Hair Loss: When to Worry and What Actually Helps

“It’s coming out in clumps, in the shower and on my pillow. Should I be worried?” It’s a question I hear more often in autumn, and it almost always comes with more anxiety than the problem itself would justify.

The honest answer is that hair loss is a symptom, not a diagnosis. Behind the same fright there can be a normal change of season, a stressful period a few months earlier, low iron, or a form of alopecia that needs following over time. Working out which situation you’re in is the first step, and almost always the most useful one.

The hair cycle, in brief

Every hair goes through three phases: a long growth phase lasting years; a short transition phase; and a resting phase of about three months, at the end of which it falls out to make way for a new hair. At any moment the vast majority of hairs are growing, and a small proportion are resting.

That’s why losing between 50 and 100 hairs a day is normal. The problem arises when an event pushes many hairs into the resting phase at the same time: around three months later, they all fall out together.

This is why hair loss seems to come out of nowhere. The cause usually lies two or three months earlier.

The most common causes of diffuse shedding

This diffuse shedding, called telogen effluvium, is the most common form, and it’s almost always temporary. The events that most often trigger it are:

• The change of season. Between late summer and autumn many people lose more hair for a few weeks. It’s physiological.
• A period of intense stress, physical or emotional: a bereavement, a house move, a very demanding stretch at work.
• High fever, a bad bout of flu, surgery.
• Giving birth. During pregnancy less hair falls out; after the birth the hairs that were “held on to” all shed together, usually a few months later.
• A crash diet or rapid weight loss, especially if intake of protein, iron or zinc drops.
• Nutritional deficiencies and hormonal imbalances, particularly low iron and thyroid changes.
• Some medications. Among these, there has been a lot of talk recently about the GLP-1 drugs used for diabetes and weight, such as Mounjaro and Ozempic.

On this last point I wrote an article for the Italian magazine Io Donna (in Italian), and the summary is this: studies show an association, not a certainty. People taking these drugs won’t necessarily lose hair, and rapid weight loss appears to be one of the factors involved, although the mechanisms are still being studied. Above all, treatment shouldn’t be stopped on your own initiative: if hair loss appears during treatment, talk to the doctor who is following you. I also cover this in the Mounjaro article.

Temporary shedding or alopecia? How to tell them apart

Not all hair loss is the same, and the difference matters because it completely changes what to do.

	What it looks like	Pattern	What to do
Telogen effluvium	Diffuse shedding across the whole scalp; lots of hair on the pillow and in the shower	Sudden, 2-3 months after an event; temporary	Find and correct the cause
Androgenetic alopecia	Gradual thinning: widening parting, more visible crown, finer hair	Slow, over years	Medical assessment; targeted treatments to slow it
Alopecia areata	Round patches with no hair at all	Sudden, in patches	Specific diagnosis: it has an autoimmune origin
Scarring alopecias	Red scalp that itches, burns or hurts; shiny areas	Variable	Prompt dermatological assessment: the follicle risks being destroyed

The first two can also overlap: telogen effluvium can reveal androgenetic thinning that previously went unnoticed. That’s one of the reasons why, if shedding doesn’t settle, it’s worth getting checked.

Which tests make sense

The first step is a clinical assessment: the history of the last few months, an examination of the scalp, the way the hairs come out. Blood tests are chosen based on what emerges, not as a standard package. The ones most often useful are:

• Full blood count and ferritin, i.e. iron stores: one of the most common deficiencies in women
• Thyroid function
• Nutritional status, including protein, vitamin D and other markers when the history suggests it

It’s the same principle I apply to IV therapies: measure first, supplement second. The aim isn’t to take supplements at random, but to correct the deficiencies that are actually there.

What can be done

If it’s telogen effluvium, treatment is mainly about removing the cause: correcting a deficiency, revising an overly restrictive diet, giving the body time after a birth or an illness. In this form the follicle isn’t destroyed: once the cause is corrected, the cycle restarts on its own. It takes patience, because density returns over months, not weeks.

To support the scalp and follicle, there are also several aesthetic and regenerative medicine treatments:

• PRP (platelet-rich plasma): uses the growth factors in your own platelets to stimulate the follicle. The strongest evidence concerns androgenetic alopecia. The typical protocol involves three monthly sessions and top-ups every six months. You’ll find it among the treatments.
• Hair fillers: micro-injections based on hyaluronic acid and peptides, used within personalised protocols.
• Photobiomodulation: low-intensity light, which may be considered in some situations.
• Local ozone therapy: I use it in selected cases, but for hair loss the evidence is still limited and it shouldn’t be considered a treatment of established effectiveness.

The key point is that the evidence isn’t equivalent across these treatments: the choice depends on the diagnosis and the type of hair loss, not on whichever treatment is fashionable.

What about a hair transplant? During an active phase of diffuse shedding, it’s generally not the first route to consider. A transplant is indicated when hair loss is stable and there’s a precise diagnosis that makes it appropriate.

What doesn’t work

• Supplements without a deficiency. If iron, vitamins and protein are normal, adding more won’t stop the shedding.
• Cosmetic “anti-hair-loss” shampoos and lotions against telogen effluvium: the shedding depends on an event months earlier, and a product applied to the hair doesn’t change the follicle’s cycle.
• Stopping a treatment on your own because you suspect it’s making your hair fall out.
• Chasing a quick fix. Hair grows about a centimetre a month: whatever you do, recovery is measured in months.

When to see a doctor

More shedding for a few weeks, in autumn or after a difficult period, usually resolves by itself. It’s worth having it assessed, however, if:

• the shedding lasts more than two or three months without easing
• you see your parting widening or your crown thinning
• bald patches appear
• your scalp is red, sore or itchy
• the shedding comes with marked tiredness, irregular periods or other symptoms
• after pregnancy the shedding doesn’t ease within a year

In conclusion

Most of the hair loss that frightens people is temporary, and resolves once the cause is found. The real risk isn’t losing some extra hair for a few months: it’s blaming everything on the season or a medication and missing a deficiency, a thyroid problem or an alopecia that, caught early, can be slowed.

If hair loss worries you, the first step isn’t a product or a treatment: it’s understanding what kind of hair loss it is. At the consultation we start there, and only afterwards, if needed, do we choose together how to intervene.