The first step is to see your family GP, who will most likely refer you to a medical specialist with expertise or knowledge in hair loss. This may be a dermatologist (skin specialist), medical expert at a hair loss clinic or trichologist (specialist in diagnosing and treating hair and scalp disorders).
If your doctor refers you to a dermatologist, make sure he/she is a specialist dermatologist with a specific interest and knowledge in hair loss. There are many causes hair lossof, so it’s best to approach a medical specialist with appropriate expertise.
Diagnosing hair lossWith many types and causes of hair loss affecting both men and women, some are simpler to diagnose than others. The two most common types are androgenetic alopecia (male or female pattern baldness) and alopecia areata (AA), an autoimmune condition that causes patchy hair loss i.e. a single bald patch or extensive hair loss in patches.
Less common types of hair loss such as Alopecia universalis (hair loss on entire body including pubic hair), Alopecia totalis (total loss of all hair on the scalp).
Diagnosing androgenetic alopecia
If you are affected by the most common type of progressive hair loss known as male or female pattern baldness (androgenetic alopecia), a hair loss specialist will usually be able to recognise it easily.
The diagnosis will be based on the pattern and appearance of your hair loss, the incidence of hair loss in your family (especially mother, father, brother or sister) and a detailed medical history. Pattern baldness is believed to be hereditary from either or both parents.
Men with male pattern baldness are inclined to lose hair from the forehead area and top of the head while still having normal amounts of hair on other areas of the scalp.
Women with androgenetic alopecia (female pattern baldness) usually have hair thinning on the top of the head, but tend to keep their front hairline. Women very rarely go completely bald.
Diagnosing alopecia areata might be as simple as checking the extent of your hair loss and examining a few hair samples under a microscope.
If your hair loss does not fall into one of these two main category types, your doctor will probably do additional tests and assessments to determine the exact cause of your hair loss.
This might especially apply if you are a woman, since female hair loss patterns are less visible than those of men, making it more difficult to diagnose.
Why your hair loss history matters
Your doctor will determine why you are losing hair by looking at important aspects about your hair loss history such as:
Hair loss characteristics – are you experiencing hair thinning (i.e. not visible hair fall out, but rather that your scalp or parting is becoming more visible) or hair shedding (clumps of hair falling out).
Duration of hair loss – how long you have been experiencing hair loss and whether you can indicate a time period since you had a normal head of hair.
Family history of hair loss – whether immediate family (e.g. mother, father, brother, sister or other relative) has hair loss and what caused it.
Hairstyle routines – this would cover whether you regularly braid your hair, use weaves or pull your hair back tightly in a ponytail, whether you use chemical hair treatments such as bleaching, dying or perming and whether using excessively hot blow dryers, straighteners or curling irons as part of your regular hairstyling.
Illness, diet and medication – your doctor would ask questions to establish whether you’ve had any recent illnesses or skin rashes like ringworm.
It would also confirm use of medications like blood thinners (anticoagulants) or medicines for arthritis, depression, heart problems or chemotherapy to treat cancer as many medications can cause hair loss. He/she might also quiz you on your diet, especially whether you are getting in sufficient iron and protein.
Other tests and diagnostic tools for hair loss
If there is any uncertainty, your doctor may use a variety of diagnostic tools to diagnose the exact cause and type of hair loss. These tests may differ between men and women. Two most commonly used diagnostic assessments for hair loss are:
Savin Scale: Developed in 1996 by Dr Savin of Yale University, this scale records and classifies hair loss patterns in women affected by androgenetic alopecia (female pattern baldness).
Using a simple pictorial classification of nine computer illustrations, it allows a doctor to visually quantify both hair loss pattern and density (thickness of the hair).
Norwood Hamilton Scale: This is used to measure the extent of male pattern baldness. Many doctors find it useful to describe the extent of general hair loss and avoid misdiagnosis. It comprises a chart of pictures showing the most typical hair loss patterns in men affected by androgenetic alopecia.
There are several typical hair loss patterns in men, although there could also be combinations of these patterns. Of these, the most common are:
- receding at the temples
- thinning or hair loss on the top back of the head (vertex)
- diffuse or general thinning, which entails thinning of hair over large areas without any specific change to the actual hairline
Hair analysis: Your doctor will take a sample of your hair and examine it under a microscope to assess structural damage, rate of hair loss, identify genetic (inherited influences) or confirm the presence of fungus or lice.
- Blood tests: If your doctor suspects that an autoimmune disorder (e.g. lupus) or other specific condition (e.g. under- or overactive thyroid) might be causing your hair loss, he/she might do a series of blood tests which could include:
- Hormone levels (DHEAs, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone)
- C-reactive protein and erythrocyte sedimentation rate
- Serum iron and serum ferritin levels
- Thyroid stimulating hormone (T3, T4, TSH)
- Complete blood count (CBC)
- Total iron binding capacity (TIBC) – – helps to measure the ability of a protein called transferrin to carry iron in the blood.
- Antinuclear Antibodies (ANA) - measures the amount and pattern of antibodies in your blood that work against your own body (autoimmune reaction).
Scalp/skin biopsy: Although not a common procedure, a doctor might do a biopsy to evaluate hair loss inside the hair follicle. It entails removing a tiny piece of skin on your scalp and examining it under a microscope.
Hair pull test: This simple diagnostic test entails the doctor lightly pulling a small amount of hair (approx 100 simultaneously) to decide if there is excessive loss. One to three hairs per pull falls within the normal range.
Densitometry: A handheld magnification device called a densitometer checks for shrinking or miniaturisation of the hair follicles.
- International Society of Hair Restoration Surgery http://www.ishrs.org/article/hair-loss-diagnosis-and-analysis
- Androgeneticalopecia.com http://www.androgeneticalopecia.com/hair-loss-men-women/hair-loss-baldness-savin-scale.shtml
- Hishairclinic.com Norwood Hamilton Scale http://www.hishairclinic.com/norwood-hamilton-scale/
- Maybe Clinic http://www.mayoclinic.org/diseases-conditions/hair-loss/basics/preparing-for-your-appointment/con-20027666
- American Hair Loss Association http://www.americanhairloss.org
- Genetics Home Reference Androgenetic alopecia http://ghr.nlm.nih.gov/condition/androgenetic-alopecia