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Blood Tests to Have Done First for Diagnosing Hair Loss Causes

These are simple blood tests that you should have done if you think that your hair loss may be caused by a chemical deficiencyIt’s easy to get lost in the maze of tests and blood panels that your doctor should require to diagnose the cause of your hair loss. Here is a complete list of blood tests to talk to your physician or dermatologist about at the beginning of your hair loss journey, along with it’s corresponding recommended normal range/level.

Many dermatologists will recommend Rogaine (minoxidil) immediately without spending time reviewing bloodwork and ordering blood panels. It’s okay to remain assertive with your doctor and request a full series of blood tests to rule out any underlying conditions that could be causing your hair loss. Often times, a simple hormonal imbalance or vitamin deficiency can be discovered early with a blood test and you will be well on your way to restoring your hair.

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Vitamin Deficiency:

Simple blood tests to be ordered if you think your hair loss may be caused by a lack of nutrients in your diet.

CBC:
This test will show if you are anemic. Even mild anemia can often cause hair shedding. Look for lower than norm values for Red Cell Count, Hemoglobin.

RBC (Red Blood Count): normal levels: 4.2 to 5.4 mil cell/mcL
WBC (White Blood Count): normal levels: 4500 to 10000 cells/mcL
Hematocrit: normal levels: 36.1 to 44.3%
Hemoglobin: normal levels: 12.1 to 15.1 gm/dl
MCV: normal levels: 80 to 95 femtoliter
MCH: normal levels: 27 to 31 pg/cell
MCHC: normal levels: 32 to 36 gm/dL

Vitamin B12 and B6:
The lack of these vitamins can cause hairloss.
B6: optimum level: 2 to 26 ng/ml
B12: optimum level: 200 to 900 pg/ml

Zinc:
The lack of zinc is a known cause of hairloss. Be careful though, too much of zinc could cause hairloss as well. 😕

Iron:
Serum Iron: optimum level: 60 to 170 mcg/dl
Serum Ferritin: optimum level: 12 to 150 ng/ml
TIBC (Total Iron Binding Capacity): optimum level: 240 to 450 mcg/dl

A lot of hairloss specialists believe that one needs a level of ferritin higher than 40 in order to maintain hair and ferritin above 70 to regrow lost hair. There’s also a lot of opposing points of view, however in general it’s probably a good idea to get your ferritin stores at a proper level. One thing to notice is that TIBC above the norm (above 400) means the lack of iron in the iron stores. TIBC above 400 often corresponds to lower serum ferritin numbers. As ferritin increases, TIBC should drop.

ESR:
ESR: optimum level: >20mm/hr
There’s an article stating that if your ESR is less than 10 you need to considerably increase your serum ferritin level to stop/reverse hairloss.

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Electrolyte Panel:

Blood tests that you should have done prior to and during the administration of anti-androgenic medications such as spirolactone. These tests can also aid in diagnosing adrenal problems.

Sodium: normal levels: 15 to 250 mEq/L/day
Chloride: normal levels: 20 to 25 mEq/day
Potassium: normal levels: 25 to 120 mEq/L/day
CO2: normal levels: 20 to 29 mEq/L

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Thyroid Panel:

Rapid hair loss can be the worst symptom of a thyroid problem

Your thyroid gland is one of the largest endocrine glands in your body. [Image courtesy of SutterHealth.org]

Blood tests that are recommended to diagnose hyperthyroid, hypothyroid and other thyroid related problems.
TSH and T3/T4:
Thyroid conditions often cause hairloss as well. The best TSH value is between 1 and 2. Values above 3 are still considered normal by many labs (the upper level of normal is 5) however it usually indicates an overactive thyroid and should prompt for future evaluation.

TSH (Thyroid Stimulating Hormone): optimum level: .3 to 3.0 mlU/L
** if you are on thyroid medication already, your optimum level SHOULD be between .5 and 2.0 mlU/L
Total T3: optimum level: 100 to 200 ng/dL
Free T3: optimum level: 2.3 to 4.2
Total T4 (Total Thyroxin): optimum level: 4.5 to 12.5 mcg/dL
Free T4 (Free Thyroxin): optimum level: .7 to 2.0

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Auto Immune Testing:

These tests can also aid your physician in giving you a definitive answer as to what is causing your hair loss. They show the possibility of lupus, hashimoto’s, sjoren’s, alopecia areata and other autoimmune disorders.

ANA and Anti-DNA

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Adrenal Function Panel:

These are tests you should have done to rule out adrenal deficiencies which can cause hair loss as well as fatigue, joint and scalp pain.

