampoo has benefits in the treatment of Male Pattern Hair loss.  Regular use of 2% can prevent hair loss.

HOW DOES NIZORAL SHAMPOO WORK?

Nizoral Shampoo in addition to being an anti-fungal agent has anti-androgenic effects that benefit in the treatment of Male Pattern Hair Loss. Nizoral helps to increase hair thickness and decrease shedding by two mechanisms:
1.  Nizoral reduces scalp DHT by inhibiting the binding of DHT to hair follicles and helps block the conversion of testosterone to DHT.
2. In addition Nizoral is believed to remove sebum deposits that are not removed with normal scalp cleansing techniques.  These fatty sebum deposits lie on the scalp and appear to clog the hair follicles and reduce the nutritional supply to the follicle.

WILL NIZORAL WORK FOR ME?

Nizoral shampoo is prescribed online for MEN 18 years or older experiencing gradual thinning and hair loss – ANDROGENIC  Male Pattern Baldness. Research studies presented at the American Academy of Dermatology who that 2% Nizoral increased hair thickness, decreased shedding, and increased the number of anagen-growth phase hair follicles on the scalp. When used regularly Nizoral helps prevent hair loss and improves the scalp condition. The response to Nizoral varies greatly for each person and can not be predicted.

WHEN & HOW DO I USE NIZORAL SHAMPOO?

Avoid contact with the eyes. Do not use on wounds or damaged skin. If you miss an application of shampoo, do not worry.  Just resume your treatment as soon as you remember. Nizoral’s effect is long-lasting and keeps working for several days.  Therefore you do not need to use it every day.

NIZORAL SHAMPOO FOR MALE PATTERN HAIR LOSS:

In order to help prevent hair loss and improve the scalp condition, 2% prescription strength Nizoral shampoo must be used regularly. Do not get in eyes.   Using Nizoral Shampoo more frequently or in higher doses will NOT make it work better or faster. If you miss a Nizoral treatment, just continue using the next day.  Do NOT use a double dose of the medication.

• • • Wet your hair & scalp with water.
    • Apply 1 – 2 teaspoons to your scalp. Work into lather.
    • Leave on for 3 – 5 minutes before rinsing.
    • Rinse thoroughly and follow with conditioner.
    • Do NOT use more frequently than prescribed.
    • Apply daily in place of your usual shampoo for 14 days and thereafter apply 1 -2 times weekly.

NIZORAL SHAMPOO FOR DANDRUFF:

Dandruff is actually associated with increased numbers of a type of fungus/yeast called Pityrosporum. Nizoral is a potent #1 recommended prescription anti-dandruff shampoo. For treating dandruff, apply twice a week for 2 – 4 weeks, then use once every 1 – 2 weeks to prevent dandruff symptoms from returning.

• • • Wet your hair & scalp with water
    • Apply 1 – 2 teaspoons to your scalp. Work into lather.
    • Leave on for 3 – 5 minutes before rinsing.
    • Rinse thoroughly and follow with conditioner.
    • Do NOT use more frequently than prescribed.
    • Apply twice weekly for 2 – 4 weeks, then use once every 1 – 2 weeks to prevent dandruff symptoms from returning.

CAN I CONTINUE TO USE SPRAYS, MOUSSES, GELS, and STYLING AIDS  WITH NIZORAL?

There is no need to change your usual hair care routine when using Nizoral. If combining with Minoxidil, use Nizoral shampoo in the morning when you wash hair and use Minoxidil on a dry scalp at night.

CAN I HAVE MY HAIR CHEMICALLY TREATED – PERMANENTS, TINTS, RELAXED WHILE USING NIZORAL?

There is no evidence that chemical treatment of hair changes the effect of  Nizoral. However, chemical treatments can result in scalp irritation. Therefore do not use Nizoral shampoo the day you chemically treat your hair. Although rare, discoloration has been reported in colored, dyed,  tinted, or permed hair. If you experience any irritation, sensitivity, or scalp redness after a chemical treatment, wait until the scalp is 100% healed before applying Nizoral. Do NOT make up for missed doses.

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT ABOUT NIZORAL?

