September and October are our busiest months for hair-fall consultations. Patients arrive panicked — handfuls in the shower, hair on the pillow, on every chair. Most of these cases are not permanent loss. But the rate of shedding is alarming, and that alarm itself drives a lot of mistakes.
Telogen effluvium vs. genetic hair loss
Two very different conditions, often confused:
Telogen effluvium (TE)
A reactive shed. Triggered by a stressor — illness, monsoon's humidity-and-fungus combo, post-COVID, post-pregnancy, sudden weight loss, severe iron deficiency. Hair sheds 2-3 months after the trigger event. Reverses on its own in 3-6 months. Patients shed from all over the scalp evenly.
Androgenetic alopecia (AGA)
Genetic, patterned, progressive. Temple recession in men, widening part-line in women. Doesn't reverse without intervention. Often co-exists with TE — which is why a sudden monsoon shed can reveal underlying AGA that was being hidden by overall density.
Counting strands isn't the metric. We look for: bald patches, scalp showing through the part-line, density change in temple/crown, and family history.
First-line workup
Before we recommend any treatment, we usually order:
- CBC (rules out anaemia)
- Ferritin (the iron stores number — total iron alone isn't enough; ferritin under 50 ng/mL is often the cause)
- TSH and free T4 (thyroid)
- Vitamin D (often low in indoor-life patients across India)
- Trichoscopy in the clinic — a painless scalp scan with a magnifier
What works, in order of evidence
Topical minoxidil — the most studied, most reliable option for both TE and AGA. Six-month commitment minimum. Stopping reverses gains.
Oral therapy — for AGA, not for everyone, supervised. Conversation about side-effect profile happens before prescription, never after.
PRP / GFC scalp injections — adjunct, not replacement. We use them on AGA patients in early-to-moderate stages, alongside topicals. We don't recommend them for pure TE — your follicles aren't sick, they're just shedding faster than usual.
Nutritional correction — fixes deficiencies. Won't reverse genetic loss. We get this question a lot; the answer is usually "yes, take iron if low, but don't expect that alone to bring density back."
If you've been losing more than your usual amount for over 8 weeks, book a trichology assessment before starting yet another over-the-counter shampoo. The plan that works depends on the diagnosis — and the diagnosis takes 20 minutes in clinic.
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