Lab Testing to Consider in Hair Loss

Dr. Julia Christensen, ND

Hair loss can present in a variety of patterns including diffuse hair loss, brittle and breaking with a straw like texture, patches of hairloss, and receding hairline.  There are many factors that must be looked at to determine the reason for these different patterns of hair loss.  Whether or not the hairloss can be delayed or improved will depend on the length of time it’s been occurring as well as determining the underlying cause of the hair loss.  In cases where hair loss is not reversible or treatment strategies are not showing improvement, PRP could be a good option to consider.  In this article, I will cover some of the lab testing that could be run to figure out the possible underlying cause for hair loss.

There are three main categories to consider for hair loss which can help to determine which lab testing should be run.  The lab testing run may include one or all of the following depending on what your health care provider thinks is going on.

Main reasons for hair loss include:

  1. Nutrient deficiency
  2. Hormone imbalance
  3. Stress

Let’s take a look at specific lab testing that could be indicated for each of the main reasons for hair loss.  Please keep in mind there may be other tests that are indicated but this will cover the majority.  In a more complex case, it’s possible to do comprehensive testing which could include the DUTCH test (urine testing) to get a complete picture of sex hormones (testosterone, progesterone, estrogen) and adrenal function (stress hormone metabolism).

  1. Nutrient deficiency
    1. The most important nutrient deficiencies to rule out include Vitamin B12 and iron (ferritin is typically tested as it is the storage form of iron). Looking at a complete blood count (CBC) is also helpful to rule out anemia (ie low Red blood cells, low hematocrit, or low hemoglobin).
    2. There is also some evidence that some amino acids (histidine, cysteine), Vitamin D3, folate, copper, and zinc deficiencies may be contributing factors to hair loss as well.
  2. Hormone imbalances
    1. Thyroid hormone imbalances may lead to hair that falls out at an increased rate, breaks more easily, is brittle, and changes in texture.
      1. It’s important to run a full thyroid panel including TSH (comes from the pituitary gland in your brain), free T4 and free T3 (your thyroid hormones) to get a clear picture of thyroid function.
    2. Sex hormones
      1. The androgens testosterone and dihydrotestosterone (DHT): DHT is a more potent form of testosterone and it is thought that conversion of testosterone to DHT in higher amounts may be a contributor to hair loss. In males this typically presents as a recession of the hair line and in females a thinning of the hair.  For women we may see this occur in a condition called polycystic ovarian syndrome.
      2. It is possible to test both testosterone (typically bioavailable testosterone) as well as DHT, and something called Sex Hormone Binding Globulin (SHBG) in the serum which will give us a good understanding of the balance of androgens in the body
  3. Stress hormones – hair loss with stress tends to look like large amounts of hair loss after a stressful event or with ongoing stress
    1. Cortisol – we are able to test cortisol levels via serum, urine or saliva. There are some great panels that include testing four times in one day so we can see what your stress hormone pattern is throughout the day and then appropriately support the body as needed.

If you’ve experienced a change in your hair texture or an increase in hair loss, check in with your health care provider and they can help you to determine the  reason(s) why it might be occurring, as well as the best set of testing and treatment options available to support you J