Hair fall (telogen effluvium / androgenic alopecia)

Losing 50-100 hairs a day is normal. Losing visibly more than that — clumps in the shower, visible thinning of the parting, receding hairline — deserves an evaluation. Most cases in our OPD turn out to have one or more of a small set of treatable causes.

Common causes

• Telogen effluvium — a stress-induced shedding where a large fraction of hairs synchronously enter the shedding phase. Triggered by: severe illness, surgery, childbirth (postpartum hair fall), significant weight loss, severe emotional stress, certain medications. Usually self-resolves over 6-9 months.
• Iron deficiency — extremely common in Indian women. Often co-exists with fatigue.
• Thyroid disease — both hypo- and hyperthyroidism cause diffuse hair fall.
• PMOS / hormonal imbalance — androgen-pattern hair thinning of the crown / parting.
• Vitamin D and B12 deficiency — common contributors.
• Androgenic alopecia (male / female pattern baldness) — genetic, gradually progressive. Different pattern in men (receding hairline + crown thinning) vs women (diffuse crown thinning, hairline usually preserved).
• Alopecia areata — discrete bald patches, autoimmune in origin.
• Tinea capitis — fungal scalp infection, more common in children.

Standard workup

For new hair fall at Asian Hospital we do: CBC + ferritin (iron stores) + TSH + vitamin D + B12 + zinc. For women with possible androgen pattern we add the hormone panel from the PMOS workup. Total ~₹2,500-3,500.

Treatment

Reversible causes (iron, vitamin D, thyroid, B12) — supplementation usually restores hair within 3-6 months. Telogen effluvium — patience; reassurance; address the trigger; usually self-resolves. Androgenic alopecia — minoxidil (topical, sometimes oral), finasteride (in men), micro-needling, PRP (platelet-rich plasma) in selected cases. Severe cases — referral to hair-transplant specialist.

Hair fall is one of those problems where being seen early matters: catching iron deficiency or thyroid disease in the first 3-6 months prevents prolonged thinning. Don't wait for "winter shedding to settle".