What can a private dermatologist do that my GP hasn't already done? (Hair loss)

[zippalippa]

I'm losing my hair at 39 and I want to know if it's worth paying a private dermatologist to pinpoint the cause? I originally started thinning on top about 4 years ago, at the time the GP did blood tests and just suggested multivitamins.

The thinning paused for a while and then very rapidly sped up this year. I am now the proud owner of a big bald patch and the remaining hair is very thin and brittle. I've been using Plantur caffeine shampoo and tonic for a couple of months with no effect (although I realise it can take longer to work).

For context I've had a horrible time over the last 9 months, I'm grieving the loss of an estranged family member and I have been severely affected by it. I did wonder if stress was the cause but to be honest I've suffered some awful life events prior to this with no impact on my hair.

Just heard back from the GP that all my bloods came back normal again but my iron levels are slightly on the low end of normal so I will try and be more diligent about taking my tablets (I'm a bit forgetful).

So my questions are:

1. What can a dermatologist do to determine the cause (apart from blood tests that the GP has already done)? Is it just their best educated guess or do they have further tests?

2. Would you start minixodil in my position? I'm concerned about committing to Rogaine for the rest of my life because what if my hair comes back naturally? It's a lot of effort with potential side effects and an ongoing expense. That's why I'm so keen to know the actual cause, but then on the other hand if I delay starting treatment then perhaps I won't ever get it back.

As you can tell I'm rather an indecisive person which has been made worse by this blow to my confidence!

TIA

I should add that I'm female. Sort of an important point when considering the causes of hair loss I guess!

Good iron levels are vital for hair growth and according to a dermatologist I spoke to should be around 70. GPs say 20 and above is fine so I would prioritise taking iron. Private dermatologists can give you steroid injections into your scalp to stimulate growth (doesn’t work for everyone but from memory maybe 60% benefit) but nhs derms will only prescribe oral steroids so the capacity for side effects is higher. This is info from a few years ago so that might have changed.

What was your ferritin level when your bloods were done? That’s the figure that needs to be 70+.

It was 29 so way off then! It's particularly difficult for me to maintain iron levels as I am a very picky eater and getting enough from plant sources is quite a hard job when my periods are so heavy. Iron tablets are very harsh on my gut. Maybe spatone is the best option but it made me nauseous when I used it for extended periods before.

So it looks possible that iron could be the cause, but that leaves me with the gamble of taking iron tablets and waiting it out for a few months. I guess I'm worried that waiting and trying stuff like that could lead to the death of more follicles and that it may not be possible to recover the full thickness the longer I leave it before trying minoxodil.

You want to see a trichologist don't you, rather than a dermo?

I suppose what I want a dermatologist to do is to definitely diagnose the cause and say right, this is the plan. Can they even know for sure though or do they work on a trial and error approach?

Yep, you want to see a trichologist. They look at the scalp too know.

Do you have any other peri menopause symptoms ?

My mum has (?) lichen something or other which destroys her hair follicles from the front first.

May be slightly different than yours as it's not thinning per se, but she's seen a hair specialist in London and prescribed malaria tablets. Has done the job but you need blood tests and eye tests so not a small step.

Iron tablets are very harsh on my gut.

There are a few different choices available on prescription. Doctors tend to stick with one. I've used ferrous gluconate most of my adult life with no issues, there's also ferrous sulphate which gives me heartburn and another one, the name of which escapes me. Prescribed is far and away a higher dosage, highest OTC I've seen is 20mg, my prescription is 300mg. I've never managed to raise my levels with OTC meds, even the MN favourite of Spatone. You do need to take iron alongside vit c for absorption.

Yes, I stopped tolerating my iron tablets after ten years (ferrous sulphate?) so I'm now on ferrous gluconate which is fine. I also take with Vitamin C and avoid drinking tea an hour before and after.

Ferrous Fumarate is the best for low ferritin. I could tolerate 1 a day.

Periods are starting to get a bit lighter and slightly less regular but nothing obvious. I did wonder if it was peri but they checked my hormones and said it was all normal so I presume it would have been apparent from the bloods?

There is a Better You iron spray now (I haven't tried it) but you might be able to tolerate that better

Their sprays are the only things that work for my low vitD/vitB12 so it might be worth a try

Has your GP mentioned alopecia? Dermatologists do treat it but the actual cause is unknown and treatments like steroid injections and elocon lotion work in some cases but not in others.

I’d say go off symptoms, not blood tests.

I have lichen planopilaris, and my hair loss is all on the top of my head and the front t tight up to my ears. I was referred to a dermatologist by my gp, and the dermatologist did a biopsy to diagnose. I also have lost most of my eyebrows, and all the hair on my arms and legs. Definitely ask for a referral to dermatology so you know exactly what is going on.

I have lichen planus, with head hair slightly thin and a motheaten hairline. My GP said it was hormones, took two years to refer me and I think lost an inch of hair that I won't get back. I take kelp daily as well as a multivitamin.

Regaine 5% treatment works on some women (and men). Minoxidil is the active ingredient.

And in answer to your op, I think it’s worth a try. If it doesn’t work after 3 months you can drop it. If it does, it’s up to you whether it’s worth the hassle to continue. The once-a-day formula isn’t too tricky.

There’s lot of expensive snake oil treatments out there, so if the GP has checked for vitamin deficiencies/medical causes, personally I’d start with minoxidil which at least has clinical evidence behind it.

Iron tablets:

There are a lot of options to make them more tolerable.

Firstly, if you were prescribed them 3x a day, don't take them so often! More modern evidence suggests we actually absorb more iron from one iron tablet taken every other day, than from 3 tablets a day

Secondly - and the above usually works - try a different iron tablet. There is sulfate, gluconate, fumerate. One of them will likely suit you better than the others.

I'd do all of the above before trying Spatone which basically doesn't upset you because there is barely any iron in it.

Lastly if you are 39 and your periods are becoming irregular, then it's peri and you don't need a hormone test or a medical degree to diagnose it. The NICE Guidance (and common sense) are clear on this.

Low iron can cause hair to fall out - I know from experience. If your iron has been low for a long time then more hair falling out.
I would get an iron transfusion - even privately. It takes a couple of weeks for my hair to stop falling out after I have one.

Yes he said it would be more patchy if it was alopecia though, he didn't think the pattern matched

So I've just had a bit of a eureka moment and remembered years ago I was prescribed iron tablets so I can only presume I must have been anemic at the time. It was during the sleepless phase of my first born so my memory is fuzzy about how it was discovered but it definitely didn't impact my hair growth at the time. Which leads me to believe that if my iron levels are higher now then it probably isn't linked to iron anyway? I will of course give it a try but I'm doubtful now.

Perimenopause is also a possibility has previous posters have suggested and I will research more about it.

I think I will probably see a specialist, I will look into trichologist Vs dermatologist as I'm not sure what's available locally to me.

Thank you for your input everyone, I really appreciate you all taking the time to help.

My mums hair loss was caused by thyroid issues. Despite blood tested it wasn't diagnosed for 7 years until she went private. The GP felt the levels were acceptable but medication has made a huge difference for hair, anxiety and feelings of well being