Hair Loss – Causes, Tests and Which Shampoo to Use

Hair shedding is a natural part of the hair’s life cycle – every day we lose dozens of hairs, and new ones grow in their place. We talk about excessive hair loss when noticeably more hair than usual falls out over a longer period, or when the hair becomes visibly thinner. The most common causes are stress, hormonal changes, thyroid disease, nutritional deficiencies and genetic predisposition. Here we explain how to recognise the problem, which tests to have and what to use for hair loss.

How many hairs fall out a day? When is hair loss excessive?

We usually lose between 50 and 100 hairs a day, and this is perfectly normal [1]. It’s a result of the hair growth cycle, which consists of a growth phase (anagen) that can last several years, a short transitional phase (catagen) and a resting phase (telogen), after which the hair falls out. At any given time, around 10–15% of hairs are in the telogen phase [2,3].

You may be losing too much hair if:

• you find noticeably more hair than usual on your hairbrush, on your pillow and in the plughole after washing, for several weeks,
• a few hairs come away when you gently tug a strand between your fingers,
• your parting is getting wider and your ponytail is getting thinner,
• thinning appears on the crown or at the temples, or bald patches appear.

Heavy hair shedding after washing is not always a problem – if you wash your hair less often, the hairs that have “collected” over several days come out in one go. Only a persistent, clear change should be a cause for concern.

Why does hair fall out? The most common causes

The most common cause of diffuse (even) hair loss is telogen effluvium – when a larger number of hairs move into the resting phase in response to a stressor on the body [2,4]. Typically, the hair doesn’t start falling out straight away but 2–3 months after the trigger. Causes of hair loss include:

• a high fever, a serious infection or surgery,
• childbirth and hormonal changes,
• thyroid disease,
• restrictive diets, protein and iron deficiency,
• severe, long-term stress,
• certain medicines (e.g. oral retinoids, beta-blockers, anticoagulants) [4],
• genetic and hormonal predisposition (androgenetic alopecia).

Hair loss in women – hormones, pregnancy and after childbirth

Hair loss in women often has a hormonal cause. During pregnancy, high oestrogen levels extend the growth phase, so hair loss during pregnancy usually decreases. After childbirth, hormone levels drop sharply and many hairs enter the resting phase at the same time. Postpartum hair loss usually begins around 2 months after giving birth, peaks at around 4 months, and hair density usually returns to normal within 6–9 months [1].

Other hormonal causes include stopping hormonal contraception, the perimenopause, as well as polycystic ovary syndrome (PCOS) and excess androgens, which can lead to female pattern hair loss – thinning around the parting and on the crown [5].

Thyroid and hair loss – what TSH level causes hair loss?

Both an underactive and an overactive thyroid can cause diffuse hair loss [6]. With an underactive thyroid, the hair becomes dry, dull and brittle, and the eyebrows may also thin. There is no single TSH threshold at which hair starts to fall out – what matters is the severity and duration of the disorder, as well as the levels of the hormones fT3 and fT4. Hair loss can be one of the first signs of thyroid disease [7], which is why TSH is one of the basic tests for excessive hair loss.

Deficiencies, stress and diet

Nutritional deficiencies can disrupt the hair growth cycle, although their role is not always clear-cut [8]. The levels most often checked are ferritin (iron stores), vitamin D, zinc and vitamin B12. Low vitamin D levels are more common in people with non-scarring alopecia [9], and iron deficiency is one of the factors behind telogen effluvium [4,10].

Stress affects the hair follicles indirectly – a severe episode of stress can trigger telogen effluvium a few weeks later. Rapid weight loss and low-protein diets have a similar effect.

Seasonal hair loss in autumn

Autumn hair shedding is something many people notice, and it has been confirmed by research. In a 6-year study of more than 800 women, the highest proportion of hairs in the telogen phase was found in summer, which translates into increased shedding in the following weeks – at the end of summer and in autumn [11]. Seasonal hair loss is temporary and usually lasts a few weeks. If it continues for more than 2–3 months, it’s worth looking for another cause. You’ll find more tips in our article on how to care for your hair in winter.

Read also: Hair Loss After Winter

Types of hair loss

Hair loss (alopecia) is not a single condition – there are several types that differ in their cause, appearance and treatment:

• telogen effluvium – diffuse, usually temporary, triggered by a stressor on the body,
• androgenetic alopecia – determined by genes and hormones; in men it affects the temples and crown, in women the area around the parting [5],
• alopecia areata – round bald patches with an autoimmune cause,
• scarring alopecia – rare, with permanent damage to the follicles; it requires urgent assessment by a dermatologist.

In women, hair loss most often takes the form of telogen effluvium or androgenetic alopecia, while hair loss on the crown in men is typical of androgenetic alopecia. With age, hair density and thickness naturally decrease – we write about this in our article on ageing of the scalp and hair.

Hair loss – which tests should you have?

If you’re losing too much hair, it’s a good idea to start with basic blood tests and a visit to a dermatologist or trichologist. The tests most often ordered for hair loss are [2,8,9]:

• full blood count,
• ferritin and iron,
• TSH (and, if needed, fT3, fT4 and thyroid antibodies),
• vitamin D (25(OH)D),
• zinc and vitamin B12,
• in women with signs of excess androgens – hormone tests (e.g. testosterone, DHEA-S, SHBG).

