When a patient comes to me with hair loss, my first job as a trichologist is to determine what type of hair loss they have and what is causing it. There are many different types of hair loss, and most of the time this can be identified by examining the scalp, sometimes with the help of a trichoscope, which allows me to observe the scalp under magnification. Biopsies of the scalp are usually unnecessary as an expert in hair loss can often identify the problem just by looking. 

In-consultation Tests

My first test is to pull gently on the hair to see how much comes out, although this will depend on when the patient last washed and/or combed their hair. However, I can assume that if the patient has come to me because of their hair loss, then there must be a problem.

The trichologist needs to spend time with the patient to identify the root cause of the problem (as opposed to just naming the problem). For example, general excessive hair loss either reflects some kind of shock to the body or a body imbalance, which can be psychological, physiological, stress-related or the result of medications. Listening to what the patient has to say in response to my questions gives me a good idea of possible causes, and which blood tests to suggest.

Blood Tests

If blood tests are necessary to pinpoint the cause of the problem, I will communicate with the patient’s doctor and ask them to run specific tests. Iron studies are particularly important because low iron or low iron storage (indicated by ferritin) is a common cause of hair loss. Very high levels of ferritin can also be a problem. Thyroid imbalances and sugar (glucose) imbalances can also contribute to hair loss and all of these can be checked with blood tests.

Blood tests can also help diagnose systemic inflammatory and autoimmune conditions. A rule of thumb is that patchy hair loss relates to the immune and nervous systems, while excessive hair loss from all over the scalp relates to imbalances of the circulation and blood, such as low iron levels. Blood tests can also check if the liver and kidneys are functioning normally.

Vitamin D is often lower in people suffering hair loss and can also be measured with a blood test. Vitamin D helps protect the hair follicles from immune attack and is an antioxidant that helps to counteract free radical damage that can lead to hair loss. Zinc is another important nutrient that can be associated with hair loss, so blood tests for zinc and copper are useful. Copper is important for the formation of red blood cells and helps keep hair strong.

Mineral Analysis

The mineral levels in hair reflect body levels, so trace mineral analysis of the hair can be useful. I use this to look for high levels of toxic minerals such as lead, arsenic, mercury and cadmium, which are rarely found in excessive amounts but can sometimes be worth investigating.

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