What laboratory tests should I order to identify potential deficiencies in a hair loss protocol?

Laboratory Testing for Hair Loss Protocol

For a comprehensive hair loss protocol, laboratory testing should include serum ferritin, complete blood count, thyroid function tests, vitamin D, zinc, and copper levels as these are the most evidence-supported markers associated with hair loss. 1, 2

Core Laboratory Panel for Hair Loss Evaluation

Essential Tests:

• Complete Blood Count (CBC) - To assess for anemia and general health status 1
• Serum Ferritin - Key indicator of iron stores; low levels associated with telogen effluvium and other hair loss conditions 3, 1
• Thyroid Function Tests:
  • TSH (Thyroid Stimulating Hormone)
  • Free T4 (Thyroxine)
  • Consider thyroid antibodies (TPO) if initial tests suggest thyroid dysfunction 4, 1
• Vitamin D (25-hydroxyvitamin D) - Levels below 75 nmol/L may contribute to hair loss 4, 2, 5
• Zinc - Serum/plasma zinc levels; deficiency associated with hair loss and treatment resistance 4, 6
• Copper - Important to check alongside zinc as they compete for absorption 4

Additional Tests Based on Clinical Presentation:

For Female Patients:

• Sex Hormones:
  • Testosterone
  • DHEAS (Dehydroepiandrosterone sulfate)
  • Androstenedione
  • Estradiol
  • FSH (Follicle-stimulating hormone)
  • LH (Luteinizing hormone)
  • Especially important in women with suspected PCOS or androgenetic alopecia 2

For Suspected Nutritional Deficiencies:

• Vitamin B12 and Folate - Both RBC folate and serum B12 4
• Selenium - Particularly if patient has other symptoms like chronic diarrhea or unexplained anemia 4

For Suspected Autoimmune Hair Loss:

• Antinuclear Antibody (ANA) - For suspected lupus-related hair loss
• Comprehensive Metabolic Panel - To assess overall health and organ function

Interpretation Guidelines

Iron Status:

• Ferritin is the primary indicator of iron status in hair loss
• Evidence is mixed regarding optimal ferritin levels, but many experts suggest maintaining levels >50 ng/mL for women with hair loss 3
• Note that ferritin may be falsely elevated in inflammatory conditions 3

Zinc Status:

• Lower serum zinc correlates with severity of alopecia areata and resistance to treatment 6
• Consider zinc supplementation when levels are low, especially in resistant cases

Vitamin D:

• Target 25-hydroxyvitamin D levels of 75 nmol/L or greater 4
• Monitor levels at 3,6, and 12 months during the first year of treatment 4

Important Considerations

1. Timing of Tests: Morning testing (around 8 am) is preferable for hormonal evaluations 4

2. Medication Effects: Note that certain medications can affect test results:

   • Finasteride lowers PSA by 50% after 12 months (important if testing male patients) 2
   • Some supplements like saw palmetto can affect hormone levels 2

3. Follow-up Testing: Consider repeating key tests after 3-6 months of treatment to assess response 2

4. Common Pitfalls:

   • Relying solely on hemoglobin to assess iron status (ferritin is more sensitive for hair loss) 3
   • Failing to check copper when supplementing zinc (they compete for absorption) 4
   • Not considering drug interactions that may affect test results

By implementing this laboratory testing protocol, you'll be able to identify the most common nutritional and hormonal deficiencies associated with various types of hair loss, allowing for targeted treatment approaches that address the underlying causes rather than just the symptoms.