Why is my hair falling out? Six surprising causes of hair loss

Hair loss becoming a cause for concern? If you're wondering why your hair is falling out, we’re here to help.

Whilst stress and the menopause might often be to blame, there are some other reasons behind hair thinning and shedding that you didn’t know about.

Dr Sharon Wong is a Consultant Dermatologist at London Bridge Hospital (part of HCA UK). Here she shares 6 surprise explanations as to why your hair might be falling out.

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1. Trichotillomania

What is issue?: Otherwise known as the hair pulling disorder, this is related to a range of underlying psychological factors including anxiety, depression and post-traumatic stress disorder (PTSD). ‘It can happen at any age and in both sexes, although more commonly in women,’ says Dr Wong. She adds that the act of hair pulling typically leaves odd-looking patches of hair loss at different lengths, usually on the same side as the person’s dominant hand. ‘Hair pulling provides momentary relief from the underlying stress which positively reinforces the repetitive habit.’

The fix: Dr Wong explains: ‘In most children who have trichotillomania, the hair pulling is mild and usually the habit stops on its own accord over time. In adolescents and adults trichotillomania is usually more severe and the causes more deep rooted. Treatment involves a lot of supportive care and needs to be directed at the underlying complex psychological issues. Psychotherapists may use a number of techniques such as habit reversal and cognitive behavioural therapy to help patients with this condition.’

2. An unhealthy scalp

What is issue?: You might not often think to care for your scalp’s skin, however, just like plants need healthy soil to flourish, our hair needs a healthy scalp to thrive. Dr Wong reveals that common conditions such as eczema, psoriasis and infections like ring worm often affect the scalp and whilst not directly damaging the hair follicles, the inflammation in the surrounding skin from these conditions can upset the hair growth cycle, resulting in hair loss.

The fix: If your scalp is looking and feeling red, inflamed, itchy, flaky and sore it is time to see your GP or Dermatologist to have the condition formally assessed, diagnosed and treated. ‘The longer scalp rashes are left untreated the more likely your hair will suffer as a result,’ says Dr Wong. ‘Typically conditions like eczema and psoriasis will settle very quickly with medicated (usually steroid-containing) shampoos or liquids. Fungal infections of the scalp are standardly treated with a course of oral anti-fungal tablets and anti-fungal shampoos.’

3. A febrile illness

What is issue?: ‘Any illness which causes a high fever can shock the hair follicles out of sync,’ says Dr Wong.‘Febrile illnesses such as the flu, glandular fever and indeed Covid can trigger more hair follicles to transit prematurely into the shedding phase. This increase in hair shedding is known as telogen effluvium and often appears 2 to 3 months after the initial trigger.’

The fix: Whilst the amount of hair that is shed and the resultant volume loss can be quite dramatic, the hair usually recovers over time without any treatment. Dr Wong does explains that it’s important to not over-stress about the hair loss as the stress and anxiety this generates can easily become all-consuming, and if anything drive further hair shedding, and delaying your recovery. ‘Typically you should start to notice the hair shedding slow down 6-9 months after recovery from the illness with a gradual return of the volume of hair.’

4. A vegan diet

What is issue?: The number of people following a vegan diet in the UK has quadrupled from 150,000 to 600,000 between the years 2014 and 2019. ‘This shift in dietary preference has meant specialists are seeing more people with nutritional deficiencies and or dramatic weight loss resulting in hair shedding,’ explains Dr Wong. She adds that certain nutrients such as iron are significantly less well absorbed from plant sources compared to meat sources and therefore iron deficiency is commonly seen amongst vegetarians and vegans and is a frequent cause for hair shedding and thinning. ‘Unlike a febrile illness, which is usually a one-off acute event, dietary choices are usually long term and so therefore, such individuals may be prone to repeated episodes of hair shedding and often require long term supplementation to help with this.’

The fix: ‘See your GP or dermatologist for a blood test to check for specific nutritional deficiencies such as iron, vitamin D and zinc which may need supplementing. There is no evidence that taking over-the-counter hair/nail supplements without a proven deficiency in the first place will make any difference to your hair growth,’ says Dr Wong. She adds: ‘If newly transitioning to a vegan diet consider consulting a nutritionist to ensure that you adopt a well-balanced diet that maximises all the macro and micronutrients your hair follicles require and importantly a diet that is maintainable in the long term.’

5. Hard water

What is issue?: Around 60 per cent of the UK is classed as having hard water, which is dictated by the quantity of calcium carbonate and magnesium sulphate in the water. Although washing your hair in hard water won’t necessarily cause hair loss, Dr Wong does explain that in can change the texture of the hair. ‘It will be noticeably different compared to washing in soft water. The hair may look and feel dry and rough due to the deposition of the minerals onto the surface of the hair fibre.’

The fix: ‘The extent that hard water affects hair texture varies from person to person,’ says Dr Wong. ‘Some people notice very little change but if this does cause significant problems with hair texture and manageability of your hair, a simple solution could be to use a clarifying shampoo as a deep cleanse to remove the mineral deposits (as well as product build-up, grime and dirt) several times per month.’ Want softer water without having to relocate to another spot in the UK? Hello Klean is a shower filter brand that actually helps remove chlorine, heavy metals, chemicals, and other impurities from your shower water. Revolutionary! A filter costs £56 – Check them out here!

5. Contraceptives

What is issue?: It might be time to check your pill as some types of synthetic progesterones act like male hormones (androgens) in the body, which can exacerbate hair loss in some women, whose hair follicles are more sensitive to the effects of sex hormones.Dr Wong explains: ‘Oestrogens have a more hair-protective effect and therefore combined contraceptives (which have both oestrogen and progesterone) are less likely to cause an issue with your hair compared to the progesterone only preparations such as the minipill.’

The fix: If you have experienced hair shedding with the mini-pill it would be worth discussing with your GP a switch to the combined pill or to opt for a non-hormonal contraceptive such as the copper coil.

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