Hair loss is one of the most heavily marketed problems in medicine, and one of the most poorly diagnosed. Before asking what to take, the more useful question is what kind of hair loss this is — because the answers differ completely.
Shedding some hair daily is normal. What matters is a sustained change in density, a receding or widening pattern, or hair coming out in clumps.
The main patterns
- Pattern hair loss — the most common by far. Gradual, follows a predictable distribution, driven by genetics and hormones. Recession and crown thinning in men; widening of the part with a preserved hairline in women
- Telogen effluvium — diffuse shedding across the whole scalp, typically two to three months after a trigger such as illness, surgery, childbirth, significant weight loss, or severe stress. Usually self-limiting
- Alopecia areata — discrete round patches of complete loss. Autoimmune, and it behaves quite differently from the other two
- Traction alopecia — loss along the hairline or wherever tension is applied, from tight styles worn over years. Reversible early, permanent late
- Scarring alopecias — less common, but the follicle is destroyed, so early recognition genuinely changes the outcome
The reason this list matters: a treatment appropriate for pattern loss does nothing for a scarring alopecia, and time spent on the wrong one is time the follicle does not get back.
What to rule out first
Diffuse shedding in particular warrants a look for a cause rather than a straight jump to treatment. Thyroid dysfunction, iron deficiency, significant nutritional shortfalls, recent illness, new medications, and in women conditions such as PCOS all show up in the hair. Correcting an underlying cause often does more than anything applied to the scalp.
Treatments with real evidence
For pattern hair loss, a small number of options have genuine trial support. Topical minoxidil is available over the counter and works for a meaningful proportion of people. Oral treatments that act on hormonal pathways are effective for appropriate patients but are prescription-only, differ between men and women, and carry considerations — including serious ones in pregnancy — that make them a prescriber conversation.
For alopecia areata, treatment is aimed at the immune process, and newer options have changed what is achievable in more extensive disease.
Two honest caveats. First, these treatments maintain and partially restore — they work far better on follicles that are miniaturising than on ground that has been bare for years. Second, they need to be continued; stopping generally returns you to the underlying trajectory over the following months.
What the evidence does not support
Most of the market. Shampoos marketed for regrowth, biotin supplements in people who are not deficient, laser combs, and the majority of ingestible hair products have little or no meaningful evidence for pattern hair loss. Biotin deserves a specific mention: it is rarely deficient in people eating normally, and it interferes with several common lab tests including thyroid and cardiac assays, which causes real diagnostic confusion.
The timeline
Any legitimate treatment needs six months before it can be fairly judged, and often shows increased shedding in the first weeks as follicles cycle. Anything promising results in a fortnight is selling something.
When to get assessed
Sooner rather than later, particularly if loss is patchy, rapid, accompanied by scalp pain, redness, scaling or itch, or if the scalp looks smooth and shiny where hair used to be. Those features point toward diagnoses where early treatment matters. Hair loss assesses well virtually with good photographs and a careful history, and bloodwork can be arranged where it is warranted.
