How much shedding is normal?
Hair renews itself in a cycle made up of growth, resting and shedding phases. For this reason it is normal to lose some hair every day; shedding about 50–100 hairs a day is generally considered usual. When shedding rises clearly above this, or when you notice your hair thinning, an assessment is appropriate.
It is important here to distinguish between two situations: excessive shedding of hair (more hairs than normal falling out from the root) and thinning of the hair or hair not growing back. This distinction helps in understanding the cause.
Common causes of hair loss
- Androgenetic (genetic) hair loss: the most common cause in both men and women. In men it usually appears as a receding hairline at the temples and thinning on the crown; in women, as diffuse thinning in the central part of the scalp with the front hairline preserved. It progresses slowly.
- Telogen effluvium (temporary excessive shedding): diffuse shedding that usually starts a few months after an event such as an illness with high fever, surgery, severe stress, rapid weight loss or childbirth. It often settles on its own once the trigger is gone.
- Hair loss after childbirth: a common form of telogen effluvium. It starts a few months after giving birth and returns to normal over time in most women.
- Iron deficiency, thyroid disease and some vitamin deficiencies: these can contribute to hair loss. Investigating them requires a physician's assessment and blood tests.
- Alopecia areata: a condition in which the immune system targets the hair follicles. It usually appears as round, well-defined, flat and smooth bald patches.
- Medicines and treatments: some medicines and treatments such as chemotherapy can cause hair loss.
- Hairstyles that pull on the hair and chemical treatments: tight braids, ponytails or frequent chemical treatments can cause hair breakage and loss.
If you think a medicine you are taking is causing hair loss, do not stop it on your own; first talk to the physician who prescribed it.
When should you see a physician?
Even mild, slowly progressing thinning can be assessed by a dermatologist; in genetic hair loss, starting treatment early can help preserve existing hair. In the following situations, however, it is advisable to see a physician without delay:
In these situations, hair loss should be assessed by a physician without delay
- Sudden or rapidly increasing shedding, coming out in clumps
- Patchy (round) bald areas on the scalp or in areas such as the beard or eyebrows
- Itching, burning, pain, redness, scaling or discharge on the scalp
- Skin in the bald area looking shiny, firm or like scar tissue (scarring hair loss can cause permanent damage)
- Hair loss together with symptoms such as fatigue, weight change, irregular periods, or excessive hair growth on the face or body
- Hair loss in children
How does a physician assess it?
The assessment usually begins with a detailed history: you are asked when the shedding started, about any illness, surgery, childbirth or stress in recent months, the medicines you take, your diet and whether there is hair loss in your family.
- Examination of the scalp and hair; if needed, examination with a dermatoscope (a magnifying instrument with a light)
- Hair pull test: assessing the degree of shedding by gently pulling on the hair
- Blood tests where the physician considers them necessary (for example iron stores, thyroid function, some vitamin levels and, in women, hormone tests)
- Rarely, when the diagnosis is not clear, a small tissue sample from the scalp (biopsy)
Taking vitamin or mineral supplements at random for hair loss may not help if there is no deficiency. Too much of some supplements can be harmful; in addition, some supplements can affect blood test results. If you take supplements, tell your physician.
With hair loss, the first step is to understand the cause. Rather than random supplements or an off-the-shelf procedure, get examined first; treatment makes sense when it is planned around the cause, and seeing results takes patience.
Dr. Hamza GemiciMedical Director, DoktorClub · Aesthetic Medicine Physician
Evidence-based medical treatments
Treatment is planned according to the cause of the hair loss. In telogen effluvium, the trigger going away is often enough; if a cause such as iron deficiency or a thyroid problem is found, treating it is the priority.
For androgenetic hair loss, the treatments whose effectiveness has been studied most are:
- Topical minoxidil: a medicine applied to the scalp; it is used in both men and women. Its effect usually starts to show within a few months, and regular use is needed for it to continue. If use is stopped, the effect gained may be lost over time.
- Medicines taken by mouth: in men, medicines such as finasteride, and in women, where appropriate, medicines such as spironolactone or low-dose oral minoxidil may be prescribed after a physician's assessment. These medicines have side effects and situations in which they must not be used; for this reason they should only be used on a physician's advice and under their follow-up.
- For immune-related hair loss such as alopecia areata, corticosteroid treatments and other medicines are planned by the physician according to the extent of the disease.
Some medicines used for hair loss are not suitable for women who are pregnant, planning a pregnancy or breastfeeding. Be sure to tell your physician about this before starting treatment.