Cortisol AM:
Cortisol is a stress hormone. Even though there’s no direct link to hairloss, a high cortisol value means the body is under a lot of stress and the adrenal gland is working overtime. This situation shows the ‘fight or flight’ reaction of the body as a result of which a lot of hormonal functions are interrupted. Stress significantly decreases the benefits of ALL the hormones. Moreover, high cortisol values can indicate a possibility of
adrenal tumor.

Cortisol: normal 8am levels: 6 to 23 mcg/dl

Serotonin:
Serotonin: normal levels: 101 to 283 ng/ml

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Hormone Panel:

Visit our online discussion forum to read more topics on hormone imbalances and how it affects hair loss in womenThese are ESSENTIAL blood tests to have done if you believe that you may be experiencing hair loss due to hormonal imbalances.

Estradiol:
For premenopausal woman the lowest estradiol value should be shown on the test taken on the 3rd day of her cycle (the week of her period). Values between 80-90 are preferable, values below 50 show estrogen deficiency. For the rest of the cycle the optimal range is 100-200 (closer to 200 the better). Younger women can produce significantly higher levels of this hormone.

Estradiol: normal levels:
**** Premenopause: 20 to 400 pg/ml
**** Postmenopause: 5 to 25 pg/ml

Total Testosterone:
If the value is above 50, it could potentially cause the situation of adrogen sensitivity, but the more important number is the one for free testosterone.

Total Testosterone: normal levels: 20 to 80 ng/dl

SHBG (Sex Hormone Binding Globulin):
Values around 90 are desirable. Values above 100 are considered too high. High values of SHBG decrease the availability of all the hormones in the body. Higher levels of estradiol are needed to raise SHBG.

Luteinizing Hormone (LH):
Luteininzing Hormone: normal levels: 5 to 20 IU/L

Prolactin:
Prolactin: normal levels: 0 to 20 ng/ml

Free Testosterone:
Values above 1-1.5 are considered on the higher end of normal range. Values closer to 0.5-0.6 are more desirable. Free Testosterone is the result of Total Testosterone divided by SHBG.

Progesterone:
Value above 5 means that woman is ovulating.

Progesterone: normal levels:
**** Pre-ovulation: >1 ng/ml
**** Midcycle: 5 to 20 ng/ml
**** Postmenopausal: >1 ng/ml

Follicle Stimulating Hormone (FSH):
Hormone that regulates production of female hormones. Levels above 15 indicate menopause. Levels of 3 and below usually indicate BCP use. Higher levels of FSH indicate decrease of estradiol production, while lower
levels indicate higher level of estradiol production.

FSH: normal levels:
**** Follicular: 3.5 to 12.5 IU/L
**** Midcycle: 4.7 to 21.5 IU/L
**** Postmenopausal: 25.8 to 134.8 IU/L

DHEA and DHEAS: Some doctors report finding that a high percentage of patients with autoimmune disorders are also deficient in DHEA, and should be tested.

DHEA: normal level for women by age:
18 to 29 years: 62 to 615 ug/dL
30 to 39 years: 52 to 400 ug/dL
40 to 49 years: 44 to 352 ug/dL
50 to 59 years: 39 to 183 ug/dL
60+ years: 11 to 150 ug/dL

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Illustration of glucose molecular structure

Diabetes is a common cause of hair loss due to the build-up of blood sugar in the body when it is not controlled.

Fasting Blood Glucose (also known as a Fasting Blood Sugar): Blood test done after fasting for 8 to 10 hours
Normal glucose tolerance: From 70 to 99 mg/dL (3.9 to 5.5 mmol/L)
Impaired fasting glucose (pre-diabetes): From 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
Diabetes: 126 mg/dL (7.0 mmol/L) and above on more than one testing occasion

Glucose Tolerance Test (OGTT or GTT): Blood test done two hours after a 75-gram glucose drink
[levels below are NOT for gestational diabetes GTT testing]
Normal glucose tolerance: Less than 140 mg/dL (7.8 mmol/L)
Impaired glucose tolerance (pre-diabetes): From 140 to 200 mg/dL (7.8 to 11.1 mmol/L)
Diabetes: Over 200 mg/dL (11.1 mmol/L) on more than one testing occasion

Fasting Insulin: normal levels: 5 to 20 mcU/mL

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Tests that your Dermatologist should do:

** Pull Test
** Scalp Biopsy

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Finding a Good Dermatologist (or Doctor in General)

doctorFinding a good dermatologist or doctor can prove to be one of the most difficult things to face when you are experiencing hair loss…

  • A good physician will say, “I’m sorry. This must be hard for you to understand.”
  • He/she will give you the address of the National Alopecia Foundation or other support organizations and tell you about the information they provide.
  • He/she will tell you there are others with this same condition and the medical field just doesn’t understand what’s going on.
  • He/she will understand that you have NEVER heard of this condition and that you are scared.
  • A good physician won’t scoff at your questions or minimize your concerns. He/her will appreciate your questions and will be willing to learn with you as much as possible about the condition.

