What Tests to Run When Suspecting Hair Loss
Updated: Jan 8
Are you noticing that your ponytail is getting thinner and thinner? Maybe you're seeing your part widen, or maybe you’ve noticed you have to vacuum more often, and it's not because of your dog.
Hair loss is a sign that there's something going on in your body. Whether it's a nutrient deficiency, stress, anemia, or hormonal issue, it tells us that your body is lacking the support that it needs to keep those hair follicles nourished and healthy!
If you suspect you're having hair loss, then you probably are! Don't let your doctor dismiss your concerns without doing a full and thorough workup!
TESTS TO CONSIDER FOR HAIR LOSS:
CBC (complete blood count) WITH ferritin
A CBC is a routine lab that’s run for so many things. It tells us the status of your red blood cells, whether you have an infection, or you're trending towards anemia. Often this gets run without ferritin and that's when we get that infamous "your labs are fine, but you don't feel fine" paradigm.
Ferritin is our storage form of iron. This can be low without our actual red blood cells being affected…yet. So it's always good to check this because low iron stores are the beginning stages of anemia. Ferritin below 50-60ng/mL might be indicating that this is the source of your hair loss!
My ever favorite panel to check, since most providers don't do a full panel!
This full panel should include MUCH more than just TSH. It should also include total T3/T4, free T3/T4, reverse T3, AND thyroid antibodies (anti-TPO, and anti-TG). The antibodies are key to figuring out whether you have an underlying autoimmune condition that is to blame for the symptoms of thyroid disease (including hair loss).
Total and free testosterone and DHT (active form of testosterone)
Most commonly, this is found to be elevated in women with PCOS and you might be experiencing hair loss along your temples or a receding hairline. This is often paired with excess body or facial hair, and acne along the chin and jawline.
FSH, LH, estrogen, and progesterone
Imbalances in these will give us a better picture of what's going on with your hormones and if you have an underlying hormonal condition. If your hair loss is paired with irregular menses, PMS symptoms, or other hormonal symptoms, these MUST be checked.
Sex Hormone Binding Globulin (SHBG)
This is a carrier protein that acts as a "bus" for circulating hormones. It grabs up excess hormones. If this protein is low, we might see that your testosterone or estrogen levels are elevated as a result.
SHBG is usually low in women with insulin resistance or PCOS.
Cortisol and DHEA-s
Cortisol is your stress hormones. It's good in small doses, we need it. But when it's chronically elevated, it causes signs of aging, including hair loss.
DHEA-s is another androgen, produced primarily by your adrenal glands (which also produce cortisol). If this marker is low, you will also see hair loss.
The pattern of low DHEAs and high cortisol is seen in women who are over-stressed and just exhausted all the time. If you've been go-go-go for quite some time, this might be a reason for your hair loss!
Fasting insulin, blood glucose, and A1c
All of these should be run together. I often find that only one or two of these get run, and it's usually the insulin that gets left out. Knowing your fasting insulin levels helps significantly with identifying an insulin resistance.
And as I mentioned earlier, elevated insulin levels cause decreased SHBG which leads to increased hair loss.
This is one of my favorite tests because it encompasses MOST of these above mentioned hormones. It includes androgens, cortisol, DHEA, estrogen, and progesterone. So we get a full picture of everything going on in your body (hormonally) to see what is causing your hormonal issues.
I have rarely seen hair loss by itself, without other symptoms of hormonal imbalances to go along with it.
So, if you've been dealing with hair loss for a while, or maybe you just started noticing it, let's do a full work up together to find out what's going on! When we start to work on what's causing the hair loss, you'll notice other symptoms of hormonal imbalances disappear as well.