Punch Biopsy to Help Determine Cause of Female Hair Loss?

23 y/o female
All over hair loss for about 1 year.

I saw a dermatologist about a year ago, who did nothing but refer me to Rogaine. I am seeing a new doctor who suggested some hormone tests (all blood results came back normal last year) for FSH and a male hormone (she did not specify which). She then said “there is likely nothing we can do, but at least we’ll know the cause”. I am quite nervous about this, as I don’t wish to go through all the testing if there is nothing that can be done, and also because I have heard that with a punch biopsy hair must be shaved and hair will not regrow. She wants to do 2. Is it worth having this done? I am already losing enough hair and certainly do not want to voluntarily get rid of more…

Hair loss in women is a difficult problem, because most of the time there is no medical cure. Even if you correct the “curable” causes of hair loss, such as low iron levels or thyroid problems, it does NOT necessarily mean your hair will grow back. I suspect this is due to genetic causes, but women’s hair loss is different from men’s hair loss. Medications such as Propecia are not approved by the FDA (even if it were approved it may not work). Hair transplantation for women is also limited, because women’s’ hair loss is generally diffuse and there is no good “donor” hair area as there is in men.

Thus, often times doctors are left when a desperate female patient coming to them with hair loss and it is often times our reflex to order blood tests and biopsies to find the “problem”. Some conditions do show up on a biopsy, some of them are expressions of genetic female balding, and sometimes autoimmune type diseases like diffuse alopecia areata. Unless your hair loss is due to major medical problems, there are very few medical options available to you and Rogaine (minoxidil) is generally the main modality of treatment. When used as directed, the Rogaine works well in a small majority of women, and mildly in a larger proportion of women. Some doctors may offer a variety of steroid shots or other hormone altering regimen, but none of these methods have been universally accepted to work. The use of spironolactone injections have been discussed on this site before.

If you are losing hair and you need to know why, you can consider a punch biopsy. This is a question you need to address with your doctor, of course, as you weigh the risks versus the benefits. Your doctor should be able to tell you why there is a need for the biopsy and what he/she is expecting to see.