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  • Writer's pictureEscuela de alopecia

Doctor, what do I need before going to our first medical appointment?

Well, so you're thinking about your hair, and in the end, you've finally decided to see what you can do with it and how to improve it. Perhaps you've skipped the doubt of whether you need to bring any complementary study to a visit from someone who's going to look at your hair. Well, it dependson what type of alopecia you have. The problem is, obviously, that you have no idea what type of alopecia you have. That's why you're going to ask.

So in this post, I'm going to give you a practical little guide on what is advisable to bring. Although it might be a bit excessive if you bring it, it can help to be a bit more efficient in the appointment.

First, if you're a man, it's most likely that no additional studies are needed. But if you have to do your blood work, it's advisable to check your tomogram, how your white and red blood cells are, how your liver is functioning, hepatic profile (GPT, GGT, GOT), kidney profile, that is, how your kidneys are functioning. The liver is important concerning how pills are metabolized. And if you also have hair loss, not thinning, which is different but if you're experiencing hair loss, then vitamin D, zinc, folic acid, and vitamin B12 are useful. Anyway, concerning hair, probably the most important things will be ferritin, not iron, which is different. Ferritin is the iron inside cells, and TSH to see if there's any thyroid alteration. And if you're above 45, a PSA test would be advisable.

Next, if you're a woman, things get a bit more complicated. If you're a premenopausal woman, I must say that I'm quite interested in seeing your blood work, especially the analysis of sexual hormones. This means that, in addition to what is usually useful for men, such as a complete blood count, liver and kidney function, vitamin D, zinc, vitamin B12, folic acid, TSH, and ferritin, I'm interested in sexual hormones. The issue is that these hormones will be affected depending on whether you're taking other medication, mainly contraceptives, or if you're using any type of vaginal ring that contains progestogens. This will influence the results, so if you're not taking contraceptives, or at least haven't taken them for three months, the results are more accurate. The sexual hormones I'm really interested in to ensure you don't have an excess of male hormones, male function, meaning that your ovaries are functioning well, your adrenal glands are functioning properly, and concerning the hormones secreted in the brain, everything is fine. Because what matters to me is testosterone, androstenedione, estradiol, 17-hydroxyprogesterone, hydroxyprogesterone sulfate, prolactin, FSH, LH, maybe even SHBG. These are the fundamental ones. And something very important is that I would like to evaluate them in the follicular phase of your cycle. This means it's in the phase when you're menstruating, i.e., the phase when you're already spotting, it's the time to have the blood work done, especially between the second and fifth day, preferably before the eighth day. If your menstrual cycle is very chaotic, very random, and many times patients come saying, "Doctor, it can be whenever." Or it comes every three months. Well, do it whenever, and based on that, we'll assess it. There's no need to do it right at the end of the cycle because then we might not know.

And if you're a postmenopausal woman, it's true that I do care about sexual hormones, but I care much less than if you're a younger woman because here the influence they can have has been decreasing over the years. So, in addition to the basic blood work I mentioned earlier, which includes a complete blood count, biochemistry, ferritin, TSH, folic acid, vitamin B12, and I think I didn't miss any, yes, zinc and vitamin D, it might make sense to check testosterone, prolactin, and even, depending on the type of alopecia, calcium. Because you know, it's related to osteoporosis. And if you have any autoimmune alopecia, I might use corticosteroids, and I'm interested in seeing how your calcium levels are.

Lastly, for children, it depends a lot on the type of alopecia. So, obviously, if there's an autoimmune alopecia with alopecia areata, I do care about knowing how the patient is. It's a basic blood test, as I mentioned before, with TSH and ferritin. If I suspect it's a very early genetic hair loss, I'm interested in having some sexual hormone values, the same ones I mentioned for premenopausal women.

So, this is a brief summary. Usually, I don't usually need most of these blood tests for the treatment. In some cases, yes. That means if you think your alopecia might be justified or affected by the blood work, I recommend you have this blood test ready when you come to see me or whoever is going to examine your hair.

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