This is the first step in your journey to tackle your hair loss, and we are here to support you through every step of this 12-month journey. Any worries, concerns or questions, just reach out to us via direct messaging through your account, WhatsApp, phone or book via this link www.manual.co/book to schedule a call with your clinician – Remember this is all free and part of your subscription plan. Now it is important that you read this treatment plan, it has all the information you need about how the treatment works, how to take the medication, what to avoid, side effects and when to seek help. Think of this as your blueprint to success in your battle against hair loss. Best results are expected when you have used the treatment for12 months.

Do hair treatments really work?

Often you are told there is nothing you can do about it and if there was, there would be no bald men. We hear this all the time, however science and medicine shows you can treat hair loss in around 90% of male pattern balding. When effective, hair loss treatments will produce one of three results:

1. Slow down your hair loss significantly 2. Stop your hair loss and retain what you have left 3. Regrow hair you have lost, and stop you losing anymore

How to get the best results?

All of the above can be good results for you, depending on your stage of hair loss. Naturally, many men want regrowth of their lost hair. In order to improve your chances of this it’s absolutely vital you do these things:

1) Start treating your hair as early as possible when you notice hair loss (the fact you have requested this treatment, means you are taking action now) 2) Take the treatment for a full 12 months consistently and then assess your final results. Stopping sooner you have not allowed enough time to see the maximum result 3) Upload your hair tracking photos (every 30 days), ensuring you also have uploaded photos before starting the treatments Why do I need to wait 12 months, you might ask? It’s a good question. Well primarily your hair growth cycle is actually long, your hair spends 2-7 years approx. in its growth phase. So, when you use treatments it takes time to allow most of your hair to get into this growth phase. Our clinicians will explain more if you have questions when you book any call.

Finasteride Tablet and Minoxidil

Here at Manual we sat down and thought about the most effective hair treatment ingredients (Oral Minoxidil and Finasteride), and put them into one treatment plan – with the sole aim of giving you the best possible results. It also helps those men who hate applying hair solutions, find they haven’t worked or have got irritated dry scalps from them.

How does it work?

One of the main causes of Male pattern baldness is the negative effect of the hormone Dihydrotestosterone (DHT) on hair follicles, causing them to progressively shrink resulting in the thinning of your hair and the shortening of your hair growth cycle leading to eventual hair loss.

Finasteride Tablet: blocks the action of DHT on the hair follicles by suppressing the enzyme 5-alpha-reductase (5AR), which inhibits the conversion of testosterone to DHT, lowering the level of DHT on the scalp. The decrease in the levels of DHT slows down hair loss and increases the number of hairs in the growth phase of the hair growth cycle, resulting in the promotion of hair growth.

Minoxidil Capsule: Topical Minoxidil does not work in a significant portion of men, as they lack the necessary enzyme SULT1A1 (Minoxidil Sulfotransferase) in their hair follicles to activate the medication from Minoxidil to Minoxidil Sulphate (the active form). The oral minoxidil solves this by working via the liver where the enzyme is present to activate the medication. A powerful hair growth stimulant in its topical form, and studies show it’s even more effective in its oral form, works by firstly increasing the flow of oxygenated blood to your hair follicles to ensure that they stay nourished and by resetting the hair growth cycle to ensure that your hair stays growing for longer.

How effective is it?

Individually these ingredients are amongst the most proven treatments available for the treatment of male pattern hair loss and when taken in combination their efficacy is estimated to be 90-94%.

Medication Status

In the UK, the sale of medicines is managed by a licensing system run by the MHRA. Each medicine has a licence that includes information about its proven effectiveness in clinical trials. Once medicine has been proven to be clinically effective against a condition in a group of patients, it can be marketed as a treatment in that area. Sometimes, the licensed medicines on the market may be considered less suitable for a patient. In that case, a prescriber can request a medicine be prepared to meet, or better meet, the patient’s needs. Our oral Minoxidil is a specially formulated preparation, which our clinical team believes will be the most effective way to treat your hair loss. As such, it is classed as an unlicensed special treatment. This means it’s a specific medication which is made to serve a specific patient’s need. This is produced by our licensed MHRA specials manufacturer that specialises in the development and manufacture of such bespoke specials. Whilst it has not undergone the MHRA licensing process, it contains well known ingredients proven to treat hair loss and would be expected to perform similarly.

