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Is a biopsy actually worth doing?

Discussion in 'Women's General Hair Loss Discussions' started by sunlit, Apr 4, 2016.

  1. sunlit

    sunlit Established Member

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    I saw a new dermatologist who wants to do a biopsy to find out the cause of my hair loss. He isn't sure if it's androgenetic alopecia or diffuse alopecia areata.

    It won't cost me anything because it's on the NHS, but it seems like a lot of pain and distress for something that might not actually benefit me.

    My hair loss is really general all over my head so it's difficult to say where would be good spots for them to take the holepunch from. There are literally zero unaffected, normal areas.
    Having said that, I'm pretty sure my hair loss is Androgenetic Alopecia - it started very suddenly at 20 and doesn't have the typical Androgenetic Alopecia pattern, BUT my mother has Androgenetic Alopecia so it makes sense I would have inherited it. I have terrible receding temples and my hairline is thinning badly as well as receding. If it is Androgenetic Alopecia, there's not really much that can be done about it (already on spironolactone and I won't use rogaine) so there doesn't seem much point.

    What are the chances of it being diffuse alopecia areata? If it is, what can actually be done about it treatment-wise?

    Are there any real benefits to having a biopsy done? Am I being needlessly cynical?
     
  2. hopeon

    hopeon Member

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    Hi sunlit. I am 19 years old so we are almost the same aged. Mine also started suddenly after a long period of stress n my blood work wasn't completely normal or very off as well. I had low haemoglobin low ferritin slightly high tsh n extremely low vit d. Anywaz the loss continued to the point that it became see through along the part n back so obviously I was told fphl/Androgenetic Alopecia. Fast forward the shed did stop n i recovered a lot of hair but it kept on falling off again like a cycle . Off course my back is thinner n density lowered at the sides.frankly at this point I dnt know what I have cuz my mom doesn't have it n I do see regrowth. Since urs were diffuse n very sudden I truely believe u could have more than one problem. Diffuse alopecia could be a reason even if u do have some Androgenetic Alopecia. When ur advised to take a biopsy u should surely do it n see for urself. Androgenetic Alopecia does not make u loose ur sides n nape within a year. It takes a long time to loose the entire top. U being so young n this progressing swiftly a scalp biopsy cannot be something to ignore.
     
  3. DisTressing

    DisTressing Established Member

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    No one can answer that question here. You need an expert's determination. Does the new derm have expertise in hair loss? If so, the biopsy should be worthwhile and help to dictate a treatment plan. I think any pain and suffering is minimal. I've not done one yet but will leave it up to an expert to say whether I should or not. I don't know if derms use a standard area to take the biopsy from, but it's best to have a hair specialist dictate where and how many punches - horizontal orientation with 3 punches is considered to be the most accurate. Seems worthwhile to me to get a definitive diagnosis.
     
  4. sunlit

    sunlit Established Member

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    Thanks for the advice.

    Is there really any treatment plan beyond minoxidil+Spironolactone though? I haven't heard of any.
     
  5. DisTressing

    DisTressing Established Member

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    Yes, there a variety of different oral medications that a derm might prescribe based on your case. Minoxidil is the only proven effective topical drug for hair loss on the scalp.
     
  6. Distraughtshedder

    Distraughtshedder Established Member

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    IMO .... It wasn't worth paying for. But if it won't cost you anything then why not? It's not that bad from what I have heard. I will say ... That no matter what the cause is .. It seems rogaine BC or Spironolactone are the first things recommended. For me .. Since I would have had to pay ...i saw no point ... Since they were just gonna tell me to try rogaine and treat my anemia. If had been free I probably would have done it. If the rogaine ever stops working I may have one done.
     
    Emily! likes this.
  7. rva207

    rva207 Established Member

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    I was glad I did it. The procedure itself didn't hurt. The anesthesia wearing off was worse. Having stitches poking out of the back of my head for 2 weeks wasn't ideal, but I have dark hair and I'm tall so I don't think anyone could tell. I believe people have posted that the biopsy revealed being that the end of their TE, which was reassuring, but I'm not sure how possible that actually is. You've been dealing with this for so long that it might be nice to have more information, if only to come to terms with whatever is truly the cause.
     
  8. fleur1979

    fleur1979 Experienced Member

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    I was also convinced I had Androgenetic Alopecia. Had three biobsies done in the four years of hair loss (going on my fifth year), and the conclusion is: chronic telogen effluvium. No signs of miniaturized Androgenetic Alopecia hairs. I also have lost most on my temples and hairline (which happens very often in CTE). So yes, I would do the biobsy, and have them check for : Alopecia Areata, Androgenetic Alopecia, and Telogen effluvium.
     
  9. labellavita1985

    labellavita1985 Experienced Member

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    I do think it's worth having a biopsy done, especially if it's covered for you. Biopsies are notoriously inaccurate, but at least they can give you an idea of what is going on, for example, anagen/telogen/catagen ratio, percentage of miniaturization, presence of inflammation and fibrosis, etc.

    It wasn't too painful at all for me, mostly just uncomfortable. I think it's a good idea to have 2-3 punches done. I only had 1 (self pay) and my results were inconclusive.

    Distraught is right though, as long as your diagnosis is not scarring alopecia, you will most likely be told to use Rogaine. It's the default recommended treatment it seems. May I ask why you won't use it? I'm just wondering.
     
  10. Lily

    Lily Senior Member

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    If I were your age I would do it. My hairloss started in perimenopause, obviously age-related hormonal Androgenetic Alopecia. If it is alopecia areata I know some people have had success with cortisone injections.
     
