When is hair loss not normal? Daily shedding and the signs to watch for

How many hairs a day is it normal to lose?

For most people, losing about 50–100 hairs a day is considered normal. These hairs finished their growth period long ago and have reached the end of the resting phase. The same follicle (hair root) usually starts growing a new hair. That is why, even though you lose some hair every day, the overall density of your hair does not noticeably decrease.

Each root on the scalp works on its own schedule: it produces a hair for years, rests for a few months after a short transition and then lets go of the old hair. The roots do not go through this cycle all at the same time but independently of each other. We describe the phases in our article on the hair growth cycle.

The number varies from person to person. Shed hair is more noticeable for people with long or thick hair. Hairs that are ready to fall out often come loose when you wash or comb your hair, which is why you notice shedding most at these times. The daily amount can also vary a little from one period to another; short, mild ups and downs often pass on their own.

You do not need to count the hairs you lose one by one; the daily number cannot be measured reliably at home. What matters more is whether anything has changed compared with what is normal for you. If the shedding clearly increases over a few weeks, is concentrated in one particular area or comes with symptoms on the scalp, you should talk to a doctor.

Shedding, hair loss or breakage?

In everyday speech, all of these are lumped together as “hair falling out”; in fact, different processes and different causes lie behind them.

Taking a close look at a hair that has fallen out can give you a clue. A hair that has come out from the root often has a small, light-colored knob at one end. This is usually a hair that has completed the resting phase, and it does not mean that the root is gone. A broken hair has no such knob, and the piece is often shorter than the length of your hair. This is not a definite way to tell them apart, but it makes it easier to describe to your doctor what you have seen.

Common causes of breakage

With breakage, the problem is often not in the root but in the hair itself: as the outer layer of the hair wears away, the hair weakens and snaps. Frequent heat styling; treatments such as coloring, bleaching, perms or chemical straightening; combing wet hair roughly; and pulling the hair back tightly can all add to this damage.

Hair that is pulled back tightly for a long time can also lead to thinning along the hairline (traction alopecia, that is, hair loss caused by pulling). If you notice this, wear your hair more loosely and talk to a doctor. Breakage is sometimes also linked to a health problem such as a fungal infection of the scalp; see a doctor especially if you notice short, broken hairs in a flaky patch on a child’s scalp.

Which signs mean you should see a doctor?

The signs below do not always mean that there is a serious problem; however, they show that the cause of the hair loss should be looked at by a doctor, preferably a dermatologist.

Hair falling out in patches

Round or oval bald patches with a smooth surface that suddenly appear on the scalp, eyebrows or beard may suggest alopecia areata (sometimes called spot baldness). Similar patches can also have other causes; a doctor tells them apart. You can find the details in our article on alopecia areata.

Symptoms on the scalp

If the hair loss comes with itching, burning, pain or tenderness, redness, marked flaking, crusting or pimple-like bumps, the scalp needs to be examined. If the skin in a bald area looks shiny and you cannot make out the tiny openings the hairs grow from, this is also a finding that should be assessed early. In scarring (cicatricial) hair loss, damaged roots often do not produce hair again; that is why early diagnosis and treatment can help preserve the remaining hair.

Shedding that increases within a short time

When the amount of hair you see in the shower, on your comb or on your pillow clearly increases over a few weeks, one common reason is telogen effluvium (many hairs entering the resting phase at the same time). This shedding often starts around two to three months after an illness with a high fever, giving birth, surgery, severe stress, rapid weight loss or a change in medication; once the trigger is gone, it often eases within months. Our article on telogen effluvium covers this type of shedding in more detail.

Even so, it is a good idea to see a doctor to confirm the cause and to look into conditions that may accompany it, such as thyroid problems or iron deficiency. An assessment is especially important if the shedding lasts longer than six months or if your hair is coming out in clumps. If the shedding started after a new medication, do not stop taking it on your own; talk to the doctor who prescribed it.

A widening part and thinning

A part that keeps getting wider, a ponytail that gets thinner, more of the scalp showing at the crown under bright light, or a hairline receding at the temples often suggests androgenetic alopecia (hair loss linked to a genetic predisposition); a similar appearance can also have other causes. This usually progresses slowly and is not urgent; however, an early assessment lets you discuss the options with your doctor in good time. For men, see our article on male pattern hair loss, and for women, our article on female pattern hair loss.

Other symptoms that come with it

If the hair loss comes with tiredness, unexplained weight changes, irregular periods, increased hair growth on the face or body, acne, changes in your nails or hair loss elsewhere on your body, tell your doctor about them. Hair loss in children should also always be assessed by a doctor.

What can you note down before you see a doctor?

The following information makes it easier to find the cause during the examination:

• When you first noticed the hair loss, and any illness, surgery, childbirth, severe stress, strict diet or medication changes in the two or three months before
• All the medications and supplements you take
• Whether anyone in your family has hair loss
• Photos of your part, crown and hairline, taken every few weeks in the same light and from the same angle
• Your hair care habits: treatments such as heat styling, coloring, bleaching or straightening, and wearing your hair pulled back tightly

Do not start a prescription medication on your own during this time. Whether the medications used for hair loss are suitable for you is determined by your doctor’s assessment. The evidence that vitamin and mineral supplements help with hair loss when there is no deficiency is limited. High doses of biotin can affect the results of some blood tests; if you take a supplement that contains biotin, tell your doctor before the test.

What is not certain?

• There is no exact limit for normal shedding. Losing 50–100 hairs a day is a commonly used rough range. Shedding a little above this number does not always mean there is a problem, and shedding below it does not prove that everything is fine.
• More than one cause can be present at once. Increased shedding can make genetic hair loss in its early stages more visible; telling the two apart requires an examination and, if needed, follow-up over time.
• What you notice at home is no substitute for a diagnosis. In addition to the examination, the doctor uses trichoscopy (examining the scalp with a magnifying device) when needed and may request blood tests or, less often, a biopsy (a small tissue sample from the scalp).

What do we look at during the examination?

When you come to us with hair loss, we first listen to your history. Together, we look at when the shedding started, whether it has spread across the whole head or is concentrated in certain areas, differences in thickness between hairs, and the condition of your scalp.

We do not diagnose from photos or messages. If your hair is falling out in patches, you have symptoms on your scalp, heavy shedding has started recently or there is no clear cause, a dermatologist first needs to clarify the cause. While heavy shedding is going on, it is also difficult to see the true density of your hair; that is why we recommend postponing a hair transplant until the shedding has settled down and its cause is understood.

The temporary loss of some of the transplanted hair or the hair around it in the weeks after a hair transplant is a separate matter; this is called shock loss. After the procedure, the written instructions we give you always take precedence over general information.

Whether you are suitable for a hair transplant is determined during the examination, and results vary from person to person.