It can be alarming to see hair falling out in clumps when you brush or wash your hair. However, some hair loss is normal. On average, people shed 50-100 hairs per day as part of the hair growth cycle. Increased hair shedding, also known as telogen effluvium, becomes a concern when you notice significantly more hairs falling out than usual over a short period of time.
What causes increased hair shedding?
There are several potential causes of increased hair shedding:
- Stress – Physical or emotional stress pushes more hairs into the shedding phase.
- Pregnancy – Hormonal changes during pregnancy cause increased shedding that peaks around 3-5 months postpartum.
- Major surgery/illness – The stress of surgery or illness causes hair to shift rapidly into the shedding phase.
- Nutritional deficiencies – Low iron, zinc, protein, vitamins B6, B12, A, etc. can disrupt the hair growth cycle.
- Medications – Drugs like birth control pills, beta blockers, antidepressants may trigger shedding.
- Thyroid disorders – Both hypothyroidism and hyperthyroidism impact hair growth cycles.
- Autoimmune disease – Conditions like lupus, celiac disease, alopecia areata cause hair loss.
- Hormonal shifts – Menopause, discontinuing/changing birth control, and other hormonal changes alter hair growth.
Is the excessive shedding permanent?
In most cases, the increased hair shedding is temporary if the underlying trigger can be addressed. The excess shedding represents hair that has prematurely reached the end of its growth phase due to a disruption in the hair cycle. However, it does not impact the normal production of new hair from the follicles.
Once the stressor is removed or deficiency corrected, the hair growth cycle will normalize and return to its regular cycle of growth (anagen), transition (catagen), and rest (telogen). The anagen phase typically lasts 2-7 years with 85-90% of hair in this growth phase at any given time.
Permanent hair loss occurs if the follicle itself is damaged and unable to produce new hair. This type of permanent loss is seen in pattern baldness and rare conditions like scarring alopecia.
How much shedding is excessive?
There is no definitive threshold for excessive shedding, but a noticeable increase in hair falling out during brushing, washing, or at random indicates excessive shedding. Some signs your hair loss may be abnormal:
- Your ponytail, bun, or braid is noticeably thinner.
- You see more hair in the shower drain or your hairbrush.
- You can see your scalp through your hair or your part/hairline recedes.
- Handfuls of hair come out when you gently pull or run your hands through your hair.
Keeping track by counting the hairs shed per day or taking pictures over time can help quantify increased shedding.
When to see a doctor
Consult your doctor or dermatologist if you notice a dramatic increase in shedding. They can help determine the underlying cause and suggest treatment options. Seek medical advice promptly if you have any of these warning signs:
- Extreme, rapid shedding develops suddenly
- You also notice patchy bald spots on your scalp
- You experience hair loss along with pain, itching, or burning
- The skin on your scalp changes or becomes painful
- You have signs of an infection like redness, swelling, oozing, crusting
- Your hair loss is asymmetric, only affecting one side of the scalp
Rarely, excessive hair shedding can be a sign of an underlying medical condition that requires prompt diagnosis and treatment. Schedule an appointment right away if your hair loss is accompanied by symptoms like fatigue, weight changes, fever, or changes in your skin or nails.
How is excessive shedding evaluated?
Your doctor will begin by reviewing your health history, diet, medications, and family history of hair loss. They will examine your hair and scalp to assess the pattern of shedding and look for any signs of infection, inflammation, or skin disorders.
You may need blood tests to check for nutritional deficiencies, hormonal imbalances like thyroid disease, autoimmune disease, or other medical conditions. Your doctor may refer you to a dermatologist who specializes in hair loss for further evaluation with tests like:
- Trichoscopy – Microscopic examination of hairs and scalp
- Scalp biopsy – Removing small skin sample to examine hair follicles
- Pull test – Gently tugging groups of hairs to count hairs shed
These tests help determine the cause and pattern of your hair loss. The results direct treatment options.
What if it’s genetic pattern baldness?
