Expert: Michael S. Fisher, <B>Ph.D., M.D.</B> - 10/4/2006

Question
I am a 33 year old female experiencing hair thinning for the past year.  I would like to know what tests that you recommend I have the dermatologist start with.  I know thyroid and iron.  Which others do you do with new patients?  Do you recommend to start with certain tests and then if those are normal to try other tests or should I just request all at the first visit?
Thanks for your time.

Answer
The first thing to do is to get blood work: CBC with Diff, Comp Metabolic pannel, TSH,ANA, total testosterone, DHEAS, RPR, ferritin, and sometimes LH and FSH.  If the tests are normal then you need a scalp biopsy.  A scalp biopsy by a dermatologist will tell you if this is Female Patern Hair loss which is genetic.  If a genetic cause, your only options are Rogaine for Woment or Rogaine for Men which is stronger.  I like to do a biopsy have the patient then get blood work and come back in 3-4 weeks and then I will have all the results and can council the patient as to the options.