Hair loss

Hair loss can have many causes, ranging from normal hair shedding and a temporary response after illness to inherited hair thinning, autoimmune disease, or inflammation of the scalp. In some cases, hair recovers on its own. In others, timely diagnosis is important to slow progression and protect the hair follicles that remain.

The key is not to count every shed hair. Pay attention to whether hair loss began suddenly, persists, changes hair density, causes bald patches, or is accompanied by scalp pain, redness, scaling, or signs of scarring.

In brief: the key points about hair loss

• A small amount of daily hair shedding is a normal part of the hair growth cycle.
• Increased hair shedding is not a single diagnosis and may have several different causes.
• Hair shedding, gradual thinning, and hair breakage are not the same.
• Hair loss may be diffuse, patchy, or follow a particular pattern.
• Not everyone needs the same blood tests or the same treatment.
• Shampoos, vitamins, and procedures are not universal solutions.
• Sudden, patchy, painful, or scarring hair loss should be assessed by a dermatologist.
• Whether hair will regrow depends on the cause and the condition of the hair follicles.

Increased hair shedding: normal or a problem?

Hair grows in cycles. Each hair follicle passes through an active growth phase called anagen, a short transition phase called catagen, and a resting phase called telogen. The hair then detaches and sheds, and a new hair may begin to grow from the follicle.

Because not all hairs are in the same phase at the same time, a small amount of hair is shed every day. An often-cited guide is approximately 50–100 hairs a day, but this number is not a diagnostic test. The amount of hair that is visible depends on hair density and length, washing frequency, brushing, and the individual growth cycle.

It is more useful to notice changes compared with what is normal for you. Possible signs of a problem include:

• considerably more hair in the shower, on a brush, or on the pillow;
• a smaller ponytail circumference;
• a widening parting;
• a receding hairline;
• more visible scalp;
• distinct bald patches;
• many short or broken hairs;
• loss of eyebrow, eyelash, beard, or body hair;
• scalp pain, burning, redness, pustules, crusting, or marked scaling.

What can the pattern of hair loss indicate?

The appearance of hair loss is not a diagnosis by itself, but it can help determine what type of assessment may be needed.

A person may have more than one cause of hair loss at the same time. For example, temporary telogen effluvium may make previously developing androgenetic alopecia more noticeable.

Hair shedding, thinning, or breakage: what is the difference?

Increased hair shedding means that more hairs than usual detach from the follicles at the same time. This may occur, for example, in telogen effluvium.

Hair thinning can develop without a dramatic increase in shed hairs. In androgenetic alopecia, the follicles gradually produce shorter and finer hairs, reducing overall hair density.

Hair breakage results from damage to the hair shaft. Broken hairs are often different lengths. Bleaching, chemical straightening, perming, excessive heat, aggressive brushing, and certain inherited or acquired hair-shaft disorders may contribute.

Alopecia is the medical term for hair loss. It does not refer to one disease, but to a group of different conditions. Read more about the types of alopecia in the Medart article Alopecia.

Common causes of hair loss

Telogen effluvium

Telogen effluvium is a diffuse and usually non-scarring form of hair shedding. It occurs when an unusually large number of follicles enter the resting phase at the same time after physical or emotional stress on the body.

Possible triggers include:

• an illness with a high temperature;
• surgery or major trauma;
• severe or prolonged stress;
• rapid weight loss or a restrictive diet;
• insufficient protein or certain nutrients;
• iron deficiency;
• thyroid disorders;
• certain medicines;
• other major changes affecting the body.

Shedding usually becomes noticeable several months after the triggering event rather than immediately. It is therefore important to discuss the preceding months during a consultation, not only the most recent days.

Hair often recovers gradually after the trigger has been corrected. Regrowth is not immediate, however, and in some people shedding may persist or no clear trigger can be identified.

Telogen effluvium may also become chronic when it continues for more than six months, or it may recur in several episodes. In these cases, possible triggers should be assessed and other forms of hair loss, including androgenetic alopecia, should be excluded.

Androgenetic alopecia

Androgenetic alopecia is a common form of hair thinning influenced by genetics and hormones. Hair follicles that are sensitive to androgen activity gradually become smaller and produce shorter, finer hairs.

The process usually develops gradually. A person may not notice pronounced shedding, but over time the hairline may recede, the parting may widen, or the scalp may become more visible.

