Hair Fall: Separating the Treatable from the Inevitable

Normal shedding versus real loss

Every hair follicle cycles through growth, transition and resting phases, and shedding fifty to a hundred hairs daily is entirely normal. What matters is whether the density is actually reducing — visible scalp, a widening parting, or a ponytail that has become noticeably thinner.

Take a photograph of your parting and crown every month in the same light. Memory is unreliable for gradual change, and this is the simplest way to know whether anything is truly progressing.

Telogen effluvium — reversible

This is diffuse shedding across the whole scalp beginning two to three months after a triggering event: a high fever, dengue, typhoid, COVID, surgery, childbirth, rapid weight loss, severe stress, or starting or stopping certain medications.

It looks alarming because handfuls come out at once, but it recovers fully over six to nine months once the trigger has passed. Treatment is correcting any nutritional deficiency and being patient. No specific medication accelerates it substantially.

Pattern hair loss — treatable, not curable

Androgenetic alopecia produces a receding hairline and crown thinning in men, and central widening of the parting with preserved hairline in women. It is genetic and progressive, and it responds to treatment but returns if treatment stops.

Topical minoxidil and, in men, oral finasteride have the best evidence. Both take four to six months to show effect and often cause a temporary increase in shedding in the first weeks, which is expected and not a reason to stop. Starting early preserves considerably more hair than starting once significant loss has occurred.

Deficiencies worth testing for

• Iron and ferritin — the commonest reversible cause in Indian women; ferritin below 30 affects hair even without anaemia
• Vitamin D — widely deficient
• Vitamin B12 — particularly in vegetarians
• Thyroid function — both underactive and overactive thyroid cause hair loss
• Zinc and protein intake
• In women with irregular periods and excess facial hair, testing for PCOS

What does not help

• Frequent oil massage does not increase growth; it can help condition hair but does not affect follicles
• Expensive shampoos — hair falls from the root, and shampoo contacts the scalp for under a minute
• Most multivitamin 'hair supplements' if there is no actual deficiency
• Onion juice, garlic and similar remedies — very limited evidence
• Cutting hair, which has no effect on growth rate or thickness
• Frequent chemical treatments, tight hairstyles and excessive heat, which do actively cause damage

See a dermatologist promptly for

• Patchy, coin-shaped bald areas — alopecia areata
• Scalp redness, scaling, pain or pustules
• Scarring, or areas where follicle openings are no longer visible
• Sudden rapid loss
• Hair loss with other symptoms such as fatigue, weight change or menstrual irregularity