Is it worth having a scalp biopsy to determine the cause of my thinning hair?

Question

I am a 33 year old female. I have never had majorly thick hair but started noticing more of my scalp last year. I went to the doctors and had blood tests. I was found to be slightly anaemic and my prolactin was high (since returned to normal) but everything else came back normal. The dermatologist said that he thinks it's androgenic alopecia but said I can have a scalp biopsy "if I want". What will this show? Could it show that it is something else that could be cured?

Jason Emer, MD · Answer

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

Stefan Rene Adair, MD · Answer

Although not always definitive, scalp biopsy is relatively quick and easy and can rule out certain pathology if present. Proceeding with this has little downside, and may answer some of your questions.

Robert V. Mandraccia, MD · Answer

I agree that the biopsy may well be inconclusive. PRP injections have proven to work in both men and women but may require multiple injections in some people.

Jeff Donovan, MD, PhD · Answer

A scalp biopsy if taken from a representative area and examined under the microscope by a dermatopathologist who is knowledgable can be helpful if the diagnosis is not clear. Many hair loss diagnoses do not require a scalp biopsy but rather a careful review of the patient's history and careful examination of the scalp via dermoscopy. Biopsies are not always 100% and sometimes one needs to interpret the result to make sure it fits with the clinical diagnosis. In other parts of medicine, a biopsy is the 'final' answer - that is not true in hair medicine.A biopsy would show the number of hairs and if there is miniaturization (a feature of genetic hair loss) and whether there are other features like scarring and inflammation.

Karl Hekimian, MD · Answer

There are systemic issues that can cause hair loss that require  biopsy for definitive diagnosis.  If you show no clinical signs it is less likely, but if there is doubt it is not a bad idea.

William Rassman, MD (retired) · Answer

A biopsy should be the last thing you should do to get a diagnosis.  Read my post below which discusses the work-up for females with thinning or hair loss

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Is it worth having a scalp biopsy to determine the cause of my thinning hair?

Answers (6)

HAIR LOSS TREATMENT PROVIDERS NEAR YOU