An important examination is trichoscopy, an assessment of the scalp and hair under magnification. This non-invasive method makes it possible, for example, to tell androgenetic alopecia apart from alopecia areata and to assess the condition of the hair follicles [12]. Test results should always be interpreted with a doctor – a result that is “within the normal range” does not always rule out a problem.

What helps with hair loss? Care and supplements

The most effective way to deal with hair loss depends on its cause – so the key is to identify it and remove or treat it (e.g. by correcting deficiencies or treating a thyroid condition). Scalp care is an important support: it helps keep the scalp in good condition, strengthens the hair and reduces breakage. Remember that the condition of your hair depends on the condition of your scalp – we write about how dandruff, greasiness and excessive hair loss are linked in our article on scalp and hair problems.

Read also: Scalp Seborrhea – What Causes It and How Can You Effectively Restore Balance?

Which shampoo should you choose for hair loss?

A shampoo for hair loss should cleanse the scalp gently and contain ingredients that support the hair follicles. Look out for caffeine, plant extracts, amino acids and vitamins. Caffeine is one of the better-studied cosmetic ingredients – in a study of 210 men with androgenetic alopecia, a caffeine-based product applied to the scalp performed comparably to minoxidil [13].

• The Dermedic CAPILARTE range for weakened hair and excessive hair loss includes:
• Strengthening Anti-Hair Loss Shampoo – with the Pilotantum® and Procapil™ complexes, vitamins C, E and PP and thermal water; it strengthens the hair’s structure and anchoring,
• Hair Growth Stimulation Treatment Shampoo – with caffeine, zinc PCA and apple stem cell extract, designed for people with excessive hair loss of various causes.

It’s best to massage the shampoo into the scalp and leave it on for 2–3 minutes, and to use a conditioner on the lengths.

Scalp tonics and serums for hair loss

Scalp tonics and serums work for longer than shampoo because they stay on the scalp. They are usually applied daily or several times a week for at least 3 months – the time needed to assess results over the hair growth cycle. One example is CAPILARTE Hair Growth and Regrowth Stimulation Treatment Serum with caffeine, birch sap and the Pilotantum® and Procapil™ complexes, which supports microcirculation around the hair bulbs.

Once a week, it’s also worth cleansing the scalp of excess sebum and product build-up – for example with the Trichological Scalp Peel. We describe more proven methods in our article on what helps hair grow.

For androgenetic alopecia, European guidelines recommend minoxidil (for women and men) and – in men – finasteride [5]. These are medicines, so their use should be discussed with a doctor.

Which vitamins help with hair loss?

Vitamins for hair loss mainly help when the hair loss is caused by a deficiency. The nutrients most often supplemented are iron, vitamin D, zinc and vitamin B12 – but only once a deficiency has been confirmed by tests [8]. Popular biotin has no proven benefit in people who are not deficient [14], and too much of it can distort the results of some laboratory tests, including thyroid hormone tests. Taking supplements “just in case” won’t speed up hair growth, and with some nutrients (e.g. vitamin A, selenium) an excess can even increase hair loss [8].

Home remedies for hair loss – what works and what’s a myth?

Home remedies for hair loss can support your care routine, but they won’t replace a proper diagnosis. It’s worth:

• massaging your scalp gently while washing, avoiding tight hairstyles and limiting heat styling,
• following a balanced diet with enough protein,
• not counting on frequent trims to stop hair loss – it starts at the roots, not the ends,
• not worrying about washing your hair – washing more often doesn’t cause hair loss, it simply removes hairs that would have fallen out anyway,
• being careful with homemade scalp treatments containing alcohol, garlic or onion – they can irritate the scalp.

Hair loss in children – when to see a doctor?

Hair loss in a child always needs to be checked by a GP, paediatrician or dermatologist, because its causes differ from those in adults. The most common are scalp ringworm (especially in children aged 3–7), alopecia areata, compulsive hair pulling (trichotillomania) and telogen effluvium after an infection with a fever [15,16]. See a doctor especially if your child has scaly patches with broken hairs, round bald patches, or a red, itchy scalp. Scalp ringworm requires oral treatment prescribed by a doctor.

FAQ – frequently asked questions about hair loss

What can I buy at the pharmacy for hair loss?

At the pharmacy, you can buy dermocosmetic scalp products for hair loss – shampoos, serums and scalp tonics with caffeine or complexes that support the hair bulbs, for example from the Dermedic CAPILARTE range. Products containing minoxidil, which is a medicine, and food supplements are also available. Before buying supplements, it’s worth having tests done so that you only address genuine deficiencies.

Is heavy hair shedding after washing a cause for concern?

Heavy hair shedding after washing is usually not a cause for concern – washing removes hairs that were already in the resting phase. It may be a problem if you lose a lot of hair for more than 2–3 months, your hair becomes noticeably thinner or bald patches appear.

When does hair loss need a trichologist or dermatologist?

Hair loss needs a dermatologist’s attention if it lasts longer than 3 months, gets worse, or comes with bald patches, redness, pain or an itchy scalp, as well as when it is accompanied by other symptoms such as fatigue, weight changes or irregular periods. A trichologist can help assess the condition of your scalp and choose the right care, but diagnosing and treating medical conditions is a job for a dermatologist.

This article is for educational purposes only and does not replace medical advice. If your hair loss is severe or persistent, consult a dermatologist.

References