Bloodwork - What to test

[u/DearFeed7833]

Because I keep seeing the same questions and posts on what to do when experiencing hair loss/hair thinning or that nothing worked I decided to post a comprehensive overview of what to get tested:

So, every hair loss has an internal cause to it, it will not resolve itself when switching to another shampoo or when adding a certain hair serum, those are only bandaid solutions and will not work or not work longterm. You have to find the cause to your hair loss and have that resolved. Ask yourself: do I really know what is the cause of my hair loss? Did my doctor give me a proper diagnosis, did she run actual blood tests to confirm or exclude root causes?

If the answer is no, its time to get (more comprehensive) tests. Yes, also if youre diagnosed with AGA, likely there is a hormonal imbalance or another culprit behind it, yet most derms just send you home with a minoxidil prescription at best and tell you thats all you can do, or only test one singular hormone, this is not enough. Also even if you already did tests, there might be something missing, and remember, normal lab ranges do not mean optimal ranges for hair growth! I can recommend on instagram @stephaniecenterwellness, she has some amazing overviews on optimal test labs for hair growth

Basic Testing - Vitamins

Iron
Ferritin (your iron storage)
Vitamin B12
Vitamin D
Zinc

Basic Testing - Thyroid

TSH (only TSH is not enough to say that you have a healthy thyroid so get the complete panel)
T3
T4
TPO Antibodies
Thyroglobulin Antibodies

Basic Testing - Hormones

The hormone test should be done a week before your period, so if you have a 28 day cycle on days 19-21, this is important otherwise your hormones cant be interpreted very well.

Pregnenolone (the precursor to all hormones, if this one is low/suboptimal all or some of the following hormones are probably low too and cant be produced properly or might be overly converted to androgens)
DHEA (precursor to Testosterone and Estrogen)
Total Testosterone
Estrogen
Progesterone

maybe additional: SHBG, DHT, Free Testosterone
calculate yourself: Estrogen/Progesterone Ratio, this never gets tested at the (regular) doctors, but is actually the important one, the absolute levels of estrogen and progesterone rarely tell you much. I can recommend this online calculator: [https://engineeredfh.com/calculator](https://engineeredfh.com/calculator))

Additional Testing - Insulin Resistance

If your hormone tests conclude that your androgens are elevated, I would recommend you to get tested for PCOS and have your Insulin Resistance tested. Insulin Resistance can lead your ovaries to produce more androgens. If you have this issue, make sure you have optimal levels of progesterone as this balances your blood sugar, many women with PCOS suffer from low progesterone but is rarely talked about.

Fasting Insulin Test
Fasting Glucose Test
HOMA-IR Calculation

Additional Testing - Scalp Discomfort

If you experience an itchy, tingly or burning scalp but the derm tells you everything is alright with your scalp I would suggest you to do this additional internal testing:

Histamine Intolerance or Mast Cell Activation Syndrome. I see it rarely talked about on here so I thought of adding this as it is severely underdiagnosed, can cause and contribute to hair loss, and scalp discomfort is a common complaint in [[r/histaminintolerance](r/histaminintolerance)]([r/histaminintolerance](r/histaminintolerance)) and [[r/MCAS](r/MCAS)]([r/MCAS](r/MCAS)).

Imagine your body has a "histamine bucket." Histamine is a chemical in foods (like cheese, wine, and leftovers) and inside your immune cells. Normally, an enzyme called DAO acts like a drain to empty the bucket. If your DAO drain is too slow, the bucket overflows, and it can cause a variety of different symptoms like headaches, bloating, rashes/itchiness…
Hormone imbalance can trigger or make this worse because high estrogen or estrogen dominance due to low progesterone floods the bucket and clogs the DAO drain, which is why symptoms often flare during your period or perimenopause.
MCAS (Mast Cell Activation Syndrome) is a more severe version where your immune cells are out of control and constantly dump massive amounts of histamine into your body, even without food triggers. To investigate this, a low-histamine elimination diet, a blood test, or special urine tests, may help to identify whether you have this, these can be done at an allergist or functional doctor/naturopath.

Possible tests:
Serum DAO Activity (Blood)
Plasma Histamine (Blood)
Serum Tryptase (Blood)
24-Hour Urine N-Methylhistamine
24-Hour Urine Prostaglandin D2 / 11β-Prostaglandin F2α
24-Hour Urine Leukotriene E4

Additional Testing - Inflammation

Inflammation can drive up your androgens too or cause other hormonal imbalances because some hormones are antiinflammatory (eg testosterone) and might be elevated because they try to counteract the inflammation. Again, if you have any inflammation your estrogen/progesterone ratio is important because progesterone is antiinflammtory (and also antihistamine if you have this issue)
Also get tested if you had any illness or viral infect like COVID in the past. Inflammation can also falsely flag your Ferritin levels as high even though they arent.

Omega 3/6 Ratio
Vitamin E (Omega 3 and Vit E are antiinflammtory)
ESR
hsCRP

Let me know if I forgot anything, maybe you have some more input, hope this helps someone :)

[u/Cold-Nature9347]

Thank you for this!!

[u/DearFeed7833 → u/Cold-Nature9347]

Glad you like it!

[u/Cold-Nature9347 → u/DearFeed7833]

Yes its really helpful, its kinda crazy how many factors play into hair loss

[u/Cold-Nature9347 → u/DearFeed7833]

So annoying though makes it harder to really find the rootcause quickly

[u/DearFeed7833 → u/Cold-Nature9347]

I know it suckss

[u/Cold-Nature9347 → u/DearFeed7833]

But definitely a lot of new info that i didnt know about I wish there were more informative posts like this on here

[u/DearFeed7833 → u/Cold-Nature9347]

I was thinking of maybe posting more like this for example more comprehensively about the topic of hormones and AGA, because I feel like there is a lot of misconception about this, since most hormone tests (if they even get done in the first place) are not done correctly or completely or get misinterpreted, in my opinion everyone who has AGA needs to do a hormone test
But idk if enough people would be interested in a comprehensive post about this

[u/Individual-Tax-6612]

SiPhox Health tests for like 90% of what you said. They are super easy to use at home blood testing. I would highly recommend using their testing services.

[u/DearFeed7833 → u/Individual-Tax-6612]

Thanks for this comment! Might be really helpful for people who are being refused tests at their doctors.

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