Hair loss in autumn: normal or a reason to go to a trichologist

Why hair falls out more in the fall

Hair growth occurs in cycles. The hair grows for several years (anagen phase), then growth stops, and the hair remains in the follicle without growth for 2–3 months (telogen, or resting phase), after which it falls out, and a new one begins to grow in its place. Normally, about 90% of the hair on the head is in the growth phase, and about 10% is in the resting phase.

According to a Swiss study in which trichograms (analysis of hair roots under a microscope) were performed on healthy women with complaints of hair loss, the proportion of hair in the resting phase is maximum in the summer and minimum in late winter. Since it takes 2-3 months from the transition to the resting phase to shedding, the summer peak of telogen is manifested by increased shedding in the fall.

The reason for the seasonality of the cycle has not yet been established. A moderate increase in hair loss in autumn in a healthy person is normal. The amount of hair lost and the duration of the period matter.

How much hair is lost per day normally?

The American Academy of Dermatology calls 50–100 hairs per day normal, with reviews on telogen effluvium finding an upper limit of 100–150. The number depends on the thickness of the hair and the frequency of washing your hair: when washing once every three days, the hair that has accumulated over three days will fall out.

There is no need to count hairs individually; dermatologists have objective guidelines:

• Hair pull test: the doctor gently pulls a small section of hair. If more than 10% of the hairs come out easily, this indicates active shedding.
• Wash test: do not wash your hair for 5 days, then wash it over gauze and count the hair that has fallen out. More than 100 hairs speaks in favor of telogen loss

What is telogen effluvium and why does it lag

Telogen effluvium: The most common cause of diffuse (even throughout the scalp) hair thinning. A strong load on the body immediately transfers part of the growing hair into the resting phase, and the proportion of telogen hair increases from the usual 10–15% to 30% and higher. This hair does not fall out immediately, but after the resting phase ends, after 2–3 months. Therefore, when complaining in October, the cause is sought in the events of July.

What triggers telogen effluvium:

• Illness with high fever, surgery, major blood loss
• Childbirth: postpartum prolapse begins after 2–3 months and goes away on its own
• Severe stress
• Strict diets and rapid weight loss
• Deficiency of iron, protein, zinc, vitamin D
• Diseases of the thyroid gland, both with a decrease and with an increase in its function
• Starting or stopping certain medications: hormonal contraceptives, systemic retinoids, beta blockers, antithyroid drugs

In some cases, the cause cannot be determined. Acute telogen effluvium stops on its own when the effect of the trigger ends: it subsides within 3–6 months, the previous thickness is restored after another few months, and there are no drugs that accelerate this process. If the loss continues for more than 6 months, they speak of a chronic form, and in this case the cause must be looked for.

How is it different from androgenetic alopecia

Androgenetic alopecia (female pattern hair loss) develops differently. This is not a one-time hair loss, but a gradual miniaturization (thinning): the follicles in the parietal zone, due to hereditary sensitivity to androgens, form thinner and shorter hair with each cycle until it becomes vellus. Hence the differences:

• With telogen effluvium, there is a lot of hair on the comb, but the parting does not widen, and the hair throughout the head is approximately the same thickness
• With androgenetic alopecia, there may be little hair on the comb, but the parting widens and the parietal zone thins, and the hairline above the forehead is preserved. More often it appears after 50 years, but often at 30–40 years

Both conditions can be combined: seasonal loss makes visible hereditary thinning that was previously not noticeable. It is impossible to distinguish them visually; this requires trichoscopy.

Warning Signs: When It's Out of Season

Seasonal and telogen hair loss are uniform and are not accompanied by scalp changes. Contact your doctor immediately if you notice:

• Lesions: Round or oval hairless areas with clear boundaries. This is how alopecia areata, an autoimmune disease, manifests itself; in some patients it is accompanied by changes in the nails
• Itching, burning, pain, redness or flaking of the scalp along with hair loss. This is how cicatricial alopecia can begin: the follicle is destroyed, and hair no longer grows in this place. The sooner you stop inflammation, the more hair you can save
• Displacement of the hairline above the forehead and at the temples, thinning of the eyebrows, smooth shiny skin in place of the hair. These are signs of frontal fibrosing alopecia, which occurs mainly in women after menopause.
• Widening of the parting and thinning of the parietal zone, which increases over months
• Loss lasting longer than 6 months, especially in combination with weakness, cycle disorders, changes in body weight

What a trichologist checks

Trichologist: A dermatologist who specializes in diseases of the hair and scalp. The diagnosis in most cases is made at an appointment, without a biopsy. What is included in the examination:

• Questioning about the last six months: illnesses, surgeries, childbirth, diets, new or discontinued medications, stress, time of onset of hair loss and its dynamics. This is an essential tool because the telogen effluvium trigger is always in the past
• Scalp examination and tension test
• Trichoscopy (examination of skin and hair under magnification). It shows whether the hair is the same thickness (with androgenetic alopecia there are many thin ones), whether there is short growing hair (a sign of recovery), yellow and black spots (characteristic of alopecia areata), inflammation around the follicles
• Trichogramma: several dozen hairs are removed and the growth phase of the roots is determined under a microscope. More than 25% of hair in the resting phase confirms telogen loss
• Tests: complete blood count, ferritin, TSH, if necessary, thyroid hormones and antibodies to it, vitamin D. A scalp biopsy is rarely performed if cicatricial alopecia is suspected

Iron and ferritin are tested first in women with hair loss. More details about them, with a list of tests, can be found in the magazine article on constant fatigue.

Why vitamins “for hair” without deficiency do not help

The logic “hair loss means you don't have enough vitamins” is wrong for two reasons. Firstly, if there was already a trigger (illness, childbirth, diet), the hair loss will stop on its own, and supplements will not speed up this process. Secondly, the supplement only works in cases of confirmed deficiency: a 2019 review of vitamins and minerals for hair loss found reasons to replenish iron and vitamin D in cases of deficiency, but found no evidence for taking it “just in case.”

Separately about biotin. Its deficiency in people with a normal diet practically does not occur, and there are no studies in which biotin would help people without deficiency: the described cases of the effect concern patients with impaired biotin metabolism or rare pathologies of hair and nails. At the same time, biotin in supplements “for hair, skin and nails” is hundreds of times more than the daily requirement, and in such doses it distorts the results of laboratory tests: the FDA warns about erroneous results of troponin (a marker of heart attack) and hormonal tests, including the thyroid gland. If you are taking biotin, tell your doctor before getting tested.

Excess is also harmful: an overdose of vitamin A and selenium itself causes hair loss. The order is as follows: first tests, then supplements, and only those whose deficiency is confirmed.

When it's time to see a doctor

Moderate seasonal hair loss without other symptoms can be observed: note the start date, photograph the parting and parietal area in the same lighting and compare after 2-3 months.

It's worth making an appointment with a trichologist if:

• Hair loss lasts longer than 3 months and does not improve
• Lesions have appeared, the parting has widened, the eyebrows are thinning or the hairline is shifting
• There is itching, pain, flaking or redness of the scalp
• You're already taking hair vitamins and want to know if you need them

You can start by consulting a trichologist. If tests are needed based on the results of the examination, the clinic has a program for identifying and correcting deficiencies. Further tactics depend on the diagnosis: with telogen effluvium, the main thing is to establish and eliminate the cause; with androgenetic alopecia, the doctor selects long-term therapy; with focal and cicatricial alopecia, inflammation is treated.

Clinic servicesConsultation with a trichologist · Identifying and correcting deficiencies