What is a trichologist and how do they compare to a dermatologist for hair loss treatment?

Table of Content:
Trichologist vs dermatologist | When to see each? | Can trichologists prescribe? | How to get a hair loss prescription? | What hair loss medications can I get? | Trichologist education | Dermatologist education | What do trichologists do for hair loss? | What do dermatologists do for hair loss?

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What is a trichologist?

A trichologist is a person (without a medical background) who has taken a certification course in trichology, the scientific study of hair and scalp conditions.  Trichologists are not medical doctors, and the training to become a trichologist along with accreditation of the programs that provide that training is often unclear.  Trichology certification is not uniform, and can be obtained over a few months or multiple years.  Trichologists obtaining certification often need no pre-qualifications, and their backgrounds may be wide ranging from hairstylist to healthcare worker.  There is also no overarching regulation of trichology certification, meaning there is no standard criteria that needs to be met to ensure those marketing themselves at trichologists have an acceptable baseline level of proficiency.  However, those marketing themselves as trichologists, especially if holding a certification, have demonstrated a particular interest in helping people with scalp and hair issues, and may be able to help in some cases.  

Trichologist vs dermatologist: What is the difference?

Dr. Ryan Trowbridge, board-certified dermatologist, says that a trichologist is very different from a dermatologist. “I view trichologists as individuals who have demonstrated a strong interest in helping people with scalp or hair problems.  However, the qualifications to become a trichologist and the variability in the training required to get a certificate make it very hard to know what type of knowledge and experience is had by the trichologist you are seeing.”

To become a trichologist, you need to have taken a certification course, of which there are many, in trichology, the science of the hair and scalp.  To take a certification class in trichology you don’t necessarily need to have any pre-qualifications. You may be a hairstylist, barber, cosmetologist, medical assistant, or any one else with interest in the hair and scalp.  They are not healthcare professionals, but can give advice on which over-the-counter hair and scalp products to use, as well as overall health and well-being advice that could help contribute to a healthier scalp and hair. 

On the other hand, Dr. Trowbridge says that a dermatologist is a medical doctor who specializes in the diagnosis and treatment of skin, hair, and nail disorders. They are trained to handle a wide range of medical conditions, including hair loss (alopecia), scalp disorders, and other related issues. Dermatologists can prescribe medications, perform procedures, and diagnose and treat all skin or scalp problems. This is a major difference in the options a dermatologist can offer you over a trichologist.  But the difference is not just what we can provide, it’s also the level of training.  Dermatologists are highly trained health professionals who have been able to get accepted to and complete highly competitive training programs, and who have met strict criteria by state medical boards on what is necessary and sufficient to provide patient care”. Some dermatologists focus specifically on hair loss and scalp disorders, making them specialists in this area. 

Dermatologists can be considered trichologists in a medical context, but trichologists are not dermatologists because they lack medical training and the ability to prescribe medication or perform medical procedures.

Dr. Trowbridge says that a certification in trichology demonstrates that the individual had a strong enough interest in the hair and scalp to spend the time and money to get certified.  They may be educated on a broader scope of options for hair loss and scalp health, specifically when it comes to over the counter and cosmetic (non-prescription) treatments.

However, dermatologists will be able to provide most of what a trichologist could help you with and also have the expertise to prescribe medical treatments and perform procedures like biopsies and injections if necessary.

When to see a trichologist and when to see a dermatologist?

Dr. Trowbridge says, “The most important thing is finding someone who cares about you and wants to solve your problem, not sell you on products.  I am sure there are some great trichologists out there, and I am also sure there are dermatologists who provide what I would consider substandard care.  The best scenario is to find a dermatologist who has a particular interest in alopecia and is willing to spend the time and effort to educate you honestly about it and come up with a treatment plan that has reasonable expectations.  However, many dermatologists chose not to spend much time dedicated to these patients, and you may find trichologists provide you more dedicated time and offer you what appears to be more abundant resources”. 

Dr. Trowbridge says that there are very few products available, especially over the counter, that can have significant impact on scalp and hair health. But if you want an individual who can help you navigate the myriad products marketed for your hair and scalp, primarily to address cosmetic concerns related to hair texture, dryness, and appearance, a trichologist should be able to help.  However, he says that most of the products do not accomplish what they claim, and are primarily marketing efforts to get you to spend money.”