Androgenetic alopecia does not necessarily mean that blood hormone levels are elevated. Genetically determined follicle sensitivity is also important. Early diagnosis may help preserve existing hair and slow further thinning.

Alopecia areata

Alopecia areata is an autoimmune condition in which the immune system disrupts the function of hair follicles. It most commonly appears as one or more smooth, round or oval bald patches.

Hair loss may also affect the beard, eyebrows, eyelashes, or other parts of the body. The follicles are usually not destroyed by scarring, so regrowth is possible. However, the course varies from person to person and the condition may recur.

Scarring alopecia

In scarring alopecia, inflammation damages and may permanently destroy hair follicles. Hair usually does not regrow in areas that have already scarred. The main aim of treatment is therefore to control inflammation early and protect the follicles that remain.

Possible signs of a scarring process include:

• pain, burning, or marked tenderness;
• redness or scaling around hair follicles;
• pustules and crusting;
• smooth or shiny skin;
• loss of visible follicular openings;
• progressive hair loss in a particular area.

These signs should not be treated for long periods with cosmetic products alone.

Anagen effluvium

Anagen effluvium occurs when the production of actively growing hairs is abruptly disrupted. It may be associated with chemotherapy, other toxic exposure, or certain diseases. Hair loss usually begins more rapidly than in telogen effluvium.

The likelihood of regrowth depends on the cause and on whether the follicles have been permanently damaged.

Traction alopecia

Traction alopecia is caused by repeated and prolonged pulling on the hair. Very tight ponytails, buns, braids, hair extensions, and other hairstyles that place constant tension on the follicles may contribute.

Hair may regrow if traction is stopped at an early stage. Prolonged damage can cause scarring and permanent hair loss. If a hairstyle causes pain, a pulling sensation, or small bumps along the hairline, it is too tight.

Scalp infection and inflammation

A fungal scalp infection can cause scaly, red areas, broken hairs, and bald patches. It is particularly important in children. An inflammatory infection may be painful and carry a risk of scarring, so medical treatment is needed.

Psoriasis, seborrhoeic dermatitis, and other inflammatory scalp conditions may also contribute to breakage or shedding, especially when the skin is scratched intensely.

Hair pulling and hair-shaft damage

Trichotillomania is a condition in which a person repeatedly pulls out their hair. Irregularly shaped areas with broken hairs of different lengths are typical. It is not simply “bad behaviour”. Both dermatological and psychological or psychiatric support may be needed.

Hair shafts may also be damaged by aggressive bleaching, chemical straightening, heated styling tools, mechanical friction, and unsuitable hair care.

Diseases, medicines, and nutrient deficiencies

Hair growth may be affected by thyroid disease, iron deficiency, inadequate nutrition, severe acute or chronic illness, and certain medicines.

This does not mean that everyone with hair loss has a vitamin or hormone disorder. Tests are selected according to the medical history, symptoms, and examination findings.

If a medicine is suspected of causing hair loss, it should not be stopped without medical advice. Speak to the clinician who prescribed it.

Hair loss in women

When assessing hair loss in women, pregnancy, the postpartum period, menstrual changes, menopause, polycystic ovary syndrome, and other hormonal or reproductive factors may be relevant. The possibility of pregnancy and breastfeeding must also be considered when selecting treatment.

Causes that are specific or particularly relevant to women, appropriate investigations, and treatment limitations are discussed in the separate article Hair loss in women.

When should you see a dermatologist?

A dermatologist consultation is recommended if:

• hair loss begins suddenly or rapidly worsens;
• hair loss continues for more than six months or recurs after improving;
• round or irregular bald patches appear;
• many broken hairs are visible;
• eyebrow, eyelash, beard, or body hair is also lost;
• the scalp is painful, burning, or very tender;
• there is redness, scaling, crusting, pustules, or discharge;
• the skin becomes smooth, shiny, or appears scarred;
• hair loss begins in a child;
• ongoing hair loss visibly reduces hair density;
• hair loss has a significant effect on emotional wellbeing.

More urgent assessment is needed if hair loss progresses rapidly or is accompanied by marked scalp inflammation, pus-filled lesions, fever, or feeling generally unwell.

How is the cause of hair loss diagnosed?

