Diagnosis
Before making a diagnosis, your doctor will likely give you a physical exam and ask about your diet, your hair care routine, and your medical and family history. You might also have tests, such as the following:
- Blood test. This might help uncover medical conditions that can cause hair loss.
- Pull test. Your doctor gently pulls several dozen hairs to see how many come out. This helps determine the stage of the shedding process.
- Scalp biopsy. Your doctor scrapes samples from the skin or from a few hairs plucked from the scalp to examine the hair roots under a microscope. This can help determine whether an infection is causing hair loss.
- Light microscopy. Your doctor uses a special instrument to examine hairs trimmed at their bases. Microscopy helps uncover possible disorders of the hair shaft.
Treatment
Effective treatments for some types of hair loss are available. You might be able to reverse hair loss, or at least slow it. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment within a year. Treatments for hair loss include medications and surgery.
Medication
If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for a few months.
Medications are available to treat pattern (hereditary) baldness. The most common options include:
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Minoxidil (Rogaine). Over-the-counter (nonprescription) minoxidil comes in liquid, foam and shampoo forms. To be most effective, apply the product to the scalp skin once daily for women and twice daily for men. Many people prefer the foam applied when the hair is wet.
Products with minoxidil help many people regrow their hair or slow the rate of hair loss or both. It'll take at least six months of treatment to prevent further hair loss and to start hair regrowth. It may take a few more months to tell whether the treatment is working for you. If it is helping, you'll need to continue using the medicine indefinitely to retain the benefits.
Possible side effects include scalp irritation and unwanted hair growth on the adjacent skin of the face and hands.
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Finasteride (Propecia). This is a prescription drug for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show new hair growth. It may take a few months to tell whether it's working for you. You'll need to keep taking it to retain any benefits. Finasteride may not work as well for men over 60.
Rare side effects of finasteride include diminished sex drive and sexual function and an increased risk of prostate cancer. Women who are or may be pregnant need to avoid touching crushed or broken tablets.
- Other medications. Other oral options include spironolactone (Carospir, Aldactone) and oral dutasteride (Avodart).
Hair transplant surgery
In the most common type of permanent hair loss, only the top of the head is affected. Hair transplant, or restoration surgery, can make the most of the hair you have left.
During a hair transplant procedure, a dermatologist or cosmetic surgeon removes hair from a part of the head that has hair and transplants it to a bald spot. Each patch of hair has one to several hairs (micrografts and minigrafts). Sometimes a larger strip of skin containing multiple hair groupings is taken. This procedure doesn't require hospitalization, but it is painful so you'll be given a sedation medicine to ease any discomfort. Possible risks include bleeding, bruising, swelling and infection. You may need more than one surgery to get the effect you want. Hereditary hair loss will eventually progress despite surgery.
Surgical procedures to treat baldness are not usually covered by insurance.
Laser therapy
The Food and Drug Administration has approved a low-level laser device as a treatment for hereditary hair loss in men and women. A few small studies have shown that it improves hair density. More studies are needed to show long-term effects.
Lifestyle and home remedies
You might want to try various hair care methods to find one that makes you feel better about how you look. For example, use styling products that add volume, color your hair, choose a hairstyle that makes a widening part less noticeable. Use wigs or extensions, or shave your head. Talk with a hair stylist for ideas. These approaches can be used to address permanent or temporary hair loss.
If your hair loss is due to a medical condition, the cost of a wig might be covered by insurance.
Preparing for your appointment
You're likely to first bring your concerns to the attention of your family doctor. He or she may refer you to a doctor who specializes in the treatment of skin problems (dermatologist).
What you can do
- List key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins and supplements that you're taking.
- List questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For hair loss, some basic questions to ask your doctor include:
- What is causing my hair loss?
- Are there other possible causes?
- What kinds of tests do I need?
- Is my hair loss permanent or will it grow back? How long will it take? Will it have a different texture after it grows back?
- What is the best course of action?
- Should I change my diet or hair care routine?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover seeing a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Do you have any brochures or other printed material that I can take home with me?
- What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing hair loss?
- Has your hair loss been continuous or occasional?
- Have you noticed poor hair growth, hair breakage or hair shedding?
- Has your hair loss been patchy or overall?
- Have you had a similar problem in the past?
- Has anyone in your immediate family experienced hair loss?
- What medications or supplements do you take regularly?
- What, if anything, seems to improve your hair loss?
- What, if anything, appears to worsen your hair loss?