Hair Loss
Assessment and treatment of hair thinning or excessive hair shedding after identifying the underlying cause
What is hair loss?
Hair grows in cycles. Each follicle spends years in a growing phase, a few weeks in a resting phase, and then sheds the hair and starts again, and at any moment most of your follicles are growing while a small share is resting. Losing fifty to a hundred hairs a day is normal.
Trouble shows up in two broad patterns. In one, hairs shed in larger numbers all over the scalp, usually two to three months after something disrupted the cycle: a fever or illness, surgery, childbirth, a crash diet, marked stress, iron deficiency or a thyroid problem. In the other, the follicles themselves shrink with each cycle under the influence of hormones and inheritance, producing progressively finer and shorter hair in a recognisable pattern at the temples, the crown or along the parting.
A third and less common group destroys follicles permanently through scarring, and the scalp itself is abnormal in those.
What you might notice
- Hair thinning at the crown or hairline
How it is diagnosed
Your dermatologist examines the scalp itself instead of the hair, often with magnification, and the key question is whether the follicle openings are still there. Follicles that are present but shrinking can recover; a smooth scalp with no openings means the follicles have gone, and that changes everything about what is possible.
They will look at the pattern and the density, check the hair at the margins and the parting, gently pull a small bundle to see how many come away, and examine the nails and the rest of the skin.
They will ask what happened three months before the shedding began, about diet, weight change, cycles, pregnancy, medicines, family history and how you style and treat your hair. Blood tests for iron stores, thyroid function and, in women, hormones are usually arranged, since deficiencies are common and correctable.
Recovery
Shedding after an illness, a delivery or a diet corrects itself. It continues for around three months and the density rebuilds over six to twelve months without anything being done beyond fixing the cause, and short new hairs along the hairline are the sign it is working.
Pattern thinning responds slowly and needs treatment continued. Shedding often increases for the first four to six weeks of treatment as resting follicles are pushed out ahead of new growth. The first real change appears at four to six months and the result is judged at twelve, so photographs in the same light and the same parting every three months are more reliable than a mirror.
Regrowth from any treatment depends on staying on it. Stopping returns you to the trajectory you were on over the following six to twelve months. There is no time off work, and in-clinic sessions are given as a course with nothing more than a tender scalp for a day.
If it is left untreated
Shedding that follows an identified event settles on its own, and that group needs reassurance and a blood test more than treatment.
Pattern thinning is progressive. Follicles shrink cycle by cycle, and after enough cycles the follicle closes and produces nothing, at which point no medicine will bring it back. This is the practical argument for starting early: treatment holds and partly reverses what is still alive, and it cannot recover what has already gone, so the density you keep is largely decided by when you start.
Two situations need seeing sooner. A scalp that itches, burns, scales or is tender, or areas where the skin looks smooth and shiny, suggests a scarring process that destroys follicles permanently and needs prompt treatment to stop it spreading. And hair loss with fatigue, weight change or heavy periods points at something treatable in the blood, which is worth finding.
Questions about hair loss
Is my hair loss reversible?
It depends on which kind you have, and your dermatologist establishes that by examining the scalp for follicle openings. Shedding that follows an illness, delivery, crash diet, iron deficiency or thyroid problem recovers fully over six to twelve months once the cause is corrected. Pattern thinning is partly reversible while the follicles are still alive and shrinking, and treatment holds and improves what remains. Where follicles have closed, or where scarring has replaced them, no medicine regrows hair in that area and the conversation turns to what can be done with the hair you still have.
How soon will I see results from treatment?
Slower than you expect. Most treatments increase shedding for the first four to six weeks, which alarms people and is a sign the cycle is being reset. The first visible change comes at four to six months, and twelve months is when the result is judged. Take a photograph at the start in good light with the same parting and repeat it every three months, since gradual change is almost impossible to see in a mirror. Stopping early is the commonest reason a working treatment is abandoned.
Will it come back if I stop treatment?
For pattern thinning, yes. Treatment works for as long as it is used: it slows the shrinking of the follicles and thickens the hair that is there, and it does not change the underlying tendency. Stopping usually returns you over six to twelve months to the density you would have had without it, and the loss can feel sudden because it arrives together. Discuss this before you start, since it is a long-term commitment. Shedding that followed an illness or a deficiency is different and does not need ongoing treatment once the cause is fixed.
Other dermatology & cosmetology treatments
Treatment of acne and acne-related marks based on skin type, severity and recurrence
Day CareEvaluation and treatment of uneven skin tone, dark spots and other pigmentation concerns
Day CareTalk to a care coordinator about hair loss
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one