Diagnosis

May 17th, 2017          Written by a Staff Member of Hair Loss in Women, and reviewed by a Medical Doctor.

Diagnosing Hair Loss in Women

Many women self diagnose their hair loss. Sometimes they can correctly find out what’s causing their hair loss. But often times they don’t because they don’t understand the causes of female hair loss. Here’s everything you need to know about properly diagnosing hair loss in women.

You may have thought of supplementing biotin, trying a different shampoo, or trying other things that you’ve heard work. The problem with self diagnosing is that if you’re not attacking the cause of your hair loss. You might see small improvements (like individual hair strands may look healthier) but your scalp is still thinning. In addition, something that may have worked for a friend of yours may not work for you, because your situation is different.

For example, if you have androgenetic alopecia (responsible for 90% of all women’s hair loss), and you don’t deal with the androgens in your system that lead to miniaturization of your follicles (causing the hair shaft to get smaller and smaller), your hair is going to continue to get thinner.

There are circumstances where it may be easier to find the cause of your hair loss, such as if you’ve undergone chemotherapy, were crash dieting, or just had a baby.

But if you’re not sure, talking to your doctor could keep you from guessing. They have the experience to save you the time, money, and aggravation of trying to figure out the best treatment option. They will collect data about your situation to help pinpoint the cause of your problem.

What Type Of Doctor Should You See About Your Hair Loss?

Just like in every industry, there are some professionals that are excellent. There are many that are average, and a smaller percentage that are substandard.

As far as what type of doctor you need to see, a general practitioner is an option, but you might have more success with a specialist. If you suspect that your hair loss may be hormone related, an endocrinologist may be the best choice for you. Another excellent choice is a dermatologist-their focus is the skin, nails, hair, and sweat glands.

Whatever physician that you choose to see, remember that if you don’t feel comfortable with the doctor (they don’t seem to be interested in your situation, or very knowledgeable about female hair loss), feel free to move on. You can also get more than one opinion about your hair loss.

The Visit To The Doctor or Dermatologist

The first step in properly diagnosing hair loss in women is to visit a doctor or dermatologist. Usually the first thing that a doctor is going to do is a medical history. They’ll ask several questions, usually including:

  • Is there a history of hair loss on either side of your family?
  • Have you recently gone through a pregnancy, menopause, used birth control, or had any conditions that would affect your hormone levels?
  • Are you having regular periods?
  • Have you recently been through a major illness, or stressful event?
  • What medications have you taken recently?
  • Have you done any crash or extreme dieting recently?
  • Are you protein deficient?
  • Sign or symptoms of thyroid imbalance.
  • Do you normally wear your hair in cornrows or any hairstyle that put a lot of stress on your hair?

They are going to do an examination of the physical pattern, extent of the hair loss, and condition of the hair. Is it diffuse across the scalp, or are there patches? Whatever type of hair loss you’re experiencing, its appearance may give clues as to its cause and treatment.

They may check the health of the nails as well, as it may give clues to a health issue that is causing the hair loss.

To check for thyroid issues, they may do a physical exam of your thyroid (just below your A apple).

Diagnosing Androgenic Alopecia

90% of female hair loss is androgenetic or androgenetic alopecia, which is hair loss due to genetics. This occurs when androgens (male hormones) convert to dihydrotestosterone (DHT), which attacks hair follicles, causing miniaturization, as well as lengthening the resting phase of the growth cycle of hair (reducing the growth phase). As men have more androgens that convert to DHT, they often lose all of their hair on the front of their scalp and their crown. Women usually get diffuse thinning throughout the scalp.

If a woman has a history of hair loss in their family, there is a thinning of the hair on the front and sides of the scalp. If the thinning was gradual, and miniaturization is occurring, the most likely situation is androgenetic alopecia.

To check for miniaturization (the reduction of the diameter of the hair shaft that occurs with androgenetic alopecia), a physician will use a densitometer. A densitometer is a handheld magnification device.  A small section of hair will be cut to about 1 mm in length, and then analyzed for a reduction in thickness. If genetic hair loss that includes an excess of male hormones is suspected, the doctor may perform blood tests.

Laboratory Testing

An option for diagnosing hair loss in women is laboratory testing. If your hair loss doesn’t seem to be caused by androgenetic alopecia, there are several tests used to determine the cause of your hair loss.

  • Hormone levels (testosterone, androstenedione, DHEAs, prolactin, follicular stimulating hormone, and leutinizing hormone), prolactin, cortisol, and thyroid stimulating hormone (T3, T4, TSH)
  • Serum iron and serum ferritin
  • Total iron binding capacity (TIBC)
  • Complete blood count (CBC)
  • Antinuclear antibody test (ANA) for Lupus

Hair Pull Test

An additional method for diagnosing hair loss in women is the hair pull test. The hair pull test is to test for telogen effluvium, which is a larger amount of hair shedding that often occurs after pregnancy, stress, or a reaction to a drug. This condition usually occurs a few months after the stressful event.

The doctor will grab approximately 100 hairs and gently pull. If more than 3 hairs come out, then you have a higher than normal amount of shedding.

Hair Pluck Test

Another option for diagnosing hair loss in women is the hair pluck test. There is also a hair pluck test. The test involves pulling approximately 30 hairs from the scalp and then examining under a microscope. A healthy scalp will have 80% of its hair in the growing (anagen) phase. If you have more than 20% of your hairs in the resting (telogen) phase (no longer growing) that will also point to telogen effluvium.

Biopsy

Conducting a biopsy is another option for properly diagnosing hair loss in women. If the cause of your hair loss is still unclear the doctor may do a scalp biopsy. A scalp biopsy is where the doctor removes a small section (usually just a few millimeters) of scalp to be analyzed.

They may also check for skin conditions, caused by lupus, lichen planus, and sarcoidosis, which will usually cause a patch of missing hair.

 

Have you visited a dermatologist, endocrinologist, general practitioner or trichologist? What was your experience? Please let us know in the comments below.

 

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