scalp biopsy

[Bees]

Dear Dr R.

I have been loosing my hair for 5.5 months now, am 38 years old 2 children and never lost hair before not even with pregnancies, infertility and strarting or stopping b/c pills. My derm wants to do a scalp biopsy to see if it is T.E or FMB. Is it worth doing this, all my bloodwork is okay just ferritin is slightly low 48 so now I am on iron supplements. I am so stressed from this, have or should I say had thick hair and have lost about 40% in the last 5.5 months. The reason for doing this scalp biopsy is because if it is T.E. he said aldactone will not help but if it is FMB then I need to start aldactone. What are thoughts on this?

[tallwoman]

Dear Dr R.

I have been loosing my hair for 5.5 months now, am 38 years old 2 children and never lost hair before not even with pregnancies, infertility and strarting or stopping b/c pills. My derm wants to do a scalp biopsy to see if it is T.E or FMB. Is it worth doing this, all my bloodwork is okay just ferritin is slightly low 48 so now I am on iron supplements. I am so stressed from this, have or should I say had thick hair and have lost about 40% in the last 5.5 months. The reason for doing this scalp biopsy is because if it is T.E. he said aldactone will not help but if it is FMB then I need to start aldactone. What are thoughts on this?

Have they checked your hormone levels? I was in perimenopause at 38 (I'm now 47 and postmenopausal) I lost a ton of hair in my 30's and now I'm convinced it was due to a drop in my hormone levels...but at 38, no one thinks of that. I've been using spironolactone for 2 yrs and it has helped a lot. Last yr I was wearing wigs!! I'm also on HRT, but not testosterone even though I have none of my own. I fear it will cause my hair to fall out again.

[Bees]

thanks for your help. I have had some of my hormones, checked, but am on b/c and so I understand that is difficult to measure estrogen and progesterone when on the pill, how many mg of aldactone are you taking

[tallwoman]

I only use 50mg. A lot of people use much higher doses. I tried 100mg to start with, but my blood pressure is naturally low and Spironolactone is originally used for high blood pressure so the higher doses make me extremely fatigued.

[Geoffrey Redmond, MD, FACE]

Dear Dr R.

I have been loosing my hair for 5.5 months now, am 38 years old 2 children and never lost hair before not even with pregnancies, infertility and strarting or stopping b/c pills. My derm wants to do a scalp biopsy to see if it is T.E or FMB. Is it worth doing this, all my bloodwork is okay just ferritin is slightly low 48 so now I am on iron supplements. I am so stressed from this, have or should I say had thick hair and have lost about 40% in the last 5.5 months. The reason for doing this scalp biopsy is because if it is T.E. he said aldactone will not help but if it is FMB then I need to start aldactone. What are thoughts on this?

Most hair loss in women is due to problems related to testosterone (if too much) and/or estrogen.(if too little).
Hair loss due to hormones is diffuse. Most often it starts without any apparent trigger but giving birth and stopping birth control pills can induce hair loss.

I have seen thousands of scalp biopsy reports over the more than 25 years I have been working in this field and only once have I found one to give any useful information. The distinction between ttelogen effluvium and androgenic alopecia is a delusion. Diagnosis of TE implies the hair will grow back by itself but I have seen countless unfortunate women who were told they had TE but continued to shed, thus losing valuable time.

A ferritin level of 48 is completely normal. It is almost never possible to increase it further. Women are told it should be at least 70 but it usually will not go up that high.

If hair loss is hormonal Aldactone (spironolactone) is usually effective. There are several variables that determine if this is appropriate treatment but a diagnosis of TE does not mean it will not work.