Trichologist or dermatologist: who to see, and when

It gets asked as though it were a choice between two competing options, and it isn't. They do different things, and for a lot of people the honest answer is both, in a particular order.

The short version

A dermatologist is a medical doctor who specialises in skin, hair and nails. They can diagnose disease, prescribe medication, and take a scalp biopsy. If there is a medical condition affecting your hair, they are the person who can name it and treat it.

A trichologist is a certified specialist in hair and scalp health who is not a doctor. A trichologist takes a long history, assesses hair and scalp in detail, helps you understand what may be happening and what to do about it, and refers when something needs medical attention. What a trichologist mostly has, that a fifteen-minute appointment does not, is time.

Your GP sits alongside both: the right person for blood work, for ruling out systemic causes, and for the referral into dermatology.

See a doctor first if

• Hair has come out in patches.
• The scalp is painful, burning, sore, or has sores, crusting or pus.
• The skin where hair has been lost looks smooth, shiny or scarred. Scarring hair loss needs assessing early, because the window in which anything can be done is limited.
• Loss is rapid, or accompanied by fatigue, weight change, fever or joint pain.
• You are losing hair from other parts of your body.
• The person losing hair is a child.

None of these are reasons not to see a trichologist. They are reasons to see a doctor first, or at the same time. If you come to me with any of them, that is what I will tell you, and I would rather tell you before you have paid than after.

A trichologist may be the more useful first step if

• You have been told your bloods are normal and given no further explanation.
• You have a diagnosis but no sense of what it means for you in practice.
• You have gradual thinning without any change to the scalp.
• You have tried several products and don't know what you were treating.
• You need someone to spend an hour on it rather than ten minutes.
• You want help preparing for a medical appointment. Knowing what to ask makes a short appointment far more productive.

What a trichologist cannot do

This is worth being blunt about. A trichologist cannot diagnose a medical condition, cannot prescribe, cannot biopsy, and cannot interpret your blood results the way a doctor can. Anyone presenting themselves otherwise is overreaching, and in a largely unregulated field that is worth watching for.

It is also worth asking any trichologist you are considering: what are you certified by, and what do you do when something is outside your scope? The answer to the second question tells you most of what you need to know.

The order that usually works

1. GP first for blood work if you have not had any: iron studies including ferritin, thyroid function, full blood count.
2. Dermatology if there is anything on that red-flag list, or if the picture is unclear.
3. Trichology for context, understanding, scalp and hair care, and for the long conversation that neither of the first two has room for.

That order is not fixed, and plenty of people arrive at it the other way round. What matters is that nobody in the sequence is pretending to be another part of it.