Diagnosis of the state of my scalp, are there any other methods but biopsy? Please, help. (photos)

Hello to all, I have been suffering from hair loss for the past 3 months now, all my blood tests are fine, including ferritin, thyroid and other hormones, unfortunately, I’m not in the US now and doctors here in Europe refuse to do a biopsy, what can I do? I’m worried my scalp is inflamed and worry it it might be scarring alopecia that cannot be diagnosed by eye as it occurs under the scalp skin. Are there any other methods that could help with diagnosing my condition?

Doctor Answers 4

Seeking Answers-Hair Loss Treatment: PRP and Progesterone

You don't necessarily need a biopsy, a scalp evaluation can be helpful in diagnosis. I suggest seeing an expert to evaluate the cause of your hair loss and consider the best treatment options. There are great non-invasive options like PRP/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 190 reviews


A consultation with a dermatologist at the very least, or a consultation with a hair restoration expert can help with diagnosis. Your medical history as well as symptoms will be reviewed, and your scalp and hair evaluated. You may still need a biopsy, and may find a physician who does it if it is found to be warranted.

Craig L. Ziering, DO
West Hollywood Hair Restoration Surgeon
4.8 out of 5 stars 13 reviews

Females hair loss

To rule out scarring alopecdias, you must have a biopsy. Even with scarring alopecias, we have been doing scalp micropigmentation for females with thinning, see below

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 27 reviews

Do I have a subtle scarring alopecia?

Even if you have a subtle scarring alopecia, there are usually clues

1.sometimes itching, burning and pain

2. sometimes a positive pull test for anagen hairs 

3. evidence of scalp redness and loss of ostia (follicular pores).

Most people with hair loss have normal blood tests so that statement in and of itself is not helpful. Patients with genetic hair loss often have normal blood tests as do the majority with alopecia areata and scarring alopecia. 

IF doctors refuse to do a biopsy, there's a few options including searching for another doctor. Your doctor if he or she knows what they are doing may be trying to protect you. Biopsies are NOT 100 %. What will you do if your biopsy comes back showing a scarring alopecia and that's not truly what you have? A biopsy is never what a patient NEEDS. What a patient always needs someone who can put everything together. Every single day of my clinic, I have to explain to patients that "even though this is what your biopsy shows, this is not what you have"


Jeff Donovan, MD, PhD
Vancouver Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.