Basic test to do for hairfall
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basic blood tests for hair fall investigation
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Here is a complete, clinically organized guide to the basic tests for hair fall:
Basic Tests for Hair Fall (Alopecia)
Tier 1 - First-Line Tests (Recommended for Everyone)
| Test | What It Detects |
|---|---|
| CBC (Complete Blood Count) | Anemia (low hemoglobin, low MCV), nutritional deficiencies |
| TSH (Thyroid Stimulating Hormone) | Hypothyroidism and hyperthyroidism - both cause diffuse thinning |
| Serum Ferritin | Iron stores; should be >70 ng/mL in active hair shedding (even "normal range" of 15+ may be too low for hair) |
| Serum Iron + TIBC | Iron deficiency assessment; confirms ferritin findings |
| Vitamin D3 (25-OH Vitamin D) | Deficiency linked to telogen effluvium and alopecia areata |
| Vitamin B12 | Deficiency causes hair thinning and anemia |
| Fasting Blood Sugar / HbA1c | Diabetes-related hair loss |
Tier 2 - Hormonal Panel (Especially for Women with Diffuse Loss or Virilization Signs)
According to Harrison's Principles of Internal Medicine (22nd ed.), in women with androgenetic alopecia, elevated circulating androgens may result from ovarian or adrenal dysfunction or neoplasm.
| Test | What It Detects |
|---|---|
| DHEAS | Adrenal androgen excess |
| Free & Total Testosterone | Androgen-driven hair loss (FPHL / PCOS) |
| LH / FSH | Polycystic ovarian syndrome (PCOS) |
| Prolactin | Hyperprolactinemia-related hair loss |
| Androstenedione | Adrenal/ovarian androgen excess |
Tier 3 - Inflammatory / Autoimmune (If Pattern Suggests Alopecia Areata, Lupus, or Patchy Loss)
| Test | What It Detects |
|---|---|
| ANA (Antinuclear Antibody) | Systemic lupus erythematosus (SLE) - causes both scarring & non-scarring alopecia |
| ESR / CRP | Systemic inflammation; elevated in autoimmune conditions like lupus |
| Anti-dsDNA | Confirmatory for SLE |
| VDRL / RPR | Secondary syphilis - causes "moth-eaten" patchy alopecia |
| Cortisol (morning) | Chronic stress/adrenal dysfunction |
Additional Notes
- Telogen effluvium (diffuse shedding after illness, stress, delivery, crash dieting) - CBC, ferritin, thyroid, vitamin D are the priority tests.
- Androgenetic alopecia (pattern baldness) - hormonal panel if female; may not need extensive workup in males with classic M-shaped recession.
- Alopecia areata (patchy, coin-shaped loss) - ANA, thyroid antibodies (anti-TPO, anti-TG), CBC.
- Scalp biopsy is considered if the diagnosis remains unclear after blood tests, especially to distinguish scarring from non-scarring alopecia - as Harrison's notes, fibrosis and loss of follicular openings on exam (or biopsy) indicate scarring alopecia which has a different prognosis.
Quick Summary Panel to Order in One Go
- CBC
- TSH + Free T4
- Serum ferritin + Serum iron + TIBC
- Vitamin D3
- Vitamin B12 + Folate
- HbA1c / fasting glucose
- DHEAS + Total testosterone (especially women)
- ANA + CRP/ESR (if patchy loss or autoimmune features)
Sources: Harrison's Principles of Internal Medicine 22E (2025), Dr. Paul Farrant - Blood Tests & Hair Loss, American Hair Loss Association
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