Why am I going bald? How to tell normal shedding from hair loss

Some shedding every day is normal

Every hair on your head goes through a cycle: it grows for several years, rests for a few months and then falls out, making room for a new hair from the same follicle. Because of this, most people lose somewhere around 50 to 100 hairs a day, and slightly more on days when they wash or brush their hair thoroughly.

Shedding on its own is not a sign of disease. What matters is whether you are losing noticeably more than before and, more importantly, whether new hairs are growing back. When follicles stop replacing lost hair, the hair gradually becomes thinner and bald areas appear.

Hair loss is known medically as alopecia. It affects both men and women and can begin at any age. In women it most often appears as diffuse thinning over the whole head, which can be more pronounced than people expect.

Common reasons for hair loss

Hair loss can have many causes, and often several of them act together. Everyday life, especially in a busy city, adds a number of factors that affect the hair:

• Genetics and hormones. The most common cause of gradual thinning is androgenetic alopecia, which runs in families and is linked to the effect of male hormones on sensitive follicles.
• Stress. A period of intense emotional or physical stress, an illness or surgery can trigger temporary shedding a few months later.
• Health problems. Thyroid disorders, iron-deficiency anaemia and autoimmune conditions can all lead to hair loss.
• Diet. Crash diets and a lack of protein, iron, zinc or B vitamins may weaken the hair.
• Styling habits. Frequent use of hair dryers and straighteners, harsh chemical treatments and tight hairstyles damage the hair shaft and can strain the follicles.
• Unsuitable hair care. Products that do not suit your scalp can cause irritation and make hair look thinner and more fragile.

A simple home check: the pull test

A quick pull test can give you a rough idea of how much hair you are shedding. Take a small section of dry hair, about 50 to 60 strands, preferably from the side of the head near the temple, hold it close to the scalp and gently slide your fingers along it to the ends.

• If up to about 10 hairs come away, this is usually within the normal range.
• If noticeably more hairs come out, it is worth having your scalp examined by a doctor. This is a reason to get checked, not a reason to panic.

The test is only a rough guide. Results vary with the time since your last wash and with how firmly you pull, and it cannot tell you why the hair is falling out. Only a doctor can assess that after an examination.

Signs that it is more than normal shedding

Pay attention to changes that develop over weeks and months rather than to a single day of heavier shedding:

• a hairline that is moving back at the temples;
• a crown or parting that looks wider or shows more scalp than before;
• round or oval patches without hair;
• a ponytail that feels noticeably thinner;
• itching, redness, flaking or tenderness of the scalp;
• hair that breaks easily or becomes finer and shorter.

Taking photos of your hair in the same light every few months is a simple way to see whether anything is really changing.

When to see a doctor and what to expect

If shedding stays heavy for more than a few weeks, if you notice patches or a clear change in your hairline, or if hair loss comes with other symptoms such as fatigue or weight changes, see a doctor. A dermatologist is the main specialist for hair and scalp problems; a general practitioner can also start the investigation.

The doctor usually examines the scalp, asks about your family history, health, diet and stress, and may recommend blood tests to check for anaemia, thyroid problems and vitamin or mineral deficiencies. Trichoscopy, a magnified examination of the scalp, helps to see what is happening at the level of the follicles.

Treatment should be chosen by the doctor based on the cause. Avoid starting medication or supplements on your own: they may not address the real reason for your hair loss.

What can help in the long term

Many causes of hair loss can be improved once they are identified: stress-related shedding often settles by itself, and correcting a deficiency or changing styling habits can help the hair recover. Gentle hair care, a balanced diet and avoiding tight hairstyles support healthy hair in any case.

When hair loss is caused by androgenetic alopecia and has led to stable bald or thinning areas, a hair transplant may be an option. FUE is used for androgenetic alopecia, and a combined FUE and DHI approach is used for androgenetic alopecia and to add density to thinning areas. A transplant needs enough healthy donor hair, so it is not suitable for total alopecia, and it does not remove the cause of hair loss. You can read more on the hair transplant page.

Consultation at City Medical Centre

City Medical Centre works with international patients. The first consultation is free and can be held online: send photos of your hairline, crown and the back of your head, and describe when you first noticed the change. The doctor assesses whether a transplant is appropriate and names the cost, which is then fixed in the contract. A personal coordinator stays with you from your first message to the end of recovery, and photos and questions can be sent by WhatsApp. Learn more on the hair transplant page.

Frequently asked questions

How much hair loss a day is normal?

Most people lose roughly 50 to 100 hairs a day as part of the normal hair cycle, sometimes more on wash days. It becomes a concern when shedding is clearly heavier than usual for several weeks or when new hair does not grow back in its place.

Can stress make my hair fall out?

Yes. Intense emotional or physical stress, an illness or surgery can push many hairs into the resting phase at once, and they fall out a few months later. This type of shedding is usually temporary, but a doctor should rule out other causes.

Why do women lose hair?

Common reasons include hormonal changes after pregnancy or during menopause, thyroid problems, iron deficiency, stress, restrictive diets and damaging styling. Female pattern hair loss also exists and usually shows as diffuse thinning on top of the head.

Which doctor should I see about hair loss?

A dermatologist is the main specialist for hair and scalp problems. A general practitioner can also start with blood tests and refer you further. Treatment should be prescribed only after an examination, because it depends on the cause.

Is a hair transplant a solution for going bald?

For stable androgenetic alopecia with enough donor hair, a transplant can restore hair in bald or thinning areas. It is not suitable for total alopecia and does not stop the underlying process, so the doctor assesses your case first.