Why Is My Hair Falling Out? You Could Just Be Shedding
Everyone sheds about 50 to 100 hairs each day. As hair goes through its growth cycle, it is completely normal for hair follicles to go through a resting phase and shed hair. However, when excessive hair is shed, it may indicate that your body is under stress and is conserving energy by not supporting hair growth.
While the three phases of hair growth are the same for everyone—anagen (growth phase), catagen (transition phase), and telogen (rest phase)—the length of these phases and the percentage of hairs in each phase vary throughout your lifetime. Anagen typically lasts for about three years, catagen lasts only a few days, and telogen lasts for about three months.
Hair loss is a concern because it affects self-image, but it does not always indicate a health condition and, in many cases, it may be treatable.
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Hair Shedding Or Hair Loss?
Other than counting the number of hairs that fall or clump in your comb, how can you tell the difference between normal hair shedding and abnormal hair loss or shedding?
Everyone has about 100,000 hair follicles on their head. Of these, about 85% to 90% are in the anagen phase, 1% to 3% in catagen, and 5% to 10% in telogen. If more hair follicles than expected go into the telogen resting phase, you will notice increased hair shedding. This condition is called telogen effluvium. It causes hair to come out in clumps because many hair follicles have prematurely entered the resting phase. Telogen effluvium typically occurs three to five months after the stressor that caused it and is typically self-limiting.1 Anagen effluvium usually affects hair follicles all over the scalp. The onset is more rapid than telogen effluvium, and it can cause widespread hair loss.
Hair loss usually has an underlying physical cause, and until that is resolved, hair loss will typically continue. If you have hair loss, talk to your doctor to see if you have any medical problems or are taking any medications that are associated with hair loss. Hair shedding is a response to a physiological or psychological stressor. It occurs suddenly and resolves when the stressor resolves.
Causes Of Hair Loss In Women And Men
Hair loss occurs when the balance between hairs entering the growth and resting phases is imbalanced.
Potential causes of hair loss in women and men include:
- Immune system: Inflammatory conditions such as alopecia areata can cause damage to the hair follicle, and hair loss occurs after the immune system attacks the hair follicle. While the cause is not fully understood, it is likely to be an autoimmune condition. Immune-triggered hair loss usually has a sudden onset and is patchy in distribution.1
- Anagen effluvium: Medications can cause toxic or inflammatory damage to the hair follicle. Chemotherapeutics, bismuth, levodopa, colchicine, albendazole, and cyclosporine can all cause hair loss.2
- Hairstyles: Hairstyles that put excessive tension on hair can cause focal hair loss.
- Trichotillomania: This is a condition in which a person cannot stop pulling on their hair. Damage to the hair follicles causes patches of hair loss in the front and sides of the head. Eventually, hair loss may involve the back of the scalp, eyebrows, and eyelashes.
- Chemicals: Exposure to thallium, boron, and arsenic can all cause hair loss.3
- Dermatitis: Scalp skin conditions such as psoriasis and seborrheic dermatitis can cause inflammation and hair loss.
- Skin infections: Localized skin infections such as tinea capitis can cause patches of hair loss. Tinea is a fungal infection that is more common in children. The exposed scalp is commonly red, flaky, and itchy with visible sores.
- Androgenetic alopecia/ female pattern hair loss: Approximately half of all women and men are affected by female or male pattern hair loss by the age of 50.4 There is usually a family history of hair loss. In men, hair thinning is on the vertex of the scalp and is associated with a receding hairline. Women have diffuse hair thinning on the crown but no receding hairline. Read more about what causes male pattern baldness or hair loss.
- Burns: Scarring from a burn can cause localized hair loss.
- Trichorrhexis nodosa: This condition occurs as a result of damage from hair styling or the use of hair products.
Causes Of Hair Shedding In Women And Men
Physiological stress causes telogen effluvium, a condition that causes diffuse hair thinning, so treatment depends on the underlying cause. In most cases, telogen effluvium resolves on its own. However, if you are losing more hair than the expected 50 to 100 per day, here are some potential causes:
- Rapid or dramatic weight loss: Crash dieting, anorexia, low protein diet, and chronic iron deficiency that may occur when changing your body composition are associated with increased hair shedding.
- Pregnancy: Hormonal changes in the postpartum period can cause an imbalance of estrogens and androgens and cause increased hair shedding.
