Hair loss that does not follow typical male or female pattern baldness often has a hormonal cause that a dermatologist alone may not diagnose. An endocrinologist specializes in hormonal disorders and should be your next step when blood work reveals thyroid dysfunction, hormonal imbalances, or when hair loss accompanies other systemic symptoms.
This article is for informational purposes only and does not constitute medical advice. Consult a licensed physician for personalized diagnosis and treatment.
Dermatologist vs. Endocrinologist: Which Do You Need?
A dermatologist is the right first stop for most hair loss. They diagnose androgenetic alopecia (pattern baldness), prescribe finasteride and minoxidil, and manage straightforward cases. However, when hair loss does not fit a typical pattern, or when it occurs alongside fatigue, weight changes, or menstrual irregularities, an endocrinologist becomes essential.
Here is a quick decision framework:
| Symptom Profile | See a Dermatologist | See an Endocrinologist |
|---|---|---|
| Temple recession, vertex thinning | Yes | Not usually |
| Diffuse thinning across entire scalp | Yes (first) | Yes (if labs are abnormal) |
| Hair loss + fatigue + weight gain | Refer out | Yes |
| Hair loss + irregular periods (women) | Refer out | Yes |
| Hair loss + heat/cold intolerance | Refer out | Yes |
| Hair loss after stopping birth control | Optional | Yes |
| Normal blood work, typical pattern | Yes | Not needed |
The key distinction: dermatologists treat the scalp and follicles directly, while endocrinologists treat the hormonal systems that influence hair growth from within.
Hormonal Conditions That Cause Hair Loss
Several endocrine disorders directly trigger or accelerate hair loss. Understanding these helps you recognize when standard treatments like finasteride (80-90% effective at halting loss) or minoxidil (40-60% regrowth) may not be enough on their own.
Thyroid Disorders
Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) cause diffuse hair thinning. Unlike androgenetic alopecia, thyroid-related hair loss affects the entire scalp uniformly rather than concentrating at the temples and crown.
Key signs that suggest thyroid involvement:
- Hair loss spread evenly across the scalp, not just the hairline
- Brittle, dry hair texture that breaks easily
- Fatigue, unexplained weight changes, or temperature sensitivity
- Eyebrow thinning, especially the outer third
A simple TSH blood test can screen for thyroid dysfunction. If confirmed, thyroid hormone replacement often restores hair growth within 6 to 12 months.
PCOS (Polycystic Ovary Syndrome)
PCOS is the most common hormonal cause of hair loss in women of reproductive age. Elevated androgens (male hormones) trigger female pattern hair loss, often concentrated at the crown and part line.
PCOS-related hair loss typically appears alongside:
- Irregular or absent menstrual cycles
- Acne, especially along the jawline
- Excess facial or body hair (hirsutism)
- Weight gain concentrated around the midsection
An endocrinologist can test for elevated testosterone, DHEA-S, and insulin resistance, all of which contribute to PCOS-driven hair loss.
Adrenal Disorders
The adrenal glands produce DHEA and cortisol, both of which affect hair growth. Cushing's syndrome (excess cortisol) and adrenal insufficiency can both cause hair thinning. Chronic stress elevates cortisol levels even without a formal adrenal disorder, and sustained high cortisol shifts more hair follicles into the telogen (resting) phase.
Insulin Resistance
Insulin resistance, even without a diabetes diagnosis, can accelerate androgenetic alopecia. Elevated insulin increases free testosterone and DHT production, worsening hair loss. An endocrinologist can test fasting insulin and glucose levels to identify this contributor.
What to Expect at an Endocrinology Appointment
An endocrinologist will typically order comprehensive blood work including:
- Thyroid panel: TSH, free T3, free T4
- Androgen levels: total and free testosterone, DHEA-S
- Metabolic markers: fasting insulin, fasting glucose, HbA1c
- Iron studies: ferritin, serum iron, TIBC
- Other hormones: prolactin, cortisol, estradiol (women)
Bring your myhairline.ai density tracking data to your appointment. Objective density measurements help your endocrinologist correlate hormonal lab values with actual hair changes over time. This is especially valuable because hormonal treatments may take 3 to 6 months to show results in hair density.
How to Track Hormonal Hair Loss Treatment
Hormonal hair loss treatments work differently than standard pattern baldness medications. While finasteride and minoxidil target follicles directly, hormonal treatments address the root cause systemically. Response timelines vary:
| Hormonal Treatment | Expected Hair Response | Timeline |
|---|---|---|
| Thyroid hormone replacement | Regrowth once levels normalize | 6 to 12 months |
| Spironolactone (anti-androgen) | Reduced shedding, some regrowth | 6 to 12 months |
| Metformin (insulin resistance) | Slowed loss, potential regrowth | 6 to 9 months |
| Birth control (PCOS) | Stabilized shedding | 3 to 6 months |
| Cortisol management | Reduced telogen effluvium | 3 to 6 months |
Monthly AI density scans with myhairline.ai create an objective timeline your endocrinologist can review alongside your lab results. This paired approach, combining lab data with density tracking, gives the clearest picture of whether treatment is working.
When to Combine Endocrinology with Dermatology
Many patients benefit from seeing both specialists. Your endocrinologist addresses the hormonal root cause while your dermatologist manages direct scalp treatments. For example, a woman with PCOS might take spironolactone (prescribed by the endocrinologist) alongside topical minoxidil (prescribed by the dermatologist).
For patients whose hormonal issues are resolved but pattern loss has already progressed, surgical options become relevant. FUE procedures achieve 90-95% graft survival with 7 to 10 days of recovery. Graft requirements vary by Norwood stage: Norwood 2 needs 800 to 1,500 grafts, while Norwood 5 requires 3,000 to 4,500 grafts.
Learn more about the Norwood scale complete guide and how AI hair loss analysis provides objective tracking data.
Frequently Asked Questions
What is the current state of hair transplant technology?
Hair transplant technology in 2026 centers on FUE (Follicular Unit Extraction), which achieves 90-95% graft survival rates with 7 to 10 days of recovery. DHI (Direct Hair Implantation) using the Choi pen is growing in popularity for its precision. AI-powered planning tools now help surgeons optimize graft placement for natural-looking results.
How does AI improve hair loss diagnosis?
AI tools like myhairline.ai analyze photos to estimate Norwood stage, measure density changes over time, and track treatment response with objective data. This gives both patients and doctors a consistent baseline rather than relying on subjective visual assessment alone.
What should I know before choosing a hair transplant clinic?
Look for board-certified surgeons with specific hair restoration training, check before-and-after photos of patients at your Norwood stage, verify the clinic's graft survival rate claims, and understand total costs including follow-up care. FUE costs $4 to $6 per graft in the US, $1 to $2 in Turkey, and $3 to $5 in the UK.
Not sure if your hair loss is hormonal or pattern-based? Get a free AI hairline analysis at myhairline.ai/analyze to assess your current Norwood stage and density, then share the results with your doctor to guide the next step.