What is your age?
Pick one:
a) I have a full head of hair
b) My hair is thinning on top
c) My hair is receding at the temples
d) My hairline is receding generally
e) I am bald (by choice or nature)
Pick all that apply:
a) My male relatives had similar hair issues at my age
b) My hair-loss is rapid compared to the other men in my family
c) My hair-loss is manifesting early in life compared to the other men in my family
d) I have Male Pattern Baldness in my family
e) all the above
Have you noticed an increase in hair-loss that you associate with any pro-hormone(s)?
If so, please list the PH(s) you associate w/ the hair-loss:
Please rate the hairloss associated w/ each prohormone:
0 - negligible
1 - mild
2 - moderate
3 - severe
4 - extreme
Please describe the cycle (stack, dosing and duration) during which you became aware of the hair-loss:
Was this your first cycle with the PH(s) in question?
If not, please identify any differences between this and previous cycles:
Pick one:
a) My hair-loss slowed or stopped after the cycle in question
b) My hair-loss has continued since the cycle in question
Which any of the following compounds have you used?
a) minoxidil
b) azaelaic acid
c) spironolactone
d) ketoconazole
Please rate the effectiveness of the compound(s):
0 - no effect
1 - marginal
2 - okay
3 - definite improvement
4 - very noticeable
Pick one:
a) I have a full head of hair
b) My hair is thinning on top
c) My hair is receding at the temples
d) My hairline is receding generally
e) I am bald (by choice or nature)
Pick all that apply:
a) My male relatives had similar hair issues at my age
b) My hair-loss is rapid compared to the other men in my family
c) My hair-loss is manifesting early in life compared to the other men in my family
d) I have Male Pattern Baldness in my family
e) all the above
Have you noticed an increase in hair-loss that you associate with any pro-hormone(s)?
If so, please list the PH(s) you associate w/ the hair-loss:
Please rate the hairloss associated w/ each prohormone:
0 - negligible
1 - mild
2 - moderate
3 - severe
4 - extreme
Please describe the cycle (stack, dosing and duration) during which you became aware of the hair-loss:
Was this your first cycle with the PH(s) in question?
If not, please identify any differences between this and previous cycles:
Pick one:
a) My hair-loss slowed or stopped after the cycle in question
b) My hair-loss has continued since the cycle in question
Which any of the following compounds have you used?
a) minoxidil
b) azaelaic acid
c) spironolactone
d) ketoconazole
Please rate the effectiveness of the compound(s):
0 - no effect
1 - marginal
2 - okay
3 - definite improvement
4 - very noticeable
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