For androgenetic or female pattern baldness, options may include:
- Minoxidil – Topical medication to stimulate hair growth
- Laser devices – Low level light therapy to stimulate follicles
- PRP injections – Your plasma injected to stimulate growth factors
- Hair transplants – Moving hair follicles from the back of the scalp
- Medications – Finasteride and spironolactone can slow hair loss
Can I stop the excessive shedding?
Treatment aims to address the underlying cause of the excessive shedding to normalize the hair cycle. Steps you can take to reduce hair loss include:
- Take medications as prescribed if hair loss is related to thyroid disorders, other chronic disease, or hormonal birth control
- Correct nutritional deficiencies in iron, zinc, biotin, vitamin D, protein
- Avoid very tight hairstyles that pull on the hair roots
- Manage stress with lifestyle changes like exercise, meditation, therapy
- Stop smoking which can damage hair follicles
- Reduce styling damage from dyes, bleach, chemicals, heat tools
Your doctor may also prescribe anti-inflammatory drugs, topical steroids, or topical Ketoconazole to help reduce shedding.
What is the outlook for excessive hair shedding?
The prognosis depends on the cause of your hair loss. In cases of temporary shedding like telogen effluvium, your hair should regrow and return to normal once the trigger is removed. Nutritional deficiencies must be corrected, while postpartum shedding resolves on its own within 6-12 months.
When hair loss results from medical conditions like thyroid disorders, lupus, or anemia, shedding improves with successful treatment of the disease. If the underlying condition cannot be cured, medications to slow hair loss can help stabilize your hair.
Permanent hair loss is more likely if shedding results from scarring conditions like lichen planopilaris, folliculitis decalvans, dissecting cellulitis, radiation damage, or conditions like traction alopecia.
With early intervention for the trigger and proper hair care routines, excessive shedding can often be stopped and hair regrowth restored within 6-12 months. See your doctor if you do not see improvement with self-care.
How can I prevent excessive hair shedding?
You may be able to reduce excessive shedding by taking these proactive steps:
- Follow a nutritious, balanced diet with plenty of protein
- Take vitamins and supplements your doctor recommends
- Find healthy ways to cope with stress
- Avoid very tight hairstyles that pull on roots
- Allow hair to air dry instead of over-styling
- Use gentle, sulfate-free shampoos and heat protectants
- Handle hair gently when washing, brushing, and styling
See your doctor regularly for checkups to diagnose conditions like thyroid disease early on. Address diseases, infections, and deficiencies promptly to minimize disruption of the hair growth cycle.
When does shedding become a concern?
Look for these red flags that indicate shedding is excessive and needs evaluation:
- You consistently lose more than 100-150 hairs per day
- Your ponytail or braid is much thinner than usual
- You see large amounts of hair in the shower or brush
- Your part widens and more scalp becomes visible
- You start developing bald patches on your scalp
Also seek medical advice if hair loss impacts your quality of life. Feelings of depression, social isolation, poor self-esteem and other psychological effects can occur with excessive shedding.
What are some myths about hair shedding?
There are many myths about hair shedding and growth. Here are some facts:
- Myth: Wearing hats and helmets can cause hair loss.
Fact: There is no evidence headwear leads to permanent hair loss. Hats don’t impact follicles or growth.
- Myth: Frequent hair washing makes hair fall out.
Fact: Gentle washing does not accelerate shedding. Hair is firmly anchored.
- Myth: Dyeing or perming hair increases hair loss.
Fact: Chemical processing doesn’t cause permanent loss but can damage hair quality.
- Myth: Cutting hair makes it grow faster and thicker.
Fact: Trimming doesn’t change the growth rate or make hair thicker.
- Myth: Stress is linked to permanent baldness.
Fact: Stress can increase shedding but doesn’t cause permanent loss.
Conclusion
Increased hair shedding can be worrying but is rarely permanent. Talk to your doctor if you notice excessive hair falling out when brushing or washing. With the right diagnosis and treatment of underlying triggers, most people see their hair return to normal. Being gentle with your hair and minimizing damage from styling, processing, and coloring may help reduce shedding as well.