Treating Without a Diagnosis (TWAD)

Do you practice TWAD?


A large percentage of the population practices what I term TWAD - or Treatment Without a Diagnosis.

I often use an analogy to help patients understand why treating any condition without a proper diagnosis is not the ideal plan.

Consider an individual who comes running into your home with with red burning hands. You are alarmed by their repeated shouting “my hands are burning, my hands are burning” ... and naturally want to help. And so you rush to find an ice bucket. You may think that placing the patient’s hands in cold water or an ice bucket is a good idea ... but what if the cause of the burning hands was frostbite or severe cold injury? Placing the individual’s hands in cold water if the diagnosis was frostbite could cause more harm!

But what if the next time an individual comes shouting to you about burning hands you take them to a bath of warm water and wrap their hands in warming blankets only to later realize the cause of their burning hands was actually a burn received while cooking food ? Warming the hands again sends the patient down the wrong direction, delays proper treatment and likely even has permanent consequences. That individual actually needed an ice bucket.

Thanks to the internet, we live in an era of massive available information. We live in an era of self-diagnosis. Unfortunately we live in an era where large numbers of people practice TWAD.

It’s very alarming to have hair loss and individuals wish to act quickly to help themselves - just like in the two examples above. Many patients buy supplements without a diagnosis. Many patients start a variety of treatments without a diagnosis. Many patients practice TWAD.

The Potential Harms of Practicing TWAD

I’m not here to preach that practicing TWAD is bad and the world must stop this potentially harmful and misguided practice. Clearly not everyone with hair loss can see a physician tomorrow. Clearly many patients wish greater autonomy over their health decisions. But I will say that practicing TWAD is not always without negative health consequences. Most over the counter supplements are reasonably safe - but certainly not all. Acne, weight gain, altered blood tests are among the consequences of some over the counter supplements. Through the years, I’ve had patients purchase, order, buy, import and use some of the most unusual, strange and even serious drugs - all on account of their interest in practicing TWAD. Other than the high cost, the main side effect of TWAD is generally a delay in starting the correct treatment and sometimes irreversible hair loss on account of such a delay. But rarely other potentially serious health consequences exist. Liver injury (hepatitis), mood changes, alterations in blood tests and unknown long term risks are among the potential side effects of practicing TWAD.


Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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