Can a scalp biopsy tell what kind of hair loss you have? Is it genetic or telogen effluvium? (Photo)

Telogen Effluvium simply refers to the synchronous loss of hair in the hair cell cycle.  Therefore, a scalp biopsy is probably not going to make the call.

Dr John E Frank, MD

If a scalp biopsy is performed properly and sent to an experienced dermatopathologist (who regularly interprets scalp biopsies) the etiology of the alopecia can be determined. Here are some important factors. Multiple biopsies should be obtained. At least two and possibly three locations. The biopsy has to be deep enough to include the hair follicles. It must be sent with instructions for horizontal sectioning, if one is trying to determine the etiology of a non scarring Alopecia. This is different than the normal processing for a skin biopsy. One needs to at least ask for telogen and anagen ratios as well as terminal and vellus hair ratios. Additional information can be provided by the dermatopathologist. Find a hair loss expert who can interpret the biopsy  results and review your treatment.

Yes, You'll need a full evaluation for a diagnosis, which will help determine best treatment options. There are great non-invasive options like prp/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

It does not replace a good physical examination, but if a doctor is uncertain about the cause of your hair loss he/she may obtain a biopsy for more insight to the root of the problem.

genetic alopecia is the most common reason of hair loss in women and men  and it is more common than it is thought to be. 25% of the women at the ages of 35-40, 50% of the women and men at the ages above 40 suffer from hair loss. Other reasons of hair loss are: Hypo- and hyper-tiroidism (hair loss may be one of the early signs of thyroid dysfunction, and hair loss stops after treatment); polycystic ovarian syndrome (an inherited ovarian disease, seen in 10% of the women during adulthood); pregnancy-related hormonal changes (temporary hair loss which can be seen during pregnancy stops after birth)..

The reason of the hair loss may related with factors other than genetic like connective tissue disorders, stress, anemia, lupus, medications, hormonal and seasonal changes, nutritional problems, severe diets, bulimia, protein/calorie deficiency, zinc and essential amino-acid deficiency, mal-absorption (intestinal and digestive problems), A-vitamin excess, general anesthesia, affective mood disorders.

Drugs that may cause hair loss in woman 

Anti-coagulants such as warfarin and heparin  
Epilepsy drugs, especially dilantin
Gout drugs, allopurinol and colchicum
Antihypertensive drugs, diuretics, beta blockers.... etc
So you may need dermatoscopy and ıf needed a skin biopsy and to have a full exam with an hair surgeon and/or endocrinologist , to find out any reason for hair loss.

Provided the biopsy is taken from the right area and performed properly (4 mm punch deep, parallel to hairs)  and submitted for proper horizontal sectioning in the path lab and read by a dermatopathologist who is experienced in reading horizontal sections ... the answer to your question is yes. However, most of the time one can distinguish telogen effluvium from androgenetic alopecia by proper clinical examination. A biopsy is usually not necessary.

Hello Kittenmoon,
This type of very rapid hair loss is typically not genetic. I agree with Dr. Rassman's response to your question. His method likely goes to the root of your issue(s). This is critical, treating the symptoms will likely only lead to more adverse side effects manifesting in yet other unknown ways.  
If hormone deficiencies are identified, be sure to only use Bio-Identical Hormone Replacement Therapy (BHRT). These types of hormones are made to be identical to what your body is expecting. Non bio-identical or taking something like estrogen orally can lead to more problems. Bio-Identical hormones are the safest.  
Once the root problem is addressed, you will still likely need a boost to regain hair more rapidly and more fully. I recommend considering PRP regeneration therapy after your root problems are addressed.
Hope I have helped. Wishing you all the best in finding a solution that works for you.
Warmly,
Arbella Sarkis, MD 

The correct diagnosis will involve a complete history and examination which will lead to the correct diagnosis in many cases. There are many tests to perform and discuss, those are best done with a dermatologist.

Some times a biopsy can distinguish genetic hair loss. Female hair loss is a difficult analysis and requires many tests, not just thyroid testing. I simply can’t write a textbook on the subject on this site, but here’s a list of past posts that may help you understand what you’ve got going on:1. Female Genetic Hair Loss Is Different From Male Genetic Hair Loss2. Birth Control Pills and Hair Loss3. Woman With Thinning Hair After Family Tragedy4. Diseases Causing Women’s Hair Loss5. Female Hair LossThe first step in evaluating hair loss in women, after a detailed history and physical exam, is to rule out any underlying medical causes of hair loss which can be treated. If clinically appropriate, the following disease processes should be considered: anemia, thyroid disease, connective tissue disease, gynecological conditions and emotional stress. Furthermore, over 50% of women going through change of life hormone fluctuations (menopause) experience significant hair loss. It is also important to review the use of medications that may cause hair loss, such as (but not limited to) oral contraceptives, beta-blockers, Vitamin A, thyroid drugs, coumadin, and prednisone. The following laboratory tests have been recommended to rule out the aforementioned medical conditions:Some common blood tests for female hair loss:• Sex Hormone tests• SHBG (Sex Hormone Binding Globulin) used to test status of male hormones• Estradiol is a sex hormone• FSH (Follicle Stimulating Hormone) *not hair follicle but follicle in the ovary*• LH (Luteinizing Hormone) is a sex hormone• Free Testosterone• Total Testosterone• ANA (Anti Nuclear Antibody) used to test for Lupus or other autoimmune diseases• TSH (Thyroid Stimulating Hormone) used to test for hyper or hypo-thyroid disease• Test Iron status• TIBC (Total Iron Binding Capacity)• Ferritin• Iron