Do I need blood tests for my hair loss? If so which ones

Blood tests for hair loss: Exactly what tests depends on many factors

 

Do all individuals with hair loss need to head to the lab for blood tests? This is such an important question and fuels much confusion. In general terms, blood tests are required for most women with hair loss. For men, they are usually not.  But each patient's hair loss needs to be reviewed on a case by case basis.

Men with hair loss

For men with male pattern balding (androgenetic alopecia), blood tests are not needed most of the time.  The one exception would be young males with male pattern balding where I often test cholesterol level as there may an increased risk of lipid abnormalities in this patient group. For men with hair loss due to various autoimmune causes (such as alopecia areata or lichen planopilaris) I often check blood tests such as basic blood counts (CBC) , thyroid (TSH), iron status (ferritin), ANA, B12, ESR. In some situations,  I'll consider a free and total testosterone.

Women with hair loss

For women, I'll not go without blood tests. Blood tests are required. Blood tests are mandatory. Simply put there are so many mimickers of female hair loss and diagnosing female hair loss is far more complex than diagnosing hair loss in men. I will order tests for basic blood counts (CBC), thyroid (TSH) and iron (ferritin) in all women with hair loss. For young women with acne or increased facial hair, a tests for DHEAS (hormones from the adrenal gland), androstenedione (hormones from the ovaries) as well as free and total testosterone and sex hormone binding globulin (SHBG) are ordered. Women with irregular menstrual cycles may require blood tests to evaluate polycystic ovarian syndrome including tests for LH, FSH, DHEAS, androstenedione, prolactin, estrogen, free and total testosterone and 17 hydroxyprogesterone (17OHP) and sex hormone binding globulin (SHBG). Blood sugars may also be checked. Women with dietary restriction may also have zinc levels checked and a few other minerals as well. Sometimes vitamin D is checked depending on where the patient lives. 

Similar to the discussion for men, women with potential autoimmune causes of hair loss require comprehensive evaluation including complete blood counts (CBC), thyroid (TSH), iron (ferritin), ESR, ANA, B12. 

Conclusion

All in all, there is no magic or standard template for ordering blood tests for a patient with hair loss. However, one must listen carefully to the patients story and examine the scalp. With this information, one can decide what blood tests to order - if they are needed at all.