When to talk to a doctor

You clear the shower drain and look at the clump of hair in your hand. Is this worth an appointment? You don’t want to waste a doctor’s time, and you don’t want to miss something either. The NHS answer is simple: if you’re worried about your hair loss, that’s reason enough to see a GP¹. Often, the doctor can tell what’s causing it just by looking at your hair¹.

Not every sign is equally urgent, though. Some are worth showing within the week, others can wait a few weeks while you keep an eye on them. Here’s how to tell them apart.

What can wait

Losing hair every day is normal: 50 to 100 hairs according to the American Academy of Dermatology (AAD)², 30 to 150 according to the British Association of Dermatologists (BAD)³. Nobody counts them, and the figure mostly tells you that daily shedding is nothing to worry about in itself.

Shedding that comes on suddenly, all over the scalp, about three months after giving birth, a high fever, surgery or a crash diet follows a well-known pattern called telogen effluvium³. Hair falls from everywhere, without leaving patches. The shedding phase lasts 3 to 6 months, then regrowth begins³. The AAD says most people get their normal fullness back within 6 to 9 months². So after the shedding that follows childbirth, you can watch for a while before getting alarmed.

Watching isn’t the same as doing nothing. Write down when it started, look for what happened three months earlier, and take a first photo. If you do see a doctor later, those three things will save time.

Bald patches: get them checked soon

A round or oval, smooth, hairless patch on skin that isn’t swollen or discoloured: that’s often how alopecia areata begins⁴. It can also start in the beard, affect both eyebrows, or the eyelashes of both eyes⁴. In 10 to 20% of people with it, the nails change too, most often with tiny dents⁴.

The AAD lists a bald patch or strip that appears within one or two days among the signs of sudden hair loss⁵. And if the patch is scaly, crusted or oozing pus, it could be an infection⁵: don’t wait on that one.

An itchy, burning or red scalp

It’s easy to blame these sensations on dandruff or a new shampoo. Yet intense itching, burning or tenderness right where the hair is thinning is one of the signs listed by the AAD⁵.

These symptoms can come with scarring alopecias, such as lichen planopilaris. DermNet, the New Zealand dermatology reference, describes itching, pain or burning, redness and scale around each hair at the edges of the patch, and skin where the follicle openings can no longer be seen⁶. The problem is that a destroyed follicle can’t grow a hair again⁷. So treatment needs to start early: it slows the condition down, but it can’t bring back hair that’s already gone⁶.

One caveat: temporary shedding can also make the scalp tender or sore³. A sensation on its own doesn’t mean scarring. Telling the two apart is the doctor’s job, and it’s easier sooner rather than later.

These figures come from a US survey of 1,034 people with scarring alopecia⁸. The authors point out its limits: answers rely on participants’ memories, and they were recruited through a patient charity and were mostly well-off and insured⁸. The real delay may be even longer for people who find it harder to see a doctor.

On a forum, one man describes finding out he had lichen planopilaris after a disappointing hair transplant⁹.

Testimonials posted on the HairLossTalk forum⁹.

Sudden loss, in clumps

Clumps of hair left in the comb, or losing almost all the hair on your head: the AAD classes both as sudden hair loss⁵. These are worth showing to a doctor quickly.

The AAD makes a useful distinction. With excessive shedding, the hair that falls out grows back. With hair loss, something stops the hair from growing, and it carries on until the cause stops². Only an examination can tell you which one you’re dealing with. The causes checked first after rapid hair loss are often simple to look for.

If the shedding follows a new medicine, talk to the doctor who prescribed it. But never stop a treatment on your own: the AAD warns that stopping some medicines abruptly can cause serious health problems⁷.

Shedding that lasts more than six months

The BAD considers temporary shedding chronic when it lasts more than six months³. It can also come back if its cause, such as iron deficiency, isn’t treated³. A blood test can rule out a thyroid problem or low iron³. The six-month mark applies after childbirth or illness too: if the shedding isn’t slowing down, it’s no longer time to wait.

When other signs come with it

Hair loss on its own doesn’t mean the same as hair loss that arrives alongside something else. Talk to a doctor if it comes with:

• extreme tiredness: the French Society of Dermatology (SFD) lists the thyroid and iron deficiency, common in women, among the causes to look for¹⁰ (see the deficiencies that make hair fall out);
• irregular periods or other hormonal signs: an excess of male hormones, as in polycystic ovary syndrome, can play a part¹⁰;
• hair loss elsewhere: eyebrows, eyelashes, beard, nose hair or pubic hair⁵.

And if your hair loss is getting you down, that’s a reason in its own right. The NHS says a GP may be able to arrange counselling if it’s causing you distress¹.

Slow thinning: not urgent, but don’t leave it for years

Temples receding a little each year, a widening part, a thinner ponytail: these early signs of pattern hair loss don’t call for an appointment this week. Pattern hair loss progresses slowly, over years or even decades, and faster when it starts early¹¹.

No rush, then, but no reason to wait years either. As the AAD puts it, if you need treatment for regrowth, the earlier you start, the more likely you are to see regrowth¹². To work out which doctor to see about hair loss, starting with your GP is usually simplest.

Photos that show what’s changing

The man on the forum realised from old photos what the mirror hadn’t shown him. That’s the idea: slow thinning or a spreading patch is hard to see from one day to the next, and easy to see from one month to the next, as long as the pictures are comparable.

With Calvap, you take one photo a week, always from the same spot. Your previous photo appears as a see-through overlay so you can line up exactly the same way, across the seven zones of the scalp. A journal sits alongside to note anything that might matter, such as a fever, a new medicine or a product you’re trying.

After a few weeks, you can see whether the shedding is slowing, an area is thinning or a patch is growing. And if you book an appointment, you show the doctor dated photos. Your photos stay on your phone.