Diagnosis begins with a discussion and careful examination of the hair and scalp. The clinician may need to know:

• when the hair loss began;
• whether it started suddenly or gradually;
• whether hair is lost across the whole scalp or in specific areas;
• whether hair thickness and overall volume have changed;
• whether there is itching, pain, burning, or scaling;
• whether illness, fever, surgery, or severe stress occurred in the preceding months;
• whether there have been changes in weight or diet;
• which medicines and supplements are being used;
• whether similar hair thinning runs in the family;
• which hairstyles and hair treatments are used.

Scalp examination and trichoscopy

Trichoscopy is a non-invasive examination of the hair and scalp under magnification. It assesses hair-shaft thickness and structure, follicular openings, the skin around follicles, and vascular patterns. Together, these features can help distinguish different forms of alopecia, identify hair miniaturisation and inflammation, and monitor treatment response.

Trichoscopy may help to:

• distinguish scarring from non-scarring alopecia;
• identify hair-follicle miniaturisation;
• differentiate androgenetic alopecia from telogen effluvium;
• detect features associated with alopecia areata;
• assess hair-shaft damage;
• select the most appropriate biopsy site when a biopsy is needed.

In selected cases, a hair pull test, microscopic examination, fungal testing, cultures, or a scalp biopsy may also be used.

Which tests may be performed for hair loss?

There is no single test that diagnoses every form of hair loss, and not everyone needs the same set of tests.

Depending on the pattern of hair loss, diet, medicines, and other symptoms, a clinician may consider:

• a full blood count;
• iron studies, including ferritin;
• thyroid-function tests;
• levels of selected nutrients;
• inflammatory or metabolic markers;
• hormone tests when clinically indicated;
• tests for a systemic or autoimmune condition.

A broad panel of tests without a specific clinical reason does not always help identify the cause and may reveal incidental abnormalities that are not clinically significant.

Tell the clinician about all supplements you use. High doses of biotin can interfere with certain laboratory tests and produce misleading results.

How is hair loss treated?

Effective treatment starts with a diagnosis. No single method can treat every cause of hair loss.

Treating the trigger or underlying condition

If hair loss is associated with an illness, infection, inadequate nutrition, a nutrient deficiency, or another identifiable factor, treatment focuses on correcting that cause.

The hair growth cycle responds slowly, so shedding does not stop and density does not recover immediately after the trigger has been corrected.

Minoxidil

Topical minoxidil may help with certain types of hair loss, particularly androgenetic alopecia. It is not a universal treatment and cannot replace a diagnosis.

The response cannot usually be assessed objectively after only a few weeks. Long-term use may be needed to maintain the benefit. The effect may gradually diminish after treatment is stopped.

Possible adverse effects include scalp irritation and unwanted hair growth. More general symptoms are less common and should be discussed with a clinician. The appropriate formulation and suitability for treatment should be assessed individually and the instructions for the product registered in Latvia should be followed.

Prescription treatment

Depending on the diagnosis, a dermatologist may prescribe anti-inflammatory, antifungal, immunomodulating, or other systemic treatment.

Minoxidil is commonly used for androgenetic alopecia, and a doctor may consider finasteride or other medicines, including anti-androgen treatment, for selected patient groups. Treatment may be topical or systemic, taking account of the patient’s health, contraindications, and the possibility of pregnancy.

Topical, injected, or systemic anti-inflammatory and immunomodulating treatments may be used for alopecia areata. In scarring alopecia, the main objective is to control inflammation as early as possible.

Prescription medicines have contraindications and possible adverse effects. Some treatments may be used outside their officially approved indications for certain diagnoses or patient groups, so they should only be started after medical assessment.

PRP, light therapy, and other procedures

Platelet-rich plasma, or PRP, injections and low-level light therapy are sometimes used as additional treatments for selected types of hair loss.

Study results are not entirely consistent, and devices, treatment protocols, and patient selection vary. These methods should not be presented as universal or guaranteed solutions. A diagnosis and a realistic discussion about expected benefits, limitations, costs, and the need for repeated treatment are required before a procedure.

Evidence for the different mixtures used in mesotherapy is limited. Their effectiveness and safety cannot automatically be generalised to every product or type of hair loss.

Hair transplantation

Hair transplantation may be considered for selected patients with stable androgenetic alopecia or another suitable and inactive form of hair loss.

Before the procedure, the following should be assessed:

• the diagnosis;
• disease activity and the risk of further progression;
• hair density in the donor area;
• the condition of the scalp;
• the patient’s expectations.

Active inflammatory or scarring alopecia, uncontrolled scalp disease, and an inadequate donor area may be reasons to postpone or advise against transplantation.

