Diagnosis

Before making a diagnosis, your doctor will likely give you a physical exam and ask about your medical history and family history. He or she may also perform tests, such as the following:

  • Blood test. This may help uncover medical conditions related to 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. 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 further thinning. With some conditions, such as patchy hair loss (alopecia areata), hair may regrow without treatment within a year.

Treatments for hair loss include medications, surgery to promote hair growth and slow hair loss.

Medication

If your hair loss is caused by an underlying disease, treatment for that disease will be necessary. This may include drugs to reduce inflammation and suppress your immune system, such as prednisone. If a certain medication is causing the hair loss, your doctor may advise you to stop using it for at least three months.

Medications are available to treat pattern (hereditary) baldness. Options include:

  • Minoxidil (Rogaine). This is an over-the-counter (nonprescription) medication approved for men and women. It comes as a liquid or foam that you rub into your scalp daily. Wash your hands after application. At first it may cause you to shed hair as hair follicles. New hair may be shorter and thinner than previous hair. At least six months of treatment is required to prevent further hair loss and to start hair regrowth. You need to keep applying the medication to retain benefits.

    Possible side effects include scalp irritation, unwanted hair growth on the adjacent skin of the face and hands, and rapid heart rate (tachycardia).

  • Finasteride (Propecia). This is a prescription drug approved for men. You take it daily as a pill. Many men taking finasteride experience a slowing of hair loss, and some may show some new hair growth. You need to keep taking it to retain 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. For men, the oral medication dutasteride is an option. For women, treatment may include oral contraceptives and spironolactone.

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 tiny patches of skin, each containing one to several hairs, from the back or side of your scalp. Sometimes a larger strip of skin containing multiple hair groupings is taken. He or she then implants the hair follicle by follicle into the bald sections. Some doctors recommend using minoxidil after the transplant, to help minimize hair loss. And 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 expensive and can be painful. Possible risks include bleeding and scarring.

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 may want to try shaving, other styling techniques and products, scarves, a wig, or a hairpiece. Talk with a hair stylist for ideas. These nonmedical solutions can be used to cover permanent or temporary hair loss.

If your hair loss is due to a medical condition, the cost of a wig may 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 likely 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?
  • What is the best course of action?
  • 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?