SIGNS OF A BAD DERMATOLOGIST!!!

  • Inappropriate Commentaries
  • Disbelief
  • Cruelty
  • Callousness
  • Impatience

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The craft of the physician may be judged by the thoroughness of the history and physical examination. The following list provides a schematic of some of the things that a physician should do, or consider doing, when first examining a patient with alopecia. Subsequent visits may be shorter but the physician should always be vigilant to the appearance of other autoimmune conditions, of which, thyroid disease appears to be the most common.

History
The initial part of the history is aimed at providing a background to the patient’s condition and allowing the physician to focus on particular problems. Some of the initial questions include:

  1. Is the hair coming out by the roots or is it breaking off?
  2. Is the loss slowing down or getting worse?
  3. Is your hair becoming thinner or do you have totally bald spots?
  4. Do you color, bleach or straighten your hair?
  5. Do you shampoo or condition the hair?
  6. Do you blow dry your hair or use a hot comb?
  7. Is your father’s, mother’s, sister’s or brother’s hair thinning?

The physician then documents all alopecia episodes including age of onset, duration, remissions, patterns of hair loss, relieving or exacerbating factors, treatments, and associated systemic diseases (autoimmune diseases, allergic rhinitis, asthma, atopic dermatitis, connective tissue disease, bowel disorders involving malabsorption, endocrine abnormalities, chromosomal disorders, or cancer). Some of the questions include:

  1. Do you have anorexia nervosa?
  2. Do you have a thyroid disorder?
  3. Have you gained or lost weight?
  4. Are you anemic?
  5. Are your mentrual periods heavy?

The history should date any medication and events within the past 6 months before the first and subsequent episodes of alopecia. The drugs include aminosalicylic acid, amphetamines, bromocriptine, capatopril, carbamazepine, cimetidine, coumadin, danazol, enalapril, etretinate, levodopa, lithium, metoprolol, propanolol, phenytoin, pyridostigmine, and trimethadione. Other pertinent questions include:

  1. Do you take vitamins?
  2. Do you take separate vitamin A tablets?

An inventory of stressful life events and psychiatric disorders. Specific questions will include:

  1. Did you have a baby?
  2. Have you started or stopped oral contraceptives?
  3. Have you gone through menopause?
  4. Have you had a high fever, the flu, been hospitalized or had major surgery?
  5. Have you been on a crash diet? Are you a vegetarian?
  6. Have you had any major stresses during this time?

Physical Exam of the entire cutaneous surface, oral cavity, nails, and sweating. Some of the special exam maneuvers are individualized and not done in every patient but include:

  1. Scalp examination to determine the patterns of hair loss and associated lesions. The presence or absence of hair follicles and sebaceous glands.
  2. Hair Pull Test where 50-100 hairs are pulled in several sections of the scalp. Normally 2-5 telogen hairs will be obtained in this manner, depending on when the last shampoo and styling were done. An active telogen effluvium condition will produce 3-4 times the normal amount of hair pulled; androgenetic alopecia or resolving telogen effluvium has a slight to moderate increase in the number of hairs shed.
  3. Quantitative Analysis of Hair Shedding – The patient is asked to collect ALL hairs shed daily for 7 days in individual plastic bags. The hair is then counted and averaged per day. Normal daily loss is 50-100 hairs. Patients with active telogen effluvium have a 10-40% greater loss.
  4. Density determination – By shaving a small area of the scalp, marking with a skin punch and ink pad, the hairs are counted per square centimeter (normally 150 hairs/cm). The growth rate is measured one month later (normally 1.0-1.2 cm/mo).
  5. Microscopic Hair analysis looking for telogen bulbs, broken hairs (exclamation point hairs), anagen hairs, hair diameter (a high variability in diameter of the hair shaft is evident in androgenetic alopecia), anagen-telogen ration, and sometimes potassium hydroxide is applied to an individual hair strand sample allowing visualization of fungal spores (blackdot ringworm) which causes broken hairs.
  6. Scalp Biopsy which will show them the following:
    • A normal 4-6 mm skin sample should contain 30 terminal hairs, sweat glands, and hair follicles. When alopecia appears to be scarring, the absence of these establishes the diagnosis.
    • The biopsy must go deep enough to include subcutaneous tissue in order to capture anagen hair bulbs. It is closed with suture to ensure proper healing.
    • Various stains are used to detect scarring, lupus, lichen planus, or a blistering disease.
    • Evidence of inflammation may be an indication for the use of steroids.
    • Amino acid and sulfur analysis may be done for certain rare genetic hair disorders.