Dermatologist Debriefs

Hair Loss: The Questions You’ve Been Afraid to Ask

• Stefanie Williams

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Are you noticing more hair in your brush or shower and wondering if it’s normal? Join Dermatologist Dr Stefanie Williams as she answers your most pressing questions in a fast paced and insightful session that debunks myths and reveals actionable facts. Discover why hair loss often goes unnoticed at first, how many hairs you lose each day, and why early intervention is so important. Dr Stefanie explains the full spectrum of causes—from stress to genetics—so that you can spot warning signs and make informed decisions. You’ll also learn when home solutions are enough and when to seek professional help. 

Whether you’re worried about your hair or just want to keep it healthy, this episode provides reassurance, knowledge, and practical advice to help you protect and revitalize your hair now and for the future.

Speaker 1:

Dermatologist debriefs. Join no-nonsense dermatologist Dr Stephanie Williams as she debunks myths and shares her professional insights, separating facts from fiction in just a few minutes.

Speaker 2:

Today we are doing something a little bit different. I thought I would do a quiz with you, so I'm going to talk you through 10 questions about hair loss, because hair loss is very prevalent at the moment. We see loads of it at Udello and some of these questions, I think, will be surprising. So here we go. First question what percentage of hair volume loss typically has to be lost before it becomes visibly noticeable to the average person? And I think you'll be surprised about the answer, which is 30 to 50 percent. So that's really high and I think most people wouldn't have guessed that. So, basically, when the rate of hair shedding outnumbers the rate of hair regrowth, then of course the density of hair on our scalp declines. Obviously, however, diffuse hair loss can occur very gradually over months or even years before becoming even visible to the naked eye. And only when 30 to 50 percent of the total volume of our hair is lost, only then the hair thinning becomes actually noticeable to the average person. So this gradual nature of hair loss really means that most people do not immediately recognize changes to their hair growth cycle. But of course, the earlier hair loss is diagnosed and treated, the better the outcome is diagnosed and treated, the better the outcome. So that means that you know, by the time we notice, we may have lost one third of our hair already, and that's why it's so important to really see whether you notice any changes in the pattern of hair loss. So do you see more hair coming out? Do you see more hair in the shower after washing? Do you see more hair in your brush after brushing? So if that happens, then my suggestion is to not just say, oh well, I can't see a difference on the in the density of my hair on the scalp, so it's probably nothing to worry, but to get it looked at and start a treatment as early as you can.

Speaker 2:

And question number two is which factors do actually influence hair loss? And of course that's. This is not a simple answer. There's quite a few things, and hair loss can be influenced by factors including, of course, inheritance and genetics, also hormonal imbalances such as an excess of male hormones, acute or chronic stress, vitamin or mineral deficiencies and various endocrine diseases like low thyroid function, for example. And then there are also certain times of hair loss that are caused by autoimmune reactions. So this is when our own immune system attacks the hair follicle. Examples of this are the patchy alopecia areata, lupus or lichen planopilaris. So all of these are autoimmune reactions that cause hair loss, and these types of hair loss require a very different treatment approach. So it's really vital to get an accurate hair loss diagnosis rather than just assuming it's probably stress or it's probably hormones. And these forms of autoimmune hair loss usually require prescription treatment and there are very good treatment options available. But the first point is to get a correct diagnosis.

Speaker 2:

But coming back to one of the more common types of hair loss, which is a so-called telogen hair loss, this is question number three. So how long after, say, a severe illness or a very stressful life event, will you typically notice the hair loss, so the increased hair fall? And the answer is that it's often not immediately after the event, but usually the increased hair fall happens two to four months later. And the reason is that in telogen hair loss the hair follicles prematurely shift from the growing phase, which is called anagen, into the resting phase of the hair cycle that's called the telogen. This resting phase and this shift over does not cause immediate hair loss but, as I mentioned, typically occurs maybe two, three or four months after this triggering event, because it takes about two, three or four months for the hair cycle to complete and for the affected hairs to be shed when they enter this premature resting phase, to be shed when they enter this premature resting phase.

