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Hair Loss: A Comprehensive Workup and Medical Treatment Options

Hair loss can be attributed to a combination of genetic factors, or a hormonal imbalance, health conditions, and medication use. Other contributing factors like stress, poor diet, weight loss, and environmental influences can also lead to thinning or shedding of hair. Identifying the underlying cause is crucial in determining the most effective treatment for hair loss.

As individuals age, genetic factors become a significant contributor to hair loss, particularly in cases of pattern baldness known as androgenic alopecia, which tends to run in families. Understanding the presence of this condition in your family can provide insight into your own risk of experiencing hair loss.

A thorough hair loss workup typically includes a medical history review, physical examination, and blood tests to identify any underlying health conditions contributing to hair loss. Medical treatments for hair loss may include topical minoxidil, prescription medication such as spironolactone, oral minoxidil, oral Propecia (finasteride), corticosteroid injections, or JAK inhibitors. Injections of PRP platelet rich plasma can also be used. It is essential to consult with a dermatologist for an accurate diagnosis and personalized treatment plan.

hair loss workup and medical treatments

Causes of Hair Loss

Hair loss may have various causes, with genetics being only a part of the equation. Although having a family history of hair loss can raise the chances of experiencing it, there are other significant factors involved.


A family history of hair loss, commonly referred to as male or female pattern baldness, substantially raises the chances of encountering hair loss. Around half of men aged 50 and above encounter male-pattern baldness, whereas 40% of women undergo female-pattern hair loss by the age of 50. The genetic impact of hair follicle sensitivity to hormones may result in gradual hair thinning as time passes.

Hormonal Changes

Fluctuations in hormone levels due to pregnancy, childbirth, menopause, or thyroid imbalances can also contribute to hair loss. During pregnancy, elevated estrogen levels prolong the hair growth phase, resulting in reduced shedding and thicker hair. However, after childbirth, a significant drop in estrogen levels can lead to increased hair shedding following childbirth.

Medical Conditions

Hair loss can be attributed to a range of medical conditions including anemia, hypothyroidism, thyroid disease, vitamin D deficiency, chemotherapy for cancer, and blood pressure medication. Additionally, women may experience hair thinning and a decrease in hair density due to hormonal fluctuations during menopause.

Various skin problems and autoimmune diseases such as alopecia areata, eczema/atopic dermatitis, discoid lupus erythematosus, contact dermatitis, tinea capitis, and scalp psoriasis, can also contribute to patches of hair loss. For instance, alopecia areata affects about 2% of the population at some point in their lives, while telogen effluvium, a common cause of temporary hair loss, can affect up to 50% of people at some point in their lives.

Medications and Environmental Factors

In addition to genetics and medical conditions, certain medications like chemotherapy drugs and environmental factors such as exposure to pollutants and toxins can also weaken hair health.

Stress and Nutrition

The presence of stress can negatively affect the health of hair, leading to increased shedding and the onset of conditions such as alopecia areata. Additionally, deficiencies in key nutrients like iron, protein, biotin, zinc, and others can play a role in causing hair thinning.

Understanding the Cause

It is essential to take into account these various factors when dealing with hair loss as they may necessitate different treatment methods. Identifying the underlying cause will help determine the most suitable treatment plan for your circumstances.

Aging and Genetic Influences

As we grow older, our bodies experience various transformations. One prominent change that many people observe is the reduction in hair thickness or the emergence of baldness, which is frequently influenced by a genetic predisposition. The most prevalent forms of hair loss caused by genetic factors are male-pattern baldness and female-pattern baldness, also known as androgenetic alopecia.

People often wonder why some individuals maintain a full head of hair well into their later years, while others experience significant thinning or baldness. The answer lies in the genetic predisposition for hair loss that varies among different individuals. Understanding one's family history and genetic predisposition is crucial for evaluating the potential risk of hair loss.

Genetic predisposition to hair loss can manifest differently in each person, with varying patterns and levels of severity. Some people may start experiencing hair loss in their 20s, while others may not see any significant thinning until later in life. It's important to understand that your unique genetic makeup interacts with aging to determine how and when you might experience hair loss.

To put it into perspective, let's consider the statistical correlation between aging and the onset of genetic hair loss. Research shows that the percentage of individuals experiencing hair loss due to genetic factors increases with age. For example, in their 30s, approximately 30% of men and women may experience some form of genetic hair loss, while in their 50s, this number could rise to nearly 50%. These statistics outline the profound impact that aging can have on genetic hair loss.

Genetic markers associated with hair loss and aging play a significant role in determining how an individual's hair will fare as they grow older.

The understanding of these genetic markers provides insight into the effectiveness of different medical treatments for genetic hair loss at different ages. It sheds light on the success rates of hair loss treatments based on genetic factors and age, providing valuable information for personalized treatment plans.

