What tests are used to diagnose hair loss in males?

From the Guidelines

To diagnose male pattern hair loss, a combination of physical examination, blood tests, and trichoscopy is recommended. A dermatologist will typically perform a physical examination of the scalp and hair pattern, which is often sufficient for diagnosis 1. Blood tests are commonly ordered to check hormone levels (including testosterone and dihydrotestosterone), thyroid function, iron levels, and complete blood count to rule out underlying medical conditions. A hair pull test may be conducted to assess the severity of shedding. In some cases, a scalp biopsy might be necessary, where a small sample of scalp tissue is examined under a microscope. Trichoscopy (dermoscopy of the scalp) allows for magnified visualization of hair follicles and can help distinguish between different types of hair loss. Some key points to consider when evaluating male pattern hair loss include:

• The Hamilton-Norwood classification system is commonly used to describe patterns of hair loss in males 1
• Androgenetic alopecia (AGA) is the leading cause of hair loss in both men and women, affecting 58% of men by age 50 1
• The use of autologous platelet concentrates, such as platelet-rich plasma (PRP), may be considered as a treatment option for AGA, although the evidence is still controversial and further research is needed 1
• A task force assigned by the Indian Association of Dermatologists recommends a manual double-spin method for preparation of PRP, with a minimum of 3-5 sessions, 1 month interval between sessions, and a recommended dose of 5-7 mL PRP 1 These tests and considerations help determine whether the hair loss is due to androgenetic alopecia (male pattern baldness) or other conditions like thyroid disorders, nutritional deficiencies, or autoimmune diseases, which guides appropriate treatment options such as minoxidil, finasteride, or addressing underlying health issues.

From the Research

Male Hair Loss Tests and Treatments

• Male pattern hair loss, also known as androgenetic alopecia, is a common hair loss disorder affecting up to 80% of males by the age of 80 2.
• The disorder is characterized by androgen-related progressive thinning of hair in a defined pattern, resulting in diminished self-esteem, reduced confidence, and distress in affected men 2.
• Treatment options for male pattern hair loss include:
  • 5 alpha reductase inhibitors, such as finasteride 2, 3
  • Minoxidil 2, 4, 3
  • Prostaglandins 2
  • Low-level laser therapy (LLLT) 3, 5
  • Platelet-rich plasma (PRP) therapy 2

Diagnosis and Treatment of Hair Loss

• A comprehensive history and physical examination, with targeted laboratory testing, may help diagnose the underlying cause of hair loss 4.
• Treatment options for hair loss depend on the underlying cause, but may include:
  • Minoxidil for androgenetic alopecia 4, 3
  • Finasteride for male patients with androgenetic alopecia 4, 3
  • Intralesional corticosteroid or oral immunosuppressant therapy for alopecia areata 4
  • Oral antifungals for tinea capitis 4
  • Decreasing tension on the hair for traction alopecia 4

Effectiveness of Treatments for Androgenetic Alopecia

• A systematic review and meta-analysis found that minoxidil, finasteride, and LLLT are effective for promoting hair growth in men with androgenetic alopecia 3.
• The study also found that minoxidil is effective in women with androgenetic alopecia 3.
• Another study found that LLLT represents a potentially effective treatment for both male and female androgenetic alopecia, either as monotherapy or concomitant therapy with minoxidil or finasteride 5.