Speaker 2:

Question number four what is actually the maximum number of hairs you normally lose every day? Because, of course, our hair goes through a constant cycle of shedding a certain number of hairs and regrowing them again. So some degree of hair loss is completely natural, and the answer is that it's completely normal to lose up to about 100 hairs per day. So the average person has about 100,000 hair follicles, so losing 100 hairs per day represents about 0.1% of your total hair count, and those hair follicles that shed a hair will then go on to regrow a new hair. And as long as the rate of the hair shedding and the hair regrowth is in balance, the overall hair density remains completely unchanged, although you're losing about 100 hairs every single day. But it's when you lose more than 100 hairs per day, that's when we have an excess shedding and that's when the hair density, very likely, gradually, will go down. So in this case, it's really advisable to seek help for early diagnosis and treatment, and, of course, this is when we're talking about diffuse hair loss, but if your hair loss is occurring in patches like, for example, alopecia areata, rather than diffusely all over the scalp, then of course, seek professional help straight away.

Speaker 2:

So, coming to question five and speaking about treatment diagnosis and treatment the question is who is the most qualified professional to diagnose and treat hair conditions or hair loss conditions? So the answer is actually a dermatologist, not a trichologist, and that might be surprising. So a dermatologist is a fully qualified medical doctor, of course, with extensive training and diagnosing and treating not only hair diseases but also scalp and hair conditions. So a dermatologist has completed a full medical degree and then went on to do many years of postgraduate specialist training in dermatology. So overall it takes about 10 years to become a dermatologist. And in contrast to a dermatologist, a trichologist is actually, surprisingly, not a medical doctor and therefore they can't prescribe prescription treatment. Prescription treatment and to become an accredited trichologist, you can do this even with a part-time degree. Most of it will very likely even be remote learning. So it's a very, very different type of degree and you are not allowed in the UK to prescribe prescription medication for patients.

Speaker 2:

If you are a trichologist and now you may be asking the question isn't a transplant surgeon the most expert doctor for treating hair loss, and they are very, very experienced, obviously, with the surgical treatment of hair loss, so ie hair transplants, but they are not an expert in how to treat hair non-surgically. So that would be the dermatologist treating that. In contrast, a general practitioner, a GP, is a generalist doctor. A GP is a generalist doctor, so they know a lot about different medical specialties, but they don't know as much about skin and scalp and hair diseases as a dermatologist. So for that reason, the answer is a dermatologist, which brings us to question number six.

Speaker 2:

So what type of treatments might a dermatologist actually recommend for hair loss? So, to start with, they would actually diagnose your hair loss condition, as mentioned. This is really vital. So they would take a thorough medical history, they might arrange some diagnostic tests and finally arrive at a diagnosis and then create a personalized treatment plan, and this may include home treatments like, for example, prescription strength scalp tinctures or even oral treatments in the form of tablets, scalp tinctures or even oral treatments in the form of tablets. There may be some tailored nutritional supplements as an adjunct as well. There may be some low-level laser light, and then there are also a range of in-clinic treatments available to help with hair growth. So those are things like, for example, platelet-rich plasma, exokine or exosome therapy, mesotherapy and other types of in-clinic treatments, but generally we would typically combine those with prescription strength treatments, either topically or orally treatments either topically or orally.

Speaker 2:

My question number seven is if your hormone blood levels are completely normal so say, your doctor tested your hormones and they are fine, there's no excess testosterone is it still be possible that your type of hair loss is a hormonal type hair loss and it is surprisingly so? Even if you had a blood test and your hormones in your blood are completely fine, your hair loss can still be caused by hormonal imbalances. This is called an androgenetic type of hair loss and that is because your hair follicles may simply overreact locally to regular levels of male hormones in the bloodstream. So in that case we might still treat with topical antiandrogens, so something that lowers the influence of male hormones, and that treatment might still be successful, although your hormone blood tests were completely fine all along. Question eight is is genetic testing potentially helpful for hair loss? So blood testing is definitely helpful. We can test different things, from hormones to mineral and vitamin levels.