Medicines work slowly. To judge whether treatment is working, regular use for usually a few months up to a year is needed. Shedding may temporarily increase in the first weeks; ask your physician about this.
PRP and mesotherapy: additional methods
PRP (platelet-rich plasma) is the injection into the scalp of a product prepared from a person's own blood. In androgenetic hair loss it has been found beneficial in some studies; however, the methods and results of the studies differ, and the evidence is still limited and variable. For details, you can read our article «PRP».
Mesotherapy is the application of various substances into the skin with small needles. The evidence for its effectiveness in hair loss is limited, and the mixtures used are not standardised. For details, see our article «Mesotherapy».
These methods should be considered not instead of medical treatments with stronger evidence, but, if needed, in addition to them and after a physician's assessment.
Hair transplant
A hair transplant is a surgical procedure in which hair follicles, usually taken from the area at the back of the head that is resistant to loss, are placed in thinning areas. It is mostly considered for advanced androgenetic hair loss that has become stable. Even after a transplant, medical treatment may need to be continued to preserve existing hair. Not every type of hair loss is suitable for a transplant; suitability is determined by examination.
Realistic expectations
- Telogen effluvium often settles on its own within months.
- Androgenetic hair loss is a progressive condition; the aim of treatment is often to slow shedding and preserve existing hair, and in some people the hair may also become thicker.
- Treatments require regular, long-term use; if they are stopped, the effect gained may be lost.
- In scarring hair loss, lost hair may not grow back; this is why early diagnosis is important.
Questions to ask your physician
- What might be causing my hair loss: is it genetic, temporary or related to another condition?
- Do I need a blood test, and which values will be checked?
- Could any of the medicines or supplements I take be contributing to the shedding?
- When can I expect to see the effect of the treatment you recommend, and how long should I use it?
- What are the possible side effects of this medicine, and in which situations should I contact you?
- I am planning a pregnancy or breastfeeding; which treatments are not suitable during this time?
- Would PRP or mesotherapy add anything in my case, and what does the evidence say?
- Could a hair transplant be a suitable option for me, and when should it be considered?
Frequently asked questions
How many hairs a day is it normal to lose?
Losing about 50–100 hairs a day is generally considered normal. On hair-washing days it may look as if more hair has been lost. If shedding has increased markedly or your hair is thinning, consult a physician.
Does stress cause hair loss?
Yes. Events such as severe stress, an illness with high fever or surgery can lead to temporary excessive shedding (telogen effluvium), which usually starts a few months later. This type of shedding often settles on its own once the trigger is gone.
My hair is falling out a lot after giving birth; is that normal?
Hair loss after childbirth is common and usually temporary. In most women the hair returns to its previous thickness over time. If the shedding lasts a long time or there are other symptoms, see a physician to check for causes such as iron deficiency and thyroid problems.
Do vitamin pills stop hair loss?
If there is a genuine deficiency, correcting it on a physician's advice can help. If there is no deficiency, the evidence that supplements help is limited, and too much of some supplements can be harmful.
What happens if I stop minoxidil?
Topical minoxidil can be effective for as long as it is used. When use is stopped, the effect gained is usually lost over time. If you are thinking of stopping or changing treatment, talk to your physician first.
Should I have PRP for hair loss?
PRP may give additional benefit to some people with androgenetic hair loss; however, the evidence is limited and variable. It does not replace medical treatments with stronger evidence. Assess with your physician whether it is suitable for your situation.
Sources
- Hair loss: Diagnosis and treatment — American Academy of Dermatology (AAD)
- Do you have hair loss or hair shedding? — American Academy of Dermatology (AAD)
- Hair loss in new moms — American Academy of Dermatology (AAD)
- Hair loss — NHS (United Kingdom)
- Alopecia areata — Patient Information Leaflet — British Association of Dermatologists (BAD)
- Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men – short version (Kanti V et al.). PMID: 29178529 — Journal of the European Academy of Dermatology and Venereology, 2018
- Telogen Effluvium: A Review of the Literature (Asghar F et al.). PMID: 32607303 — Cureus, 2020
- Safety of low-dose oral minoxidil treatment for hair loss. A systematic review and pooled-analysis of individual patient data (Jimenez-Cauhe J et al.). PMID: 32757405 — Dermatologic Therapy, 2020
Medical Aesthetics Expert Board
This article has been reviewed by the DoktorClub Medical Aesthetics Expert Board.
