Hair Loss Awareness Month: Why Getting the Root Cause Right Matters Most

As we begin Hair Loss Awareness Month, Alexandra Richmond, MD, founder and owner of Dermhaus in Charleston, South Carolina, emphasizes that hair loss should be approached as a symptom rather than a single diagnosis. Although hair loss can affect individuals of any age or sex, determining the underlying cause is essential to developing an appropriate, individualized treatment plan. A detailed history can help distinguish among potential causes and should include the pattern and duration of hair loss, associated symptoms, family history, medications, hormonal changes, recent stressors, nutritional status, supplements, and hair care practices.

“In reality, I think of hair loss more as a symptom and we need to come up with a treatment plan,” Richmond said. “But the first step in doing that is figuring out why we're losing the hair.”

Richmond cautions against the routine use of biotin supplements for hair loss. Biotin deficiency is uncommon, while high-dose supplementation can interfere with laboratory testing, including thyroid studies and troponin measurements. Because thyroid testing is commonly incorporated into the evaluation of hair loss, and older adults may also require accurate cardiac testing, she recommends avoiding unnecessary biotin supplementation.

The diagnostic approach also depends on whether hair loss is scarring or nonscarring. For nonscarring alopecia, identifying and treating the condition early may help restore hair growth by addressing nutritional deficiencies, inflammation, or other contributing factors. In scarring alopecia, hair follicles that have been permanently destroyed cannot be recovered, making early diagnosis and intervention particularly important for preserving remaining hair and limiting progression.

Richmond recommends using a consistent diagnostic protocol to ensure key considerations are not overlooked. Examination includes visual assessment of the scalp and hair, dermoscopy, and a hair pull test when appropriate. In some cases, a scalp biopsy is necessary, particularly when inflammation or scarring is suspected. Richmond typically samples the edge of an area of hair loss where some hair remains, allowing evaluation of the underlying follicular structures and inflammatory processes.

Once the diagnosis is established, treatment can be tailored to the patient's specific condition and circumstances. Age, sex, overall health, reproductive plans, and other individual factors may influence treatment selection. Richmond notes that the expanding number of therapeutic options has made it increasingly possible to personalize management. However, she stresses that having more treatments available does not replace the need for accurate diagnosis. Establishing the underlying cause of hair loss remains the critical first step toward selecting an effective treatment strategy and improving outcomes.

“It's an exciting time for hair loss because we do have options, so we can really personalize the plan. But I think the most important thing is making sure we have the right diagnosis so we're going down the right path,” she concluded.