  11. Heron

    Heron Member

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    If the most effective treatment is different based on the findings, a biopsy is worth it. That's how I decide what kinds of diagnostic procedures to do.

    That said, mine was basically "we don't know, but if we had to make a call we say Androgenetic Alopecia slightly edges out other issues but make sure you look at the clinical picture." Of course my derm thinks this is affirming Androgenetic Alopecia. That's not how I read it, and in fact my hair has grown back a good amount. She attributes that to hairstyle. OK, whatever, the treatment isn't dependent on her believing me or me believing her.
     
  12. eggplant

    eggplant Established Member

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    If it's free, do it. It's another piece of data that could be useful going forward. And I say this as someone who is skeptical about the results of my scalp biopsy, because you've got nothing to lose and only potential information to gain.

    If it helps to put your mind at ease: when I had it done it was fast, with very little pain, and fast healing. They'll take it from a place that isn't too obvious as well.
     
  13. sunlit

    sunlit Established Member

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    Thank you. I'm worried about mine being noticeable, as my hair isn't dark and I'm short. Actually, to be honest, I don't care if other people notice - I'm worried about whether my boyfriend will notice. I (still) haven't told him about my hair loss. He only met me after it was in full swing, so he doesn't know me looking any different. I'm sure he's noticed my hair is thin, but noticing in passing "oh, she has thin hair" is very different from knowing that I'm losing it. So if he saw stitches in my head or something, it'd bring up questions that I just don't want to answer. I literally can't talk about my hair loss without crying.


    Thanks for your post. Three biopsies in four years - can I take it they weren't painful enough to put you off?! I'm glad to hear you have no sign of miniaturised hairs.
    My temples and hairline are fast disappearing, along with the hair above and behind my ears. The nape of my neck is getting eaten away too.

    I've read too much online about rogaine causing wrinkles and it isn't worth the risk to me, as I value my skin over my hair.

    Thanks for sharing your experiences - hearing it didn't hurt much is reassuring. I think I'm due to get two punches done, but in for a penny in for a pound, I might be able to ask them to do three.
    What was the healing like if you don't mind me asking?


    Hi Sarah, so sorry to hear you're going through another shed :( I'm really glad to hear you have regrowth though - that suggests this is all temporary and you're on the mend.

    My scalp doesn't itch at all but I get scalp pain sometimes, which neither derm I've seen has been able to explain. I haven't used anti-fungal shampoos in a while but found the same thing too, that they really dry out your hair. Is it any better if you alternate between that and normal shampoo, or use a lot of conditioner?
    Recently I've been using amla oil on my hair and it makes it SO soft. I just put some on the roots and ends an hour or two before I get in the shower and then wash it out with shampoo (it seems to wash out much more easily than other oils). It's really improved the look of my hair. Also, I've started using the L'oreal fibrology thickening shampoo/conditioner and it really does seem to lift the hair and help to hide the hair loss. I don't know if it would aggravate your scalp condition but it could be worth a shot.


    Thanks for reassuring me. I think I'm sold - I'll do the biopsy. I am worried that the anaesthetic will cause more shedding but at this point I guess I need to get some answers.
     
  14. sunlit

    sunlit Established Member

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    So I had the biopsy in April, and I won't get the results til the end of bloody August. What even is the point.
     
  15. sheeny

    sheeny Established Member

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    Omg really? What takes that long?! So sorry
     
  16. rva207

    rva207 Established Member

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    Is that because that's the next available appointment so they can give you results in person or does it really take that long? That's ridiculous.
     
  17. Emily!

    Emily! New Member

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    I think you're really fortunate that the Rogaine works for you. Sadly I used it for years to no avail. My derm told me he participated in a study about hairloss in women and that he could he immediately see from the pattern of my hair loss that mine was caused by Hereditary hair loss. I think it has a very distinct pattern and apparently mine looks classic so I didn't bother with the biopsy and this saved me the time and money on what would have been useless in my case. I was in the my 30's when I started to lose my hair and it's been a little better at times and little worse at other times. It's hard especially when I've been unable to find comfortable wigs and I've tried many. I gave up on the cure for hairloss. Now I want the cure for uncomfortable wigs. I hope some wig designers read these forums!!
     
  18. tula

    tula Member

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    This is basically what happened with my biopsy too. Especially since I have less hair than my mom after a hysterectomy and no one in my family has lost enough hair to see scalp. We all have fine hair, but mine is loss. My left temple is worse than the right, the hairline is what I first noticed and now it is very prevalent in the whole front, especially in the center where I have been thinner my whole life. My ferritin was only at 17 (Dr didn't seem to think that was a problem either) Plus all over thinning.
    I have some new growth in the front, but not enough to show any change. The new growth is not even miniature growth!! The hairs falling out aren't even miniaturized! When I tried to say that she said it didn't matter. Ugh. She is supposed to be a specialist too.
     
  19. Emily!

    Emily! New Member

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    I think that because there is no cure for hair loss they just write us off. I've never found anything that worked other than intense exercise 3 or more days a week and since I've been health issues I'm no longer doing it and I've lost a lot of what I had gained. I started wearing a wig and although it's not want I want it's better than the alternative. The endocrinolgist was of no hope to me either and brushed me off almost before I could get it out of my mouth. I didn't have the wig on so she prolly already knew what I wanted to say. I'm going to look for some edgy short wigs for summer and try to make peace with this and I hope you can find peace as well.
     

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