When will I see the results?

The earlier you notice hair loss and start treatment, the greater your chances of success. The combination of Finasteride and Minoxidil starts working the moment you start taking them but it may take some time for results to show. Early results can be seen within six months, however we strongly advise giving yourself at least a year on the treatment plan in order to experience its full benefits. Remember your hair loss journey is a marathon, not a sprint! NOTE: Temporary hair loss (or shedding) may occur during the first 2-8 weeks of use. This is likely to be a result of a change in the natural hair growth cycle promoting old hair to fall out and new hair to come through, it should stop within a couple of weeks. This is an expected shedding, and indicates the treatment is working for you.

How do I take it?

Take One oral Minoxidil capsule and One oral Finasteride tablet each day with or without food.

If you forget a dose – do not take a double dose to make up for it.

What are the side effects?

Side effects can occur with any medication, so its important you are aware of those. Stop using the medicine and talk to a clinician, your own doctor or pharmacist if you experience any of the following that can be associated with Minoxidil:

• Hypertrichosis (abnormal amount of hair growth over the body)
• Changes in Hair colour
• Headache, dizziness, feeling faint due to low blood pressure
• Palpitations and/or fast heartbeat/chest pain
• Swelling in the hands, feet or legs, or shortness of breath
• Discomfort whilst breathing
• Fluid Retention/Oedema
• Skin rashes
• Breast tenderness
• Increased blood creatinine, urea or new abnormal ECG
• Decrease in blood platelets or white cells
• Gastrointestinal issues
• Pericarditis
• Cardiac Tamponade
• Pleural effusion

Finasteride is highly effective and has many years’ worth of clinical data on its safety. 98.6% of men who took Finasteride in clinical trials, continued to do so as they experienced no adverse effects to the medication. However all medications have side effects, so it’s important you understand the ones sometimes seen with Finasteride. Stop using this treatment plan and talk to a clinician, your own doctor or a pharmacist if you experience any of the following:

Potential side effects include:

• Decreased libido
• Inability to get or maintain an erection (erectile dysfunction)
• Pain or discomfort that affects the testicles
• Ejaculation / fertility disorders or problems, such as decreased ejaculatory volume
• Changes in mood or depression
• Breast tenderness or lumps
• Suicidal Ideation

If you are allergic to any of capsule ingredients, anaphylaxis or a generalised severe allergic reaction may occur. Symptoms can include fainting, shortness of breath, sudden drop in blood pressure and swelling of the face and neck. If you feel very unwell or experience serious, severe or persistent side effects please go to your local Accident & Emergency department immediately or in an emergency call 999. This advice applies to all products within the hair plan.

We want the best for you and your health. It is important you don’t feel alone, so please voice your concerns and get in touch with one of our team for more help if you need it. You can message a clinician via the messaging function on your patient account, and we will typically reply within 24hrs.

We are committed to continually improving our understanding of the medications we prescribe, including their side effects, to provide the highest level of care, guided by the latest medical insights. If you experience any side effects, please discuss them with your clinician or coach.Additionally, you can report side effects, no matter how minor, through the government-run Yellow Card reporting scheme at https://yellowcard.mhra.gov.uk/. Your feedback helps to improve medication safety for everyone.”

Who should not take it?

Our Hair treatment plans are NOT suitable for women. It is also not suitable for male patients under 18 years of age. These capsules must never be directly handled by females, who could be pregnant or are breastfeeding. This is due to the risk of the potential harm it may cause to an unborn baby.

Finasteride is not suitable:

for men with benign prostate enlargement (BPE) currently receiving treatment with a 5-alpha reductase inhibitor (e.g. Finasteride 5mg tablets or Dutasteride).

