Hair Loss: Causes, Treatment and When to Worry

Is it temporary shedding or pattern hair loss?

Temporary shedding, known medically as telogen effluvium, shows up as diffuse hair fall from the whole scalp: on your pillow, in your comb and in the shower. It usually starts 2 to 3 months after a stressful trigger such as an illness with fever, childbirth, a crash diet or severe emotional stress, and tends to settle within several months once the trigger has passed.

Pattern hair loss (androgenetic alopecia) develops slowly over years. In men it usually begins with a receding hairline or thinning at the crown; in women it more often shows as a widening parting while the front hairline stays in place. It does not stop on its own, but early treatment can help slow it down.

What are the most common causes of hair loss?

Often more than one cause is at work in the same person. The most common include:

• Low iron and low iron stores (ferritin), particularly common in women.
• Vitamin D deficiency, widespread in Saudi Arabia despite the sunshine because of limited direct sun exposure.
• Thyroid disorders, whether underactive or overactive.
• Severe stress, acute illness, surgery or rapid weight loss.
• After childbirth: noticeable shedding that often begins 2 to 4 months after delivery and improves gradually.
• Tight hairstyles worn for long periods, high heat and frequent colouring.
• Some medicines, and conditions such as alopecia areata or scalp inflammation.

Which tests might the doctor order?

The doctor will ask when the hair loss began, its pattern, your family history, your medicines and recent events in your life, then examine your scalp, possibly using a dermatoscope to look closely at the follicles.

Depending on the case, they may request blood tests such as a full blood count, iron stores, vitamin D and thyroid function, and sometimes hormone tests for women with signs like irregular periods, acne or extra facial hair. Occasionally a small scalp biopsy is needed.

What treatment options are available?

Treatment depends on the cause. Correcting a deficiency or treating a thyroid problem may be enough for temporary shedding, while pattern hair loss usually needs long-term treatment.

Most treatments take 3 to 6 months of consistent use to show results. Common options include:

• Topical minoxidil: one of the most studied treatments for both men and women. It needs regular use and may increase shedding in the first weeks before things improve.
• Prescription medicines chosen by the doctor according to sex, age and the condition; some must not be used during pregnancy or when planning one.
• Platelet-rich plasma (PRP) injections: a supportive treatment that usually needs several sessions, with results that vary between people.
• Treatment of alopecia areata or scalp inflammation according to the diagnosis.
• Hair transplantation for some cases of stable pattern hair loss, after a specialist assessment.

When is hair loss a cause for concern?

Most hair loss is not serious, but some signs deserve a prompt visit to the doctor:

• Sudden round bald patches on the scalp, beard or eyebrows.
• Rapid, heavy hair loss over a few weeks.
• Redness, pain, thick scale or pus on the scalp.
• Hair loss with severe tiredness, weight change or irregular periods.
• Hair loss in children.