By examining the interplay between aging and genetic influences on hair loss, we gain a better understanding of how these factors contribute to male and female patterned baldness.

Impact of Lifestyle on Hair Health

Hair health goes beyond just using the right products. What you eat and how you treat your body play a significant role in the strength and vitality of your hair. Let's take a closer look at three key lifestyle factors that can impact your hair: dietary choices, stress levels, and hair care routines.


The saying "you are what you eat" couldn't be truer when it comes to your hair. Protein, iron, and various vitamins are essential for healthy hair growth. Insufficient nutrient intake can contribute to hair loss as the body prioritizes essential functions over non-critical ones like hair growth when nutrient levels are low. Including foods rich in protein like lean meats, fish, eggs, and legumes, as well as iron-rich foods like spinach, lentils, and red meat can help support healthy hair growth. Inadequate intake of essential nutrients such as iron, biotin, zinc, and others can contribute to your hair thinning. The use of hair supplements might be helpful.


Stress doesn't just affect your mental well-being; it can also manifest physically through hair loss. In particularly stressful periods, your body may enter a state known as telogen effluvium, where a larger number of hairs than usual enter a resting phase before shedding. This can result in noticeable and sometimes alarming hair thinning or shedding.

Managing stress through activities like regular exercise, meditation, or seeking professional help can not only benefit your mental health but also positively impact the health of your hair.

Hair Care Practices

Overuse of heat styling tools and excessive chemical treatments can cause hair breakage and damage the hair shaft, leading to breakage and overall weakening of the hair. This doesn't mean you have to give up using these tools altogether, but being mindful of their frequency and using heat protectant sprays can minimize damage.

Regular washing and conditioning using products suited for your scalp type and avoiding harsh pulling or tugging during styling can also contribute to maintaining healthy hair. Tight braids can cause traction alopecia by pulling on the roots and damaging the hair follicle. 

Understanding the influence of various lifestyle factors and their impact on hair health, such as poor diet, high stress levels, and harmful hair care practices allows you to make informed decisions that will improve the well-being of your scalp and hair. 

Understanding how lifestyle choices and hairstyles influence hair health is crucial. Now let's explore the diagnostic procedures that can help identify the underlying causes of hair loss.

Diagnostic Procedures for Balding

Next, it is important to figure out the exact cause of your hair loss.

Your medical history will be reviewed by a doctor, who may be a dermatologist or healthcare provider. They will ask you questions about your general health, current medications, family history of hair loss, and any other health conditions you may have. This information provides them with valuable knowledge about possible genetic factors or underlying health conditions that could be contributing to hair loss.

If there's insufficient evidence from your medical history or if things aren't clear, then a scalp examination is necessary. This examination involves closely looking at your scalp and any areas where hair loss or thinning is observed with magnification.

A blood test and scalp biopsy of a patient provide valuable insights without being invasive. Blood tests can reveal valuable information about hormonal imbalances or other health conditions that might be causing hair loss, while scalp biopsies involve removing a small piece of skin from your scalp to examine under a microscope. It may pinpoint the exact cause of hair loss so that targeted treatment can begin. It is crucial to schedule an appointment as soon as you observe hair loss to address the issue promptly.

By undergoing these diagnostic procedures, you're giving yourself the best chance at uncovering the root cause of your hair loss, paving the way for personalized and effective treatment options.

Having laid down the groundwork with comprehensive diagnostic methods, it's time to delve into specific medical treatments tailored to combat hair loss.

Breakdown of Medical Treatments

When it comes to dealing with hair loss, there are a variety of medical treatment options available, each suited to different types and levels of hair loss. It's important to consult with a dermatologist or a healthcare professional to determine the best option for you.

One common topical treatment is minoxidil, which can help stimulate hair growth and slow down further loss. It comes in different strengths and is applied directly to the scalp. The higher strength is more effective. Minoxidil can also be taken orally in low doses. This is a prescription and must be monitored by a doctor. Spironolactone pills can be used for female hair loss.

Another oral medication that is often used is Propecia (finasteride), helping prevent further hair loss by reducing DHT levels in the scalp, commonly prescribed for men with male pattern baldness.

In some cases, especially for those with alopecia areata, corticosteroid injections may be recommended. These injections are given directly into the scalp and can help reduce inflammation and encourage hair regrowth in affected areas.

Platelet-rich plasma (PRP) is a treatment that involves drawing a small amount of blood from your arm. The blood is then spun in a centrifuge to separate the platelet-rich plasma, which contains growth factors. This concentrated plasma is injected into your scalp to promote hair growth. To achieve optimal results, a series of treatments is recommended, with one-month intervals for the first three months, followed by treatments every six months. 

