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Hair fall: the causes worth testing for

What you are seeing today started three months ago.

Hair follicles respond to stress, illness, deficiency or rapid weight loss by entering the shedding phase — but the shedding appears two to three months later. This delay is why the cause is so often missed, and why the timeline is the most useful diagnostic information you have.

The three-month delay

Hair grows in cycles. A significant stressor — illness, surgery, childbirth, a crash diet, a severe infection, acute emotional stress — pushes a proportion of follicles prematurely into the resting phase. Those hairs then shed two to three months later.

This is telogen effluvium, and it is the most common form of diffuse hair fall. Because the trigger is a season behind, most people look at the last few weeks for an explanation and find nothing.

The practical instruction is to look back three months, not three weeks. And the reassuring part: this form is self-limiting once the cause is addressed.

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Deficiencies worth testing

Hair is non-essential tissue, so it is among the first things the body deprioritises when something is short.

  • Ferritin. The commonest finding in women. A ferritin at the very bottom of the range, with a normal haemoglobin, is frequently the answer.
  • Thyroid function — TSH with free T3 and free T4. Both under- and over-activity cause hair fall.
  • Vitamin D, which has a role in the follicle cycle.
  • Vitamin B12, particularly with a vegetarian diet.
  • Zinc, and protein adequacy — hair is largely protein, and restrictive dieting shows up here first.

2-minute check

Could your thyroid be involved?

Four questions. A simple blood test settles it either way.

How is your energy through the day?

How do you handle temperature?

Any change in hair, skin or nails?

Weight changed without a change in habits?

When it is not nutritional

Androgenetic hair loss follows a pattern — receding at the temples in men, widening of the parting in women — rather than being diffuse. It is genetic, progressive, and treated medically. No amount of nutritional correction addresses it, though deficiency alongside will make it worse.

Alopecia areata presents as discrete round patches and is autoimmune. Scarring alopecias destroy the follicle permanently and are urgent, because what is lost cannot be recovered.

Patchy loss, visible scalp inflammation, scaling, or loss accompanied by other symptoms all need a dermatologist rather than a diet plan.

What nutrition realistically does

It corrects what is low, ensures adequate protein, and avoids the rapid weight loss that causes the problem in the first place. Where deficiency is the cause, correcting it works — slowly, because regrowth follows the same cycle that produced the delay.

What it does not do is act quickly. Three to six months before visible change is the realistic expectation, and any product promising faster is describing something other than how hair grows.

In short

Shedding appears two to three months after its trigger — look back a season.
Ferritin, thyroid function, vitamin D and B12 are the tests worth having.
Patterned or patchy loss is a dermatologist’s subject, not a nutritional one.

Questions we are asked

How much hair fall is normal?

Shedding fifty to a hundred hairs a day is normal. A noticeable increase in handfuls while washing or a widening parting is different, and worth investigating.

Do hair supplements work?

Where there is a deficiency, correcting it helps. Where there is not, biotin and similar supplements have little evidence — and high-dose biotin interferes with several laboratory tests, including thyroid and cardiac markers, which can cause real diagnostic confusion.

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Conditions this relates to

Hair fall Alopecia areata Thyroid Anaemia PCOS & PCOD

Recipes that put this into practice

Related reading

References

  1. Indian Association of Dermatologists, Venereologists and Leprologists — guidance on hair disorders.
  2. World Health Organization — guideline on use of ferritin concentrations to assess iron status.
  3. [Further references to be completed by the medical review panel.]

This article is general health information, written by a clinical nutritionist and reviewed by a doctor. It is not a diagnosis and it does not replace advice from your own clinician. Never change prescribed medication on the basis of what you read here.

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