Speaker 2:

But how about genetic testing, which is typically done with a swab from the inside of your mouth, and the answer is yes. Actually, that can give us some very interesting additional information about your type of hair loss and what treatment may or may not be successful. So hair loss related genetic testing analyzes multiple relevant genetic variations, called SNPs or single nucleotide polymorphisms, and that's across various metabolic pathways relating to hair loss, and there is one of those SNPs that can, for example, predict whether you are a likely responder to minoxidil. So minoxidil is a very common topical treatment for hair loss, something you can get over the counter in the drugstore, so a lot of people are using this as a first call if they notice hair loss. But most people don't know that only about 40% of patients will actually regrow some hair with minoxidil, and that's because only 40% of patients are genetically responders to minoxidil. So this is really useful for testing beforehand and, rather than wasting four months of treatment on something that we could have told you straight away is not going to be successful, to start with something else that has more likely success because, like with hair loss, which typically occurs two to four months after the triggering event, the regrowth of hair also shows a delay of response. So once we start with the treatment, we also have to try this type of treatment for about two to four months before we can really judge it clinically. Because of the length of the hair cycle, as mentioned, it takes a little while to show a response and also for any hair loss to occur.

Speaker 2:

The next question, question number nine, is a very important one in my opinion. So the question is does hair loss cause scarring on the scalp? And the answer is not every type of hair loss, but there are some forms of hair loss which are scarring forms of hair loss. So as dermatologists we actually distinguish between a cicatrial alopecia, which is a scarring type of hair loss, and a non-scarring type of hair loss. A non-scarring type of hair loss, and whether your type of hair loss causes scarring on the scalp or not depends very much on the cause of the hair loss, ie the diagnosis. So scarring hair loss can be caused by some autoimmune and inflammatory scalp conditions like, for example, lichen planopilaris or frontal fibrosing alopecia, and the scarring occurs when inflammation permanently destroys hair follicles and replaces them with scar tissue.

Speaker 2:

Thankfully, the non-scarring types of hair loss are more common, and that's good, because scarring hair loss is irreversible. Once you've lost that hair and the hair follicle has scarred over, there is no way to get that hair follicle back. So that's why it's so important to get a diagnosis early and get started on treatment early. And that brings us to our last question, which is are all forms of hair loss reversible? And of course you will guess now probably that the answer is no, because there are some forms of hair loss, namely the scarring hair loss type, where the hair follicle is permanently destroyed, as mentioned.

Speaker 2:

Thankfully, non-scarring forms of hair loss, such as hormonal or stress-related hair loss, are non-scarring and can be reversed with effective treatment, as long as we are starting early enough. So that's really important, even for non-scarring hair loss. And the reason is that in advanced cases of, for example, hormonal hair loss, where the hair follicle over time becomes smaller and smaller, this is called atrophy. Eventually that hair follicle will also give up producing a hair for good. And then there is another form of hair loss called traction alopecia, which is when you have very tight hairstyles and over time the hair follicle gets weaker and weaker and eventually this hair follicle also gives up. And what you will see in this, in this form of traction alopecia, is that your hairline very, very slowly recedes and once that has happened again, although it's not strictly speaking one of the scarring types of hair loss, it can still be permanent if treated too late.

Speaker 2:

So, in summary, most types of hair loss are reversible, which is great, but early diagnosis and treatment are really critical to prevent a permanent hair thinning. So if you notice an increased hair loss, make sure you see a doctor early, ideally a dermatologist, for proper diagnosis and initiation of treatment. I hope this made sense. Treatment. I hope this made sense. If you've got any other questions about hair loss, do maybe post them on social media, on the udello clinic account, and I might do another one of my podcasts about hair thinning and hair loss with additional questions. Questions.