When to see a trichologist?	When to see a dermatologist?
A trichologist is suitable for non-medical hair and scalp concerns, especially when you’re looking for advice on hair care or non-invasive treatments.	A dermatologist should be consulted when the diagnosis is uncertain, or there are more serious or medical causes of hair loss and scalp disorders.
Mild hair thinning or hair loss: If you’re dealing with gradual hair thinning, hair breakage, or general hair loss that is subtle and doesn’t seem tied to a medical condition, a trichologist can assess your scalp, recommend treatments, and provide advice on lifestyle and hair care products.	Sudden or severe hair loss, or mild thinning if seeking medical treatment: If you notice significant hair loss in a short period (for example patches of baldness or clumps of hair falling out). Or if you have mild hair loss but want prescription-strength treatments. Moderate to severe hair loss caused by hormonal imbalances or due to medical treatments (like chemotherapy), should be evaluated by a dermatologist, who can prescribe medications such as minoxidil or finasteride, when appropiate.
Mild scalp conditions: For issues like dandruff, mild scalp irritation, or an itchy scalp that isn’t causing open sores or infections, a trichologist may offer scalp treatments such as exfoliation, detoxification, and deep conditioning that some people find effective. Generally, scientifically rigorous evidence is not available for the effectiveness of these treatments.	Scalp infections, or mild scalp conditions not responding to over the counter treatments: If you have painful, inflamed, or pus-filled lesions on your scalp, or experience symptoms like fever or swollen lymph nodes, you should see a dermatologist. They can diagnose infections and prescribe medications.  However, even mild persistent dandruff is well-managed by dermatologists who have multiple treatment options.
Hair care regimen and advice: If you’re unsure about the right hair care routine or products for your hair type, or if you want to improve scalp health, a trichologist can provide personalized recommendations.	Skin conditions affecting the scalp: Conditions like psoriasis, eczema, or seborrheic dermatitis, which can cause redness, scaling, and itching, often require prescription treatments. A dermatologist can provide both topical and systemic medications.
Cosmetic treatments: For non-medical treatments like low-level laser therapy (LLLT), scalp massages, a trichologist is a valid option.  Microneedling, if the proper precautions are taken, may also be obtained with a trichologist.	Medical procedures: If you need prescription-strength treatments, such as injections of corticosteroids, or medical procedures like hair transplants or PRP (Platelet-Rich Plasma) therapy, you should consult a dermatologist or other health care professional trained to do these procedures.

Finasteride

Finasteride is medication approved by the FDA for the treatment of male pattern baldness. It inhibits the action of the enzyme 5-alpha-reductase, which reduces the conversion of testosterone to dihydrotestosterone (DHT), a hormone directly linked to hair loss.

Minoxidil

Minoxidil is an oral prescription medication used off-label in the treatment of hair loss. It can be used by both men and women. 

Dutasteride

While finasteride and dutasteride are similar, dutasteride is slightly more potent since it blocks more of the conversion of testosterone to dihydrotestosterone (DHT). However, dutasteride is only used as an off-label treatment for hair loss.

Spironolactone

Spironolactone is an oral prescription medication used off-label for the treatment of hair loss and acne related to hormonal causes in women.

More about the differences between dermatologists and trichologists

What is the education of a trichologist?

To become a trichologist in the United States, individuals must complete a trichology certification program, which does not consist of a medical degree and typically takes 12 weeks to 2 years to complete. 

Some trichology programs, such as those offered by the American Association of Hair Restoration Surgery (AAHSD), require applicants to be a licensed cosmetologist or barber before enrolling. This ensures foundational knowledge of hair care and scalp health. 

There are several organizations that offer trichology certifications such as the World Trichology Society (WTS)¹, the International Association of Trichologists (IAT)² and the American Academy of Hair and Scalp Diseases (AAHSD)³ and the US Trichology Institute (USTI)⁴. 

These programs cover topics such as hair and scalp biology, disorders, and treatments. Most of these programs also require practical experience, often gained through internships or mentorships, before applicants are able to complete their certification exams.

With most trichology programs, continuing education is usually required to maintain certification and stay updated on advances in trichology.

What is the education of a dermatologist?

To become a dermatologist in the United States, individuals must complete extensive medical education and training that usually takes about 12 years.  This begins with earning a four-year bachelor’s degree, typically focused on pre-medical studies or biological sciences. Afterward, students must take the MCAT and apply to medical school, either to earn a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Medical school lasts four years, split between classroom learning and clinical rotations. During this time, students must pass national board exams like the USMLE or COMLEX.

After medical school, graduates complete a one-year internship followed by a highly competitive three-year dermatology residency, where they gain specialized training in dermatologic medicine, surgery, and research, under scrutinizing supervision by other board certified dermatologists. Upon finishing residency, dermatologists can pursue board certification through organizations like the American Board of Dermatology. Some may opt for additional fellowship training in subspecialties like dermatologic surgery or pediatric dermatology, though this is not required for practice⁵.

What do trichologists do for hair loss?

Trichologists specialize in the science of hair and scalp health, performing non-medical hair care procedures to address hair loss, thinning, and scalp disorders. Their treatments are designed to assess and improve scalp health, promote hair growth, and manage conditions through non-invasive methods. Here are some common procedures and treatments offered by trichologists:

