VISITING A HAIR LOSS PHYSICIAN: My Top 10 QUESTIONS EVERYONE SHOULD ASK
Individuals with hair loss often ask "What should I ask when I go to my appointment?" That answer of course varies depending on the specific patient. However, here are some general pointers that all women should ask when visiting a hair specialist:
1. Do I need blood tests?
The answer should be yes for all women experiencing hair loss but this may serve as a reminder for the doctor if they are not ordered. The key point is that extensive blood tests is a waste of money and time. Blood tests must be focused. All women need recent blood tests for CBC, TSH (thyroid) and ferritin (iron) results from the last 2 year. All women under 45 with irregular periods need other tests too. Women with acne and increased hair growth on the face also need hormone testing (specifically DHEAS, free and total testosterone and androstenedione). Women with autoimmune type hair loss may need other testing.
2. Is my current diet, nutrition or current body weight creating an issue for my hair?
One needs to be sure to ask if their diet is deficient in any specific nutrient (i.e vegans and the possibility of low vitamin B12 levels), or whether low body weight is causing impaired hair growth.
3. Are any of the medications, supplements that I am taking creating a problem for my hair? Am I wasting my money on any of the supplements in my list?
Individuals with hair loss need to understand what to take and what might not help at all. Many supplements used today have no evidence of being helpful. Some do have evidence, but still limited evidence. Any medication can cause hair loss - but some are more likely than others. This needs to be carefully reviewed with the physician.
4. Do you recommend I take any specific vitamins or supplements? Specifically, should I take vitamin D? Do I need iron? Do I need a multivitamin?
It's important to ask one's physician whether intake of specific vitamins is needed. I recommend all women ask about their iron status and whether intake of a multivitamin is a good idea or not. All women in climates further from the equator should probably be taking vitamin D.
5. Could this possibly be another condition other than the condition you have diagnosed ...and if so - how will you evaluate that possibility?
I recommend that patients feel comfortable asking their physicians whether there is any possibility the diagnosis is wrong. Patients should understand what should happen with their hair if the diagnosis is correct and how the doctor will proceed if hair growth or hair loss does not go according to the proposed plan.
6. What do you expect to happen to my hair in the next 6, 12 and 24 months? (should it grow more, stay the same or should I expect more loss?). What will we do if we find your prediction is not correct?
I encourage all patients to understand the 'natural history' of their condition. What happens if the condition is left untreated? What's the best result if it is treated. For example, if a patient with chronic telogen effluvium is told that their hair will look the same in one year - what is the plan that the doctor will undertake if their is actually less hair? Will a biopsy be done? Will another medication be started.
7. (For women not diagnosed with genetic hair loss I always recommend asking this question) ...Is it possible that I have androgenetic alopecia and how do you know?
Androgenetic alopecia (female thinning) is far far more common that currently diagnosed. I encourage patients to keep this in mind and prompt their physicians to consider. If a physician is treating seborrheic dermatitis or telogen effluvium when the actual diagnosis is female pattern hair loss, density will just get worse over time. I wish more physicians considered AGA in females, but patients can consider this themselves - especially if their density in the front and middle of the scalp is less than the sides and back. One needs to be very knowledgeable to diagnose hair loss - but one does not necessarily need to be a physician.
8. What would you need to see on my scalp or hear from my particular story that would prompt you to do a scalp biopsy? In your opinion, do you think that would ever become necessary for me?
Most people do not need a scalp biopsy. It is important for patients to understand the indication for a biopsy. In other words, patients should consider asking "what needs to happen to my progress or my story in the future to prompt you to do a scalp biopsy?"
9. I understand there are many possible treatments for the condition you have diagnosed for me. Can you outline the top 5 options and the chances of success with each? I'd like to better understand the real chances of seeing an improvement with all the options there are. Do you offer these various options or would you refer me to a colleague? What are the side effects of these treatments?
Patients have the right to understand several available treatments, so that they can make a decision as to what treatment is right for them. It's fine for a clinic to only offer hair transplants, or for a clinic to only offer laser therapy, but patients should be brought up to speed on what other alternatives exist and how successful these options are. This is the key to informed consent.
10. When is my next appointment with you and what are you hoping to see on my scalp at that appointment?
Finally, patients should ask when their next appointment is. Generally it takes 6-9 months to see significant results with some types of hair loss (androgenetic alopecia) but only 1 month for some forms of alopecia areata. Patients need to understand what to expect once they leave the office and when they should return. Also, patients need to understand the circumstances that would prompt them to return sooner.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299