Furthermore, for those who have experienced significant hair loss, hair transplant surgery can be a viable option. During this procedure, hair follicles are moved from a denser area of the scalp (or other parts of the body) to the balding area, creating a natural-looking hairline.

JAK inhibitors have recently emerged as a promising option for certain types of alopecia, eczema/atopic dermatitis, psoriasis, and vitiligo treatment. These medications work by targeting specific immune responses that contribute to these conditions, showing the potential for improving symptoms and promoting hair regrowth in alopecia areata.

It's important to remember that each person's experience with these treatments may vary. What works well for one individual may not yield the same results for another. Therefore, seeking guidance from a dermatologist who can provide an accurate diagnosis and develop a personalized treatment plan is crucial.

Understanding these medical treatment options allows individuals struggling with hair loss to make informed decisions about their care. By consulting with a dermatologist or healthcare professional, one can find the most suitable treatment approach tailored to their unique needs and circumstances.

Topical Medications and their Effectiveness

Topical medications like minoxidil have a significant impact on hair loss treatment. But how effective are they, really? Let's delve into this much-discussed topic.

Minoxidil, commonly known by the brand name Rogaine, is an FDA-approved topical solution available over the counter. It's designed to be applied directly to the scalp to promote hair growth and reduce hair loss. The exact science behind how minoxidil works isn't completely understood, but it's believed to increase blood flow to the hair follicles, delivering more nutrients and oxygen, and potentially stimulating hair growth.

Research has indicated that minoxidil is most effective for adults who are in the initial phases of hair loss. It's reported to slow or stop hair loss for the majority of people and even regrow some hair in certain instances. However, results can vary among individuals. Clinical studies have found that over 40% of men using 5% minoxidil experienced moderate-to-marked regrowth, while about 19% of women using the same concentration experienced similar results; about 20% of men and 11% of women using 2% minoxidil experienced moderate-to-marked regrowth.

Minoxidil does not produce instant results; it could require several months of regular application before any visible improvements and hair growth become apparent. Some individuals may experience initial shedding when starting minoxidil treatment, which is considered a normal part of the process and is eventually replaced by new, healthier hair strands.

Topical medications such as minoxidil can lead to minor scalp irritation or, in rare cases, more serious side effects such as rapid heartbeat and dizziness. It is essential to apply minoxidil consistently to experience its benefits, as discontinuing its use may result in the loss of any progress made.

Topical medications such as minoxidil are effective when considering treatment options for hair loss. It is important to note that this medication requires dedication, patience, and consideration of potential side effects.

As we continue exploring treatments for hair loss, let's explore nonmedical solutions to address this concern.

Exploring Non-Medical Solutions

hair loss workup and medical treatments

Dealing with hair loss involves considering nonmedical options that can help improve hair health and encourage regrowth. Essential practices like regular washing and conditioning are crucial for maintaining scalp hygiene and ensuring optimal follicle function by eliminating debris, excess oil, bacteria, and product buildup. It is best to use a sulfate-free, gentle shampoo.

In addition to regular cleansing, avoiding excessive heat styling and chemical treatments is vital for maintaining the strength and integrity of your hair. Overexposure to heat from styling tools or harsh chemicals from dyes and relaxers can lead to dryness, breakage, and overall damage to the hair structure. It's important to give your hair a break from these stressors to foster a healthier environment for growth.

Furthermore, maintaining a healthy diet is not only beneficial for your overall well-being but can also contribute to better hair health. Nutrient deficiencies can impact the condition of your hair, so it's essential to eat a balanced diet rich in vitamins, minerals, and proteins that support hair growth and strength.

For example, foods like eggs, fish, nuts, seeds, leafy greens, and fruits are packed with essential nutrients such as biotin, omega-3 fatty acids, iron, zinc, and vitamins A, C, D, and E, which are known to promote healthy hair.

In addition to these fundamental practices, some individuals turn to advanced nonmedical solutions for optimizing hair health and potentially stimulating regrowth. Specialized hair care products formulated with nourishing ingredients targeted towards specific concerns such as thinning or damaged hair can complement your hair care routine.

In addition, there has been increasing interest in the use of laser therapy devices and low-level light therapy to enhance hair growth. We highly recommend the Hairmax to our patients, a laser device that can be conveniently used at home. These innovative technologies employ low levels of light energy to activate cellular activity in the hair follicle, potentially improving blood circulation, follicle function, and the overall health and appearance of the hair.

By integrating nonmedical remedies with medical treatments, individuals have the opportunity to take a comprehensive approach to managing their hair loss concerns. Each method offers unique benefits that work together to promote a healthy scalp environment and support optimal hair growth.

To schedule a consultation for your hair loss workup, give us a call at (212) 517-8855 today or send us an email on our contact form.