• Do NOT use Nizoral on wounds or damaged skin.
• Store in a SAFE place where children can not reach it! Store away from heat and direct light. Do not freeze.
• Pregnant women should NOT use Nizoral shampoo.
• Minoxidil is indicated as a topical treatment for male pattern hair loss which occurs gradually and runs in families. If you experience sudden hair loss, or you are experiencing patchy areas or hair loss or hair loss from medication or after pregnancy Nizoral is NOT for you.
• Male pattern hair loss in women can be a sign of a serious or life-threatening underlying medical condition from hormonal problems to even cancer.  Therefore women with male pattern hair loss or hair loss need to be directly followed by his/her own physician.
• Nizoral is for TOPICAL use ONLY!  Never take Nizoral orally. The active ingredient, ketoconazole, when taken orally can cause toxicity and liver damage.

WHAT ARE THE SIDE EFFECTS OF NIZORAL?

Undesirable side effects are unlikely. The most common side effects are itching, irritation, redness, or burning sensation of the scalp and dry or greasy hair. Nizoral Shampoo should ONLY be applied to the scalp. Rarely, hair discoloration of gray, tinted, dyed, colored, or permed hair may occur. If undesirable side effects persist discontinue use.

Do not get in eyes – if accidentally gets in eyes flush with water immediately.

Stop taking Avodart and seek emergency medical attention if you experience an allergic reaction such as difficulty breathing, the closing of the throat, swelling of the lips, tongue, or face.

The side effects listed above may not include all of the side effects reported by the drug’s manufacturer. For more information about any other possible risks associated with this medicine, please read the package insert provided with the medication from the pharmacy.

WHO SHOULD NOT USE  NIZORAL SHAMPOO?

• • • NIZORAL SHAMPOO IS FOR EXTERNAL USE ONLY!
    • Do NOT use if your are pregnant or breast feeding, ketoconazole has been shown to cause birth defects in animals.
    • Avoid contact with eyes. If any gets in your eyes bathe them gently with cold water.
    • Nizoral   is prescribed online for Men  with Male Pattern Hair Loss over age 18 only.
    • Do NOT use  Nizoral  if you have a sunburned, red, inflamed, infected, irritated or painful scalp.
    • Do NOT use  Nizoral  if you have any scalp condition such as psoriasis or eczema as Minoxidil can be  very irritating.
    • Do NOT use  Nizoral  if you are allergic to to Ketoconazole, anti-fungal medicines, imidazoles or any of the ingredients in Nizoral.
    • Nizoral  will NOT prevent or reverse hair loss due to chemotherapy, or nutritional problems, low thyroid states, or disease which cause scarring of the scalp.

In order to proceed to the medical consultation, you must proceed to the next section and read the complete list of contraindications. Then you must verify that you do not have any of the contraindications and understand that any pregnant or potentially pregnant woman must not use Minoxidil.  Minoxidil is NEVER indicated for hair loss due to childbirth.  Under NO circumstance do we prescribe Minoxidil to any woman or child under the age of 18 .

ORAL MINOXIDIL BLOOD PRESSURE AND HEART RATE MONITORING:

How do I prepare to start low-dose oral minoxidil treatment for hair loss?

First buy a wrist, finger or arm blood pressure monitor at your local pharmacy if you do not have one.  You should record your blood pressure and heart rate before starting oral minoxidil and then check your blood pressure once a week and keep a record.

Since oral minoxidil, even in low doses, can lower blood pressure, you should get a baseline blood pressure reading before starting oral minoxidil.   Click here for oral minoxidil monitoring chart which you can print out.  You should record your blood pressure three times before beginning treatment.  After starting treatment, monitor your blood pressure weekly. In addition, anytime you feel lightheaded or dizzy record your blood pressure and heart rate.  Even though low-dose oral minoxidil does not lower blood pressure in most patients, you should monitor your blood pressure and heart rate for the first 3 weeks. 

Since side effects correlate with dosage, higher doses of oral minoxidil increase the risk of low blood pressure and lightheadedness.  When taking 2.5mg or less daily, systemic side effects are minimal. If you feel lightheaded or faint or notice a major change in blood pressure after starting oral minoxidil, contact us at wellnessmd@medicalwellnesscenter.com.   If an emergency, contact your primary care physician or seek emergency medical treatment.