Will lost hair grow back?

The possibility of regrowth depends on the cause and on whether the hair follicles remain intact.

Hair grows slowly, so several months are often needed before the response to treatment can be assessed.

What can you do in daily life?

Daily hair care cannot cure a follicular disorder, but it can reduce additional damage.

• Wash your hair according to the needs of your scalp. Gentle washing does not cause alopecia.
• Choose looser hairstyles and vary where the hair is tied.
• Limit frequent bleaching, aggressive chemical treatment, and very hot styling.
• Comb wet hair gently.
• Avoid rapid weight loss and highly restrictive diets.
• Ensure adequate energy, protein, and nutrient intake.
• Do not take high doses of iron, zinc, biotin, or other supplements without an established need.
• Document changes with photographs taken in the same lighting, angle, and hairstyle.
• Prepare a list of medicines and supplements before your consultation.

What should you avoid if your hair is falling out?

• Do not rely solely on shampoos, oils, or supplements.
• Do not start prescription medicines without medical advice.
• Do not stop a prescribed medicine solely because you suspect it may be linked to hair loss.
• Do not use several irritating products at the same time.
• Do not delay a consultation if there is pain, pustules, crusting, or signs of scarring.
• Do not compare your treatment response with carefully selected “before and after” images online.
• Do not assume that all hair loss is caused only by stress or vitamin deficiency.

Myths and facts about hair loss

Myth: frequent washing causes hair loss

Washing makes hairs that were already in the shedding phase more visible. Gentle washing does not itself cause the loss of hair follicles.

Myth: wearing a hat causes baldness

Normal hat use does not cause androgenetic alopecia. A problem may arise only if headwear causes pronounced, prolonged friction or traction.

Myth: hair grows back thicker after shaving

Shaving cuts the hair above the skin but does not change the number of follicles or the biology of hair growth. New growth may initially feel coarser because the hair has a bluntly cut end.

Myth: vitamins always help with hair loss

Supplements may be useful when a specific deficiency has been identified. They do not treat androgenetic, patchy, or scarring alopecia and cannot replace a diagnosis.

Myth: shampoo can restore lost hair follicles

Shampoo may help manage certain scalp conditions and improve the appearance of the hair shaft. It cannot restore a follicle destroyed by scarring or treat every type of alopecia.

Myth: all hair loss is androgenetic alopecia

Hair may be lost because of illness, inflammation, infection, medication, an autoimmune process, nutritional problems, or mechanical damage. Treatment differs considerably between these conditions.

Hair loss and emotional wellbeing

For many people, hair is closely linked to identity and self-esteem. Hair loss may cause anxiety, low mood, embarrassment, and avoidance of social situations. It is not merely a cosmetic concern.

Alongside medical treatment, a change of hairstyle, hair fibres, wigs, head coverings, scalp micropigmentation, or other cosmetic options may help. If hair loss significantly affects emotional wellbeing, it is reasonable to discuss this with a doctor and seek psychological support when needed.

Summary

Hair loss is a symptom with many possible causes. Some shedding is normal or temporary, but gradual thinning, bald patches, scalp inflammation, and signs of scarring may indicate a condition that requires treatment.

Choosing the appropriate course of action requires an assessment not only of the amount of hair being shed, but also of the pattern, duration, scalp condition, and possible triggers. The earlier progressive or scarring alopecia is recognised, the greater the opportunity to protect the follicles that remain.

Medical disclaimer

This information is provided for educational purposes and does not replace an individual trichologist consultation, diagnosis, or treatment. Seek medical advice if hair loss is sudden, patchy, or rapidly progressive, or if it is accompanied by pain, marked inflammation, scaling, pustules, or possible signs of scarring. Do not start, change, or stop prescription medicines without medical advice.

References and authoritative sources

• American Academy of Dermatology (AAD): overview of hair loss
• American Academy of Dermatology (AAD): common causes of hair loss
• American Academy of Dermatology (AAD): diagnosis and treatment of hair loss
• DermNet: medical overview of hair loss
• DermNet: telogen effluvium
• DermNet: trichoscopy in the diagnosis of hair and scalp disorders
• UK National Health Service (NHS): patient information about hair loss
• MedlinePlus: causes, diagnosis, and treatment of hair loss
• US Food and Drug Administration (FDA): biotin interference with laboratory test results

Content author

Trichologist Ivanna Buvan