Hair fall: when it is normal, and when to get it looked at

Almost everybody who comes to us about hair has already been told, by somebody, that losing a hundred hairs a day is normal. That is true, and it is also close to useless as advice — because the number of hairs you lose is not the thing that matters.

Shedding and thinning are different problems

Shedding is an increase in how much hair comes out. It is dramatic, alarming, and usually temporary. You see it in the shower drain and on your pillow, and it typically follows an event — an illness, a surgery, childbirth, a crash diet, a genuinely difficult few months — by about three months.

Thinning is a reduction in how much hair is there. It is gradual, much less dramatic, and usually progressive. You notice it in a widening parting or a ponytail that has got thinner, not in the drain.

These need entirely different treatment, and treating one as though it were the other is the commonest reason a course of hair treatment disappoints.

Signs that warrant a proper look

• Your parting has visibly widened over six to twelve months.
• Your ponytail circumference has reduced.
• You can see scalp in photographs where you previously could not.
• Shedding has continued for more than three months without an obvious trigger.
• There is any patch, scaling, itch or pain — which is a different category and needs seeing promptly.

What a proper workup includes

If you take one thing from this article, make it this: nobody should inject anything into your scalp before running the following.

Trichoscopy. A magnified examination that measures follicular density and — critically — miniaturisation, which is the shrinking of follicles that characterises androgenetic thinning. It distinguishes the patterns that look identical to the naked eye.

A standardised pull test. Simple, quick, and it tells us whether you are in an active shedding phase right now.

Blood work. At minimum ferritin, vitamin D, thyroid function and a full blood count. In women with a suggestive pattern, hormonal markers as well. We find low ferritin in a strikingly high proportion of women in their thirties who present with hair loss, and no injectable will out-perform simply correcting it.

The timeframe nobody wants to hear

Hair grows about a centimetre a month, and the follicle cycle is measured in months. That means any honest assessment of whether a treatment is working takes four months, and the visible result takes six. Anyone offering you regrowth in six weeks is describing reduced shedding, which is a real and welcome early sign — but it is not the same thing.