How to diagnose hair loss: Know the important tests to undergo

Hair loss, which is a common problem, refers to the partial or complete loss of hair from the scalp. It affects men and women, young and old. Usually, factors such as genetics, hormonal changes, medical conditions, and stress contribute to hair loss. These problems need to be addressed, but instead of drawing your own conclusions, you should go for some tests that will help in diagnosing the cause of hair loss. Diagnosing hair loss involves a variety of methods. Right from physical examination to blood tests, there are many ways to measure hair loss.

What are the causes of hair loss?

You don’t have to worry if you lose between 50 and 100 hair strands in a day because our bodies grow new hair. While that happens, shedding of old hair takes place, and this shedding is not a sign of hair loss, according to the American Academy of Dermatology Association. However, if you notice significantly more hair loss such as clumps of hair falling out or bald patches, it may indicate a problem, says cosmetologist Dr Avantika Srivastava.

Here are some of the causes of hair loss:

1. Genetics

If there is a family history of hair loss, it is likely that you may experience it as well. This condition is characterised by a gradual thinning of hair, usually starting at the crown and temple areas. The genetic component influences the sensitivity of hair follicles to androgens, which can shrink follicles and shorten the hair growth cycle.

2. Hormonal changes

Pregnancy, menopause, or conditions like polycystic ovary syndrome (PCOS) can lead to changes in hormone levels. For instance, during pregnancy, elevated oestrogen levels prolong the growth phase of hair, while postpartum hormonal shifts can trigger hair shedding. Menopause and PCOS often involve imbalances in androgens and other hormones, contributing to hair thinning and loss, says the expert.

3. Medical conditions

Thyroid disorders can cause disruption in the hair growth cycle. Autoimmune diseases like alopecia areata cause the immune system to attack hair follicles, leading to patchy hair loss. Scalp infections, including fungal infections can damage hair follicles and impede hair growth.

4. Nutritional deficiencies

There is a reason why a lot of emphasis is given on a balanced diet, which is important for overall health. Lack of essential nutrients, including iron, protein, and vitamins, can lead to many health problem, including hair loss.

5. Stress

Both physical and emotional stress can impact your hair health. Stress can trigger telogen effluvium, a condition where hair prematurely enters the shedding phase. This can occur after traumatic events, major surgeries, or severe illnesses. Emotional stress, such as anxiety and depression, also disrupts hormonal balance and affects hair growth.

6. Medications

Certain medications for conditions like acne, depression, and hypertension may have hair loss as a side effect. Selective serotonin reuptake inhibitors, commonly prescribed antidepressants, can lead to slight to intolerable hair loss, as per a 2022 review published in Psychiatry Research.

What are the ways to measure hair loss?

Here are ways to diagnose hair loss:

1. Medical history

Sharing your medical history with a doctor is essential in hair loss examination. It helps determine if factors like genetics, hormonal imbalances, nutritional deficiencies, stress, or medical conditions contribute to hair loss. Understanding a person’s medical background ensures accurate diagnosis and effective treatment plans. You should reveal information like postpartum hair fall or chronic drinking and smoking habits that might have also led to hair fall.

2. Scalp examination

A scalp examination is exactly what it sounds like. It means visually inspecting the scalp to assess the extent and pattern of hair loss. The doctor will look for signs of redness, bumps, scaling, flakiness, oiliness or other abnormalities in hair follicles. This examination helps diagnose conditions like alopecia, infections, or dermatological diseases.

3. Pull test

The doctor will gently pull a small section of your hair to see how many strands come out. By gently pulling a small section of hair, the dermatologist can assess the number of hair that easily comes out, indicating the severity and type of hair loss, such as telogen effluvium or anagen effluvium, says Dr Srivastava. This test aids in diagnosing hair disorders and guiding appropriate treatment strategies.

4. Scalp biopsy

A scalp biopsy is a diagnostic procedure where a small piece of skin from the scalp is surgically removed using a punch biopsy or any other tool, and sent for examination at a diagnostic lab. This test is crucial for accurately diagnosing anything that is happening underneath your scalp and if not macroscopically visible on the surface.

5. Blood tests

Here are some of the most common blood tests used to diagnose hair loss –

• Complete Blood Count (CBC): To check overall health and detect disorders like anaemia.
• Thyroid Function Tests: To identify thyroid imbalances (TSH, T3, T4 levels).
• Vitamin D Levels: To check for deficiencies affecting hair health.
• Zinc and copper levels: Essential trace elements for hair growth.
• Folic Acid and Vitamin B12: For proper cell function and growth.
• Autoimmune panel: To detect autoimmune conditions like lupus.
• Liver Function Test: It evaluates the health of the liver by measuring levels of various substances produced by the liver. The organ metabolises hormones like testosterone and oestrogen, which can impact hair growth. Imbalances in these hormones can lead to hair loss conditions such as androgenetic alopecia.
• Homocysteine test: It measures the level of homocysteine, an amino acid in the blood that can be elevated due to vitamin deficiencies or genetic factors. Elevated homocysteine levels can indicate deficiencies in vitamins B6, B12, and folate, which are essential for hair growth.

6. Hair shaft analysis

Hair samples are examined under a microscope to assess the hair shaft’s structure and check for any abnormalities or damage. It allows for the magnified visualisation of the hair shaft and scalp, which helps in diagnosing various hair disorders and conditions.

7. Hair density measurement

Hair density measurement involves counting hair per square centimetre of the scalp to assess thinning. By quantifying the number of hair, this method helps diagnose hair loss conditions, track treatment progress, and guide effective hair restoration strategies. Hair is counted within a defined square centimetre of the scalp surface. This count includes both terminal hairs (thick, pigmented hairs) and vellus hairs (fine, light-coloured hairs), providing a comprehensive assessment of overall hair density, shares the expert.

How to prevent hair loss?

To prevent hair loss, follow these tips:

• Focus on a good diet and a lifestyle. Start with a balanced diet with essential nutrients like vitamins A, C, D, E, iron, zinc, and proteins from foods like leafy greens, nuts, fish, and eggs.
• A little bit of stress in life will always be there, but try to be less stressed.
• Practise gentle hair care, and consider regular scalp massages for better circulation.
• If you notice any irritation or redness on your scalp, reach out to your doctor immediately. Being proactive can effectively prevent hair loss.

Hair loss can be due to multiple reasons, and getting a blood test or clinical evaluation will help to find out if there are any deficiencies and hormonal imbalances.