Five things worth knowing
- Photographs matter more than description. Same spot, same lighting, months apart. Progression is nearly impossible to judge from memory and very easy to judge from images.
- The timeline is the diagnosis. When it started, whether it was sudden or gradual, and what was happening three months before. Shedding lags its trigger by about that long.
- Bring the full medication list. Including anything stopped in the last year, and contraceptives. Several common medications affect hair.
- Ask specifically about miniaturisation. Whether hairs are getting finer distinguishes a pattern process from a shedding one, and it changes what is worth doing.
- Scalp symptoms are urgent. Itch, burning, tenderness or loss of visible pore openings suggest a scarring process, where the window to slow it is short.
What the appointment can settle
Whether the process is scarring or non-scarring — the single most important distinction, because it determines whether follicles can be saved. Whether bloods are worth doing. And whether what you have is progressive or self-limiting.
Common questions
Do I need a referral?
In Australia, a GP referral is generally needed for a rebate. The GP can also order useful bloods beforehand.
What should I not do before the appointment?
Do not dye or heavily style your hair immediately beforehand, and do not shave the area in question. Both make examination harder.
Will I get a diagnosis on the day?
Often. Sometimes bloods or a period of monitoring are needed, and occasionally a scalp biopsy.
Is a biopsy likely?
Only where a scarring process is suspected or the picture is unclear. It is a small procedure under local anaesthetic.
What if I am told nothing can be done?
Worth asking specifically whether that means the follicles are gone, or that no treatment is indicated. Those are very different answers.
What an assessment establishes
- 1.Which process is causing the loss
Pattern loss, telogen effluvium, traction and scarring alopecia look similar in a mirror and behave nothing alike. The examination separates them, because the answer decides which routes are worth discussing at all.
- 2.Whether it is stable or still moving
Loss that is still progressing changes what any treatment can hold. It is the difference between planning around a fixed area and planning around one that will keep widening, and it is judged from history and examination rather than a single photograph.
- 3.Which routes are available to you, and which are not
Donor supply, scalp condition, skin type and how the loss is behaving each rule options in or out. You leave knowing what is on the table and what is not, without a price attached to the conversation.