• Microscopic hair examination: Trichologists use magnification devices to closely analyze hair shafts and scalp conditions, helping to identify issues like thinning hair, breakage, and scalp disorders such as dandruff or seborrheic dermatitis. This in-depth analysis provides a clearer picture of the hair’s condition.
• Trichograms: A hair root analysis that evaluates the growth and shedding phases of hair follicles, offering insight into the underlying causes of hair loss, such as telogen effluvium or androgenetic alopecia.
• Scalp treatments: Scalp massages, exfoliation, and cleansing treatments are used to promote a healthy scalp environment, which is crucial for hair growth. These treatments improve circulation, remove dead skin cells, and clear clogged follicles.
• Topical solutions: Trichologists apply specialized products such as oils, serums, and scalp masks to nourish the scalp and stimulate hair follicles. These treatments may include herbal extracts or medical-grade products designed to improve hair density and health, however these products are generally not rigorously studied for their safety and efficacy.
• Low-Level Laser Therapy (LLLT): Some trichologists use low-level laser devices to stimulate hair growth by improving blood flow to the scalp. This non-invasive procedure can be beneficial for people experiencing early stages of hair thinning.
• Microneedling: This involves the use of fine needles to create micro-injuries on the scalp, promoting collagen production and increasing blood circulation, which may aid in hair regrowth. Microneedling is often combined with topical treatments for enhanced effectiveness.
• Scalp detoxification: Detox treatments aim to cleanse the scalp of excess oil, dirt, and product build-up, which can block hair follicles and lead to unhealthy scalp conditions. This treatment creates a clean base for healthier hair growth.
• Deep conditioning treatments: Hydrating or protein-based treatments are applied to nourish dry, damaged hair. These treatments also improve scalp health, restore moisture, and repair the structure of brittle or weakened hair.
• Nutritional and lifestyle counseling: Trichologists often provide guidance on improving diet and lifestyle habits to support hair health. They may recommend supplements like biotin, iron, or zinc, as well as changes in hair care routines to prevent further damage.
• Hair care regimen development: Trichologists can create personalized hair care plans based on an individual’s specific hair and scalp condition, recommending products and treatments tailored to their needs.

What do dermatologists do for hair loss?

Dermatologists are medical doctors specializing in diagnosing and treating skin, hair, and scalp disorders, including hair loss and scalp conditions. Their approach is rooted in both medical and cosmetic treatments, offering comprehensive care for underlying causes of hair loss and scalp problems. Here are some common procedures and treatments offered by dermatologists:

• Medical diagnosis: Dermatologists can diagnose and treat conditions like alopecia areata, androgenetic alopecia, telogen effluvium, or scalp infections. Many dermatologists can perform microscopic hair examination and trichograms, but they frequently not necessary for optimal diagnosis and treatment.  
• Prescription medications: Dermatologists can prescribe medications to treat hair loss, such as minoxidil (topical) or finasteride (oral) for androgenetic alopecia. They may also prescribe oral corticosteroids, antifungal medications, or other drugs to address underlying scalp conditions like seborrheic dermatitis, fungal infections, or inflammatory scalp disorders.
• Topical treatments and prescription shampoos: Dermatologists may recommend medicated shampoos or topical treatments, such as those containing ketoconazole, salicylic acid, or tar to treat conditions like dandruff, psoriasis, or seborrheic dermatitis, which can affect hair growth.
• Monitoring and follow-up of chronic conditions: Dermatologists often provide ongoing monitoring for chronic hair and scalp conditions, adjusting treatment plans as necessary to ensure effectiveness and reduce side effects.
• Injectable treatments: For conditions like alopecia areata, dermatologists may offer injectable treatments such as corticosteroid injections into the scalp to reduce inflammation and promote hair regrowth in targeted areas of hair loss.
• Procedures: microneedling, scalp detoxification, and deep conditioning are treatments for hair loss that have mixed data supporting their efficacy. Because of the evidenced-based nature of medical training, most dermatologists chose not to provide these treatments, but some may offer them as part of a more comprehensive plan.
• Nutritional and lifestyle counseling: most dermatologists are aware that there are not simple dietary and lifestyle changes that lead to improved scalp and hair health, but we are learning more and more every year about how leading a healthy lifestyle and making appropriate nutritional choices can contribute to overall health including hair and scalp health.  Many dermatologists are beginning to counsel on these factors as well. 
• Platelet-Rich Plasma (PRP) Therapy: PRP involves taking a small sample of the patient’s blood, processing it to concentrate the platelets, and injecting it into the scalp. This treatment aims to stimulate hair growth by improving blood circulation and the supply of growth factors to hair follicles.
• Hair transplant surgery: Dermatologists specializing in surgical treatments can perform hair transplants, a permanent solution for hair loss where hair follicles from one part of the scalp are transplanted to areas of thinning or balding.

Do I need to find a trichologist near me to get hair advice?

Yes, if you want non-medical hair advice you should find a trichologist in your area as they typically cannot offer virtual consultations as they need to see your hair and scalp up close.

Do I need to consult a dermatologist in person too for hair or skin problems?

It depends. There are many common skin problems that dermatologists can diagnose and treat via photo-consultations. Since hair and scalp are quite visible via photos, these together with the answers of a clinical questionnaire will help you online dermatologist get all the information they need to diagnose and treat you. 

Article References:
https://world-trichology.com/
https://www.iattrichology.com/
https://aahsd.com/
https://www.ustrichology.org/
https://www.umhs-sk.org/blog/how-to-become-a-dermatologist