Women's Hair Loss: Diagnosis

2 min read

Hair loss in women isn't always as straightforward as it is in most men. In men about 90% of all cases are caused by hereditary male pattern baldness. In women, however, hair loss can be triggered by a multitude of conditions and circumstances.

The diagnostic tests below should be performed to help pinpoint the hair loss trigger. The truth of the matter is that for many patients these tests usually come back with readings within the normal range, but these tests can at the very least eliminate the possibility of certain disorders causing your hair loss.

It's important to remember that the proper diagnosis of female hair loss usually starts with the process of elimination.

  • Hormone levels (DHEA, testosterone, androstenedione, prolactin, follicular stimulating hormone, and leutinizing hormone)
  • Serum iron, serum ferritin, and total iron binding capacity (TIBC)
  • Thyroid levels (T3, T4, TSH)
  • VDRL (a screening test for syphilis)
  • Complete blood count (CBC)
  • Scalp biopsy -- A small section of scalp, usually 4 mm in diameter, is removed and examined under a microscope to help determine the cause of hair loss.
  • Hair pull -- A doctor lightly pulls a small amount of hair (about 100 strands) to determine if there is excessive loss. If more that 3 hairs come out, then the patient is likely suffering from excess hair loss. Normal range is one to three hairs per pull.
  • Densitometry -- The densitometer is a handheld magnification device used to check for miniaturization of the hair shaft.

There are two widely known female hair loss density scales used by most hair loss specialists: the Ludwig Scale and the Savin Scale. They are identical except that the Savin Scale also measures overall thinning.

In the Savin Scale, shown here, eight crown density images reflect a range from no hair loss to severe hair loss. Density 8 is rarely seen in clinical practice. Frontal anterior recession is also illustrated (see bottom row, far right -- again, it's not too common).

Published on March 1, 2010