- Stress: High psychological or physical stress levels can cause hair loss a few months after the stress.
- Hormonal imbalance: An imbalance between estrogen and testosterone that may occur throughout the menstrual cycle, after stopping oral contraceptives, and perimenopause can cause hair shedding.
- Nutritional deficiencies: Lack of nutrients, especially chronic iron, zinc, and niacin deficiency, can cause hair shedding. Your body is very responsive to nutritional deficiencies and conserves energy by prioritizing body processes, and hair growth is a low priority.
- Medications: Some medications, such as beta-blockers, anticoagulants, retinoids, and carbamazepine are associated with hair shedding.
- Recovering from an illness or operation: An illness or operation, especially if associated with a high fever, will cause more hairs to move from the catagen into the telogen phase, causing hair loss.
- Endocrine disorders: Endocrine disorders such as hypothyroidism cause telogen effluvium.
Hair Loss After COVID
Acute illnesses such as COVID-19, severe infections, major surgery, and severe trauma can all trigger hair loss. In March 2020, dermatologists published a paper in the Journal of the American Academy of Dermatology describing a 400% increase in telogen effluvium in New York City’s Hispanic and Latinx populations. This indicates that COVID-19 was especially widespread in these populations. COVID-19 infections present a severe shock to your body, which triggers more hairs to enter a telogen phase followed by shedding.
Hair shedding is not listed among the potential side effects associated with COVID-19. However, the increased number of cases of telogen effluvium after COVID-19 infections suggests that it is a trigger for hair loss. Genetic predisposition and nutritional status are likely to play a role in determining who will experience hair loss after an infection.
How To Tell The Difference Between Hair Loss And Hair Shedding
Telogen effluvium, or sudden hair shedding, causes hair to come out in clumps. Hair thinning is typically uniform over the scalp. Other than hair loss, the scalp should look completely normal. If this should happen, think back three to five months, and see if you can identify a stressor that may cause excessive hair shedding.1
If you notice patchy areas of hair loss, significant hair loss, inflammation, physical symptoms, scaling, or scalp redness, hair loss is more likely, and a dermatologist can help make an accurate diagnosis and recommend a treatment.
How To Stop Hair Shedding
Depending on the cause, you may be able to control some of the triggers for hair shedding:
- Hormonal changes: Read about 7 ways to naturally regulate your hormones
- Aging: learn 10 secrets to healthy aging
- Anxiety and stress: Read about 7 tips to reduce anxiety and manage stress
- Check your medications: Some medications will cause hair loss
- Avoid excessive brushing, heat application, and hairstyles that put traction on the hair
- Seek counseling to learn how to manage trichotillomania
- Learn strategies to manage anxiety or stress: Read 7 tips to reduce anxiety and manage stress
- Consider using supplements such as vitamins or hormones specially designed for age management
- Restore B vitamins, iron, and biotin if you may be deficient in these nutrients
Treatments For Hair Loss
Treatment options are based on personal preference and the causes of hair loss. If you think a physical condition may be causing your hair loss, see a dermatologist. The earlier conditions such as hypothyroidism, tinea capitis, and alopecia areata are treated, the more successful treatment is likely to be.
If you have hair loss consistent with male or female pattern baldness, ask your doctor about finasteride. Finasteride is a competitive inhibitor of Type II 5α-reductase. This means it inhibits the enzyme Type II 5α-reductase and decreases its ability to convert testosterone to DHT. By blocking Type II 5α-reductase, the conversion of testosterone to DHT is reduced by up to two-thirds. In people with a genetic predisposition, DHT shortens the hair growth phase from years to months. Finasteride can reduce DHT, and restore hair growth and prevent further hair loss.
- Phillips TG, Slomiany WP, Allison R. Hair Loss: Common Causes and Treatment. Am Fam Physician. Sep 15 2017;96(6):371-378.
- Schwartz R. Anagen Effluvium. Medscape. https://emedicine.medscape.com/article/1073488-overview#a7
- Campbell C, Bahrami S, Owen C. Anagen Effluvium Caused by Thallium Poisoning. JAMA Dermatol. Jun 1 2016;152(6):724-6. doi:10.1001/jamadermatol.2016.0194
- Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. Oct 2008;59(4):547-66; quiz 567-8. doi:10.1016/j.jaad.2008.07.001