Blood Tests for Hair Loss in Ukraine

The hair follicle is one of the tissues with the fastest cell division in the body, so it reacts to deficiencies and hormonal changes earlier than most other organs. An examination and trichoscopy show how the hair is thinning, but not why. Laboratory tests fill that gap.

Tests are ordered when hair starts falling out diffusely two to three months after an illness with high fever, surgery, childbirth or a strict diet; when a woman's parting is widening; or when there are signs of thyroid dysfunction such as feeling the cold, swelling, weight change or dry skin. Another group is people with heavy periods, regular blood donors, vegetarians and patients after bariatric surgery, among whom iron deficiency is common.

Sometimes a long list is not needed. In a man with typical hereditary thinning (a receding hairline, thinning at the crown and intact hair at the back of the head), laboratory values are usually normal; tests are done to avoid missing a coexisting deficiency, not to confirm the diagnosis.

There is no universal panel "for hair loss". The doctor draws up the list after an examination and trichoscopy, based on the pattern of hair loss, sex, age and medical history. Testing for "everything" is a poor idea, and not only because of cost: the more values on the form, the greater the chance of a random abnormality that has nothing to do with hair but leads to unnecessary further tests.

MediUkraine is a service that finds and coordinates treatment; it is not a clinic or a laboratory. We select the medical centre and a doctor of the right speciality, agree the dates of the blood draw and the appointment, and support you throughout, including if you travel from abroad. The doctor decides which tests are needed and interprets the results.

A complete blood count comes first. The doctor looks not only at haemoglobin but also at the red cell indices: a reduced mean corpuscular volume (MCV) and low haemoglobin content per cell (MCH) point to iron-deficiency anaemia, an increased MCV to a deficiency of vitamin B12 or folic acid. The white cell differential and ESR may point to an inflammatory or autoimmune process the patient had not linked to their hair.

Ferritin is the main marker on this list, and the reason it matters more than haemoglobin is simple. Ferritin reflects iron stores in the tissues, and these are depleted long before haemoglobin starts to fall. In other words, there is no anaemia yet and the blood count is normal, but the body is already short of iron, and the follicle, with its high rate of cell division, is among the first to suffer. There is no single threshold of "sufficient" ferritin in hair loss: some authors use 30 ng/mL, others 40–70 ng/mL, and that is exactly why interpretation is left to the doctor.

Serum iron, transferrin and transferrin saturation complete the picture, but serum iron on its own means very little: it fluctuates through the day and jumps after a single iron tablet. Low transferrin saturation together with low ferritin is a convincing combination; an isolated low iron figure on the form is not.

TSH and free T4 are checked almost always. Hypothyroidism causes diffuse thinning, dry brittle hair and sometimes loss of the outer third of the eyebrows; thyrotoxicosis is also accompanied by hair loss, though less often. TSH is more sensitive and changes earlier than T4, so a raised TSH with normal T4 is a reason to see an endocrinologist rather than set the results aside. If abnormalities persist, thyroid peroxidase antibodies are added.

Vitamin D is measured as 25-OH. Deficiency is widespread in northern latitudes and in winter, and lower levels have been described in studies of alopecia areata and telogen effluvium. However, the link is less clear-cut than with iron: correcting the deficiency does not by itself bring the hair back; it removes one possible obstacle.

Zinc is checked selectively, when there is reason to suspect a deficiency: inflammatory bowel disease, malabsorption, previous bariatric surgery or a prolonged strict diet. Taking zinc "just in case" is not advisable: long-term excess blocks copper absorption and can itself cause hair loss and anaemia.

Total and free testosterone, SHBG and DHEA-S form a panel for women with female-pattern thinning, especially with an irregular cycle, acne or excess facial and body hair. SHBG (sex hormone-binding globulin) determines what share of testosterone stays free and active: with low SHBG, total testosterone may be normal while free testosterone is raised. A high DHEA-S suggests an adrenal source of androgens. An important caveat: in a woman with typical androgenetic alopecia and no other signs of hyperandrogenism, these values are usually normal. That does not rule out the diagnosis, because follicle sensitivity to androgens is inherited and cannot be measured by a blood test.

Prolactin is checked for cycle disorders or nipple discharge, and as part of the hormone panel. A moderate rise is often due to stress or the blood draw itself, so borderline values are rechecked, sometimes together with macroprolactin: a biologically inactive form that can raise the figure without clinical significance.

Fasting glucose and insulin with the HOMA-IR index are added if polycystic ovary syndrome or insulin resistance is suspected. Testing for syphilis is ordered when hair loss is patchy and uneven ("moth-eaten"): syphilitic alopecia can resemble alopecia areata, and the treatments are entirely different. Antinuclear antibodies are checked when lupus erythematosus or scarring alopecia is suspected, alongside a scalp biopsy, not instead of it.

The key point about reading results: a figure outside the reference range is not a diagnosis in itself; it is interpreted together with the examination findings, the complaints and the other values. The reverse is also true: normal results do not mean there is no cause. In androgenetic alopecia laboratory values are mostly within the normal range, and the diagnosis is made by trichoscopy and the pattern of thinning. Do not prescribe yourself medicines based on the results, even when the abnormality is obvious: the dose, form and duration of treatment depend on how severe the deficiency is and on the rest of your medical history.

Routine tests (complete blood count, ferritin, iron, TSH, free T4 and vitamin D) are ready in 1–3 working days. Some values are available the same day. Results are sent by email or to your online account, and the paper copy can be collected later.

The next step is not searching online for normal ranges but taking the results to the doctor. Reference intervals differ between laboratories, and some markers have clinically meaningful limits that do not match the printed normal range: the classic example is ferritin, formally "normal" at 20 ng/mL, although for hair that is too little.

If a deficiency is confirmed, be prepared for months rather than weeks. Iron stores recover slowly: supplements are usually taken for three to six months, and hair responds to the correction with a further delay, because the follicle cycle is measured in months. The first changes are assessed no earlier than 3–4 months later.

The doctor orders follow-up tests, and their timing varies: ferritin is usually rechecked 8–12 weeks after starting iron, TSH roughly 6–8 weeks after a change in the dose of a thyroid medicine. There is no point in testing earlier: the value simply does not have time to respond.

A normal result is still a useful result, not wasted money. It rules out deficiencies and endocrine causes and points the search towards hereditary thinning or a scarring process. From there the tools are trichoscopy over time, standardised photographs and, if needed, a scalp biopsy.

For patients from abroad, results are issued with the laboratory's units and reference intervals, so a doctor at home can read them. If needed, MediUkraine arranges a video review of the results with the doctor who examined you.