If you are or have suffered from male breast cancer or prostate cancer

If you have galactose intolerance, lapp lactase deficiency or glucose-galactose malabsorption

Minoxidil should not be used in patients in the following categories:

Suffer from uncontrolled, dangerously low or high blood pressure

You should not take our treatments if you are allergic to minoxidil, finasteride or any of the excipients. Lastly, the treatments have not been shown to be effective in men who have complete hair loss.

Fertility or partner is pregnant.

Men who take Finasteride do have traces of the medication in their semen. Available evidence suggests this is unlikely to pose a risk to an unborn child and there is no known risk to the foetus as the amount of finasteride excreted following a 1mg dose is too small to be harmful. Having said this, foetus abnormalities can develop without an obvious reason. From an emotional point of view, if that were to happen, you may agonise and go back and try to see if ‘you did anything wrong’. This may sound illogical or unscientific but that is human nature. Given this, conservative advice is that when taking finasteride-containing treatments (such as our All-in-One Capsule) you should use a condom if having intercourse with a woman who is known to be pregnant. This is conservative advice, and you have the discretion to decide how to apply this advice, given your own risk appetite.

In relation to fertility, long-term data from the use of Finasteride and/or oral minoxidil impacting human fertility is lacking, and specific studies in subfertile men have not been conducted. The male patients who were planning to father a child were initially excluded from clinical trials. Animal studies do not show relevant negative effects on fertility, however. Some spontaneous reports of infertility and/or poor seminal quality have been reported with finasteride. In some of these reports, patients had other risk factors that might have contributed to infertility. Normalisation or improvement of seminal quality was reported after discontinuation of finasteride. We would like our patients to be as well informed as possible, before deciding on treatment. We do not want to be seen to be omitting any pieces of information. It is important to note that most of the studies deem finasteride 1mg to be safe and effective, and that is our overwhelming experience from thousands of customers. We also understand concerns that new or potential users of finasteride treatment may face when deciding whether or not to take finasteride. We advise if you are actively trying to conceive then you should consider the above information and make an informed decision on whether you wish to proceed with treatment based on your personal fertility circumstances. If you are undergoing fertility treatment or have a known low sperm count and are trying to conceive, we advise you not to take Finasteride-containing treatments so that you are not worrying about any theoretical impact they could have.

Mental Health

While Finasteride can increase the risk of depressive symptoms in a small percentage of users, it is considered an uncommon side effect. Some studies suggest a link between Finasteride and low mood, while others find no difference. Most men tolerate Finasteride well, but those with a history of depression should consider the potential risks and benefits.

When starting your treatment, monitor your mood and inform friends and family that you are taking this medication, as they can help identify any changes. If you experience depressive symptoms or suicidal thoughts, stop taking Finasteride 1mg (Propecia) immediately and contact your doctor as soon as possible.

Sexual Health

In clinical trials, less than 2% of men experienced sexual side effects from taking finasteride. Specifically, about 1.3% reported erectile dysfunction, 1.8% noted a reduced interest in sex, and 1.2% experienced ejaculation issues, including lower semen volume. If you encounter any sexual function issues, such as difficulty maintaining an erection or a decrease in sex drive, please discuss this with your prescriber or doctor. If you experience any problems with sexual function such as inability to get and maintain an erection or decrease in sex drive, please discuss this with your prescriber or doctor

What if my medical status changes or I am due a blood test?

Finasteride can lower a hormone called PSA measured in a blood test for prostate problems. Please tell your GP that you are taking this medication if you have this blood test so that they can interpret your test results correctly.

Please inform our clinicians via your patient account messaging facility: if you start taking any new medicines or if there are any significant changes to your medical history. Also if you experience any significant side effects or want further advice on your treatment. Just reach out to us via direct messaging through your account, WhatsApp, phone or book via this link www.manual.co/book to schedule a call with your clinician

It is important that you inform your GP about the medicines you take to ensure they have an accurate medication history. If you do not share this information with your GP it could result in the healthcare professional not having enough information to make informed clinical decisions about your care, increasing your risk of injuries or side effects. On your account page, you can download a letter to share with your GP that contains all the relevant information about your treatment plan.

Good Luck, excited to see your results!