Hair Fall & Androgenetic Alopecia

Shedding some hair every day is normal. Dermatologists generally consider losing up to about a hundred hairs a day to be within the usual range, because every hair follicle goes through a growing phase and a resting phase. Hair fall becomes a medical problem when the shedding lasts for weeks, when the hair that grows back is thinner and shorter than before, or when the scalp starts becoming visible. Androgenetic alopecia, commonly called pattern hair loss, is the most common cause of long-term thinning. In this condition the hair follicles are genetically sensitive to normal hormones present in both men and women, and with each cycle they produce a finer, weaker hair until they eventually stop producing visible hair at all. In men this usually shows up as a receding hairline at the temples and thinning at the crown. In women it more often shows as a widening parting line and general thinning over the top of the scalp, with the front hairline usually staying intact.

Hair fall is one of the most common reasons people visit a skin clinic, and also one of the most delayed. Many people spend months or years trying oils, home remedies, herbal powders, salon treatments and products bought online before they see a doctor. By that time some follicles may already have shrunk beyond the point where medicines can bring them back. Pattern hair loss is progressive, which means it slowly continues unless it is treated, and treatment works best while there is still hair to protect. It is also worth remembering that not all hair fall is genetic. Sudden heavy shedding after a fever such as dengue or typhoid, after childbirth, after surgery, after crash dieting, or along with thyroid problems, low haemoglobin or low iron stores is often reversible once the cause is corrected. Only a proper examination can tell which type you have, and the two are frequently present together.

Diagnosis & Treatment

Treatment starts with finding out what type of hair loss you have, because the same medicine does not suit every cause. The doctor will ask about how long the shedding has lasted, family history, diet, recent illnesses, menstrual cycles in women, medicines you take and products you use. This is followed by an examination of the pattern of thinning, the density of hair in different parts of the scalp, the condition of the scalp skin, and a magnified look at the hair and follicle openings where needed. Blood tests are commonly advised, usually to check haemoglobin, iron stores, thyroid function and vitamin levels, and hormonal tests may be added for women with irregular periods, unwanted facial hair or acne. Photographs at the first visit are useful, because hair changes slowly and memory is unreliable.

Once the cause is clear, the treatment plan is built from a few broad categories. Correcting any underlying deficiency or hormonal problem comes first, since no hair treatment works well on a body that is short of iron, thyroid hormone or protein. Topical therapy applied to the scalp is the usual foundation for pattern hair loss. Oral medication may be advised in selected patients depending on age, sex, severity and other medical conditions, and is always a prescription decision, never a self-purchase. If dandruff or scalp inflammation is present, medicated shampoos and topical treatment for the scalp are added, because a healthy scalp is needed for any regrowth. In-clinic procedures are used in some cases where indicated, and whether they are suitable for you is decided after examination. Timelines matter more than any single product. Shedding usually settles first, often over the first two to three months. Visible thickening takes longer, generally six to twelve months, and progress is judged by comparing photographs rather than by counting the hairs lost on any one day. Pattern hair loss can be controlled and often improved, but it cannot be permanently cured, so maintenance treatment is usually needed to hold the gains.

Know what to expect so that you do not stop too early. Some treatments cause a short increase in shedding in the first few weeks as resting hairs are pushed out to make room for new ones. This settles and is not a reason to abandon treatment. The most common mistakes are stopping the moment things improve, changing products every few weeks because a friend or an online video suggested something new, and buying prescription tablets or lotions from a chemist without supervision. Hair oils, home-made packs, onion juice and expensive salon treatments may condition the hair shaft or feel pleasant, but they do not reverse follicle shrinkage. Equally, be cautious with anything sold with a promise of guaranteed regrowth. Be honest with your doctor about everything you are already using, keep to a single plan for at least six months, protect your scalp from harsh chemicals and very tight hairstyles, eat adequate protein, and come for review as advised so the plan can be adjusted rather than restarted.