Why is my hair falling so much?

Hair fall arrives with a particular kind of distress. It is visible, it accumulates in evidence around the house, and it is often met with advice about oils and shampoos when the cause sits well below the scalp. A hair follicle is a demanding, fast-dividing structure fed by the bloodstream. It responds early to nutritional shortfall, hormonal change and physiological stress — which makes heavy shedding a genuinely useful clinical signal.

The first distinction is between shedding and thinning. Shedding is more hair coming out than usual, all over, with the density looking broadly even. Thinning is hair becoming finer and sparser in particular places — the parting widening, the crown showing, the hairline receding. They point in different directions, and many people have both.

Iron deficiency. The most common correctable cause in India, especially in women of reproductive age, adolescents and people eating predominantly plant-based diets. Iron from vegetarian sources absorbs less efficiently, tea or coffee with meals reduces absorption further, and heavy periods deplete stores steadily. Follicles feel this before haemoglobin does, so a normal haemoglobin with a low ferritin genuinely matters here.

Thyroid disease. Both underactive and overactive thyroid cause diffuse hair fall. Hypothyroidism is common in Indian women and usually brings fatigue, cold intolerance, dry skin, constipation and weight change alongside. Hair recovery after treatment is real but slow — often three to six months behind the blood test.

Telogen effluvium — the delayed reaction. A high fever, dengue, typhoid, COVID, surgery, childbirth, a crash in weight or a period of severe emotional strain pushes a large batch of follicles into the resting phase together. They shed two to three months later, which is why the shedding often begins just as the person feels recovered. It is self-limiting and typically settles over six to nine months.

Hormonal thinning. In PCOS, raised androgens produce thinning at the crown and parting alongside irregular periods, acne and facial hair. Androgenetic thinning also occurs independently of PCOS, in both men and women, and follows a recognisable pattern. Around menopause, falling oestrogen changes hair density and texture for many women.

Nutritional shortfalls beyond iron. Low protein intake — genuinely common in Indian diets built around cereals — vitamin D deficiency, vitamin B12 deficiency and low zinc all contribute. Rapid weight loss and very restrictive eating are frequent triggers.

Medicines and scalp conditions. Some blood-pressure medicines, retinoids, certain antidepressants, chemotherapy and hormonal treatments cause hair fall. Scalp disease matters too: seborrhoeic dermatitis and psoriasis produce scaling and itching; fungal infection is common in children; and traction from tight ponytails, braids and repeated chemical straightening causes loss along the hairline that becomes permanent if it continues.

Two patterns are different in kind and are worth naming. Smooth, round bald patches appearing over days suggest alopecia areata, an autoimmune process. Loss with scarring, shine or loss of follicle openings needs early specialist review, because that kind of loss does not regrow once established.

ⓘThis information is educational and not a diagnosis.

Most hair fall is diffuse, has an identifiable cause, and recovers when that cause is addressed. Some patterns need earlier attention.

Arrange prompt review for smooth, round bald patches appearing over days or weeks; for a scalp that is scaly, painful, oozing or has broken skin; and for any area where the skin looks shiny or scarred where hair used to grow. That last one is time-sensitive, because treatment aims to preserve what remains.

Loss of eyebrows, eyelashes or body hair alongside scalp hair points to a systemic cause and warrants assessment rather than topical treatment. So does rapid thinning accompanied by acne, a deepening voice or new facial hair growth in a woman.

Hair fall with heavy periods and breathlessness or dizziness suggests significant iron deficiency and deserves an early blood count. And shedding that began within weeks of starting a new medicine is a conversation to have with the prescribing doctor rather than a reason to stop anything on your own.

Beyond these, it is reasonable to be seen when shedding has continued beyond three months, when the scalp is becoming visible, or when hair fall comes with fatigue, weight change or irregular periods.

Get a baseline you can compare against. Photograph the parting and the crown in the same light every month — hair changes slowly enough that memory is a poor judge, and this is how you will know whether something is working. Note when the shedding began and what happened two to three months before that, since the trigger usually sits in that window.

Test before treating. A reasonable first panel is a complete blood count with ferritin, thyroid function, vitamin D and vitamin B12, with testosterone and metabolic tests added where PCOS is being considered. These are inexpensive and widely available in India, and they redirect a great deal of spending away from products that were addressing the wrong problem. Hold off starting iron supplements before the test, since they change the result.

Meanwhile, reduce the avoidable load. Loosen tight hairstyles and give heat and chemical straightening a pause. Treat scalp itching and flaking rather than tolerating it. Make sure protein is actually present at each meal — dal, curd, paneer, eggs, fish, chicken — because hair is largely protein and cereal-heavy plates often fall short.

Expect slow feedback. Even when a cause is corrected, visible improvement usually takes three to six months, because that is how long the follicle cycle takes. That is a reason for patience rather than for switching treatments every few weeks.