From the Guidelines
For a 49-year-old with hair loss, I recommend a comprehensive laboratory workup including complete blood count (CBC), comprehensive metabolic panel, thyroid function tests (TSH, free T3, free T4), ferritin, vitamin D level, and sex hormone panel. This is based on the most recent evidence from 1, which highlights the importance of identifying underlying causes of hair loss, including hormonal imbalances, nutritional deficiencies, and inflammatory conditions.
Key Laboratory Tests
- Complete blood count (CBC) to rule out anemia or other blood disorders
- Comprehensive metabolic panel to assess liver and kidney function
- Thyroid function tests (TSH, free T3, free T4) to evaluate thyroid hormone levels
- Ferritin to assess iron stores, as iron deficiency can cause hair loss even without anemia
- Vitamin D level, as vitamin D deficiency is commonly associated with hair loss
- Sex hormone panel, including total and free testosterone, DHEAS, androstenedione, and sex hormone binding globulin for women, and testosterone and DHT levels for men
Additional Tests
- Zinc, vitamin B12, and folate levels to assess for nutritional deficiencies
- Inflammatory markers like ESR or CRP to evaluate for underlying inflammatory conditions
- Antinuclear antibodies and specific autoimmune markers if autoimmune conditions are suspected
Importance of Ferritin and Vitamin D
Ferritin is particularly important, as iron deficiency can cause significant hair shedding, even without anemia, as noted in 1. Vitamin D deficiency is also commonly associated with hair loss, and assessing vitamin D levels can help identify this potential underlying cause.
Treatment Implications
Based on the results of these laboratory tests, appropriate treatments can be initiated, ranging from nutritional supplements to hormone therapy or specific hair loss medications. If the pattern of hair loss suggests androgenetic alopecia, hormone testing becomes especially relevant, as noted in 1.
From the Research
Lab Workup for Hair Loss
The appropriate lab workup for somebody at age 49 with hair loss is not explicitly stated in the provided studies. However, the following points can be considered:
- The diagnosis of hair loss can be approached by first identifying the type of alopecia, such as androgenetic alopecia, alopecia areata, or telogen effluvium 2.
- Androgenetic alopecia can be diagnosed clinically and treated with minoxidil 2.
- A thorough medical history and physical examination can help identify underlying causes of hair loss, such as hormonal imbalances, thyroid disorders, or autoimmune diseases.
- Laboratory tests may be ordered to rule out underlying medical conditions that can cause hair loss, such as:
- Thyroid function tests (TFTs) to evaluate thyroid hormone levels
- Complete blood count (CBC) to evaluate for anemia or other blood disorders
- Electrolyte panel to evaluate for electrolyte imbalances
- Hormone level tests, such as testosterone or dihydrotestosterone (DHT), to evaluate for hormonal imbalances
Treatment Options
Treatment options for hair loss depend on the underlying cause and type of alopecia. The following points can be considered:
- Minoxidil and finasteride are FDA-approved treatments for androgenetic alopecia 3.
- Low-level laser light therapy is also recognized as a safe and effective treatment for androgenetic alopecia 3, 4.
- Platelet-rich plasma (PRP) therapy has shown limited evidence of benefit for the treatment of alopecia, with most of the evidence being of low quality 5.
- Other treatment options, such as mesotherapy, microneedling, and carboxytherapy, may also be considered, but their effectiveness is not well established 4.