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For most patients with significant midlife hair changes, I still address the underlying hormonal picture, iron and ferritin status, thyroid function, and consider standard therapies like minoxidil and the appropriate use of hormone therapy first

This is the same logic that makes the sildenafil-nitrate combination contraindicated: the FDA label for Viagra states that "administration of Viagra to patients who are using organic nitrates in any form is contraindicated" because of "potentiation of the hypotensive effects of nitrates" [3]