It’s a Tuesday morning. You’re leaning over the bathroom sink, rinsing your face, and then you see it. A tangled nest of strands clogging the drain. You might feel a quick jolt of panic. Is this normal? Honestly, we all lose about 50 to 100 hairs a day, but when the clumps start looking thicker than usual, your brain immediately starts spiraling. You start wondering about what makes hair fall out and whether you’ll have anything left to brush in six months.
Hair isn't just protein and pigment. It’s a signal.
When your body is stressed or your hormones are doing a chaotic dance, your scalp is often the first place to report the news. But the internet is full of junk advice. No, wearing a hat every day isn't making you bald. And no, washing your hair too often isn't the primary culprit either. The reality is usually more clinical, and sometimes, way more fixable than you’d think.
The Shock to the System: Telogen Effluvium
Sometimes the reason your hair is shedding has nothing to do with your genes and everything to do with a calendar. About three months ago, did something big happen? Maybe a high fever, a brutal breakup, or a massive surgery?
This is called Telogen Effluvium.
Basically, a major physical or emotional shock pushes your hair follicles into a "resting" phase prematurely. Instead of growing, they just sit there. Then, a few months later, they all decide to leave the party at the same time. It’s scary because it feels sudden. You aren't going bald in the traditional sense; your body just hit the pause button on non-essential functions to focus on survival.
Dr. Shani Francis, a board-certified dermatologist, often points out that this type of shedding is temporary. Your hair isn't "gone"—it’s just cycling. Once the stressor is removed and your body recalibrates, the growth usually resumes. But if you’re constantly stressed? That cycle never gets to reset. You’re stuck in a loop of shedding that feels permanent even though it technically isn’t.
The Hormone Factor and DHT
If we're talking about long-term thinning, we have to talk about Androgenetic Alopecia. This is the big one. It’s what people usually mean when they talk about male or female pattern baldness.
It’s mostly about a hormone called Dihydrotestosterone (DHT).
Think of DHT as a relentless landlord. It attaches itself to the hair follicles in people who are genetically predisposed and starts shrinking them. The hair grows back thinner, shorter, and more brittle every time until the follicle basically closes up shop. For men, this usually starts at the temples or the crown. For women, it’s often a widening of the part or a general "see-through" quality to the hair under bright lights.
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- Men: Receding hairline, "M" shape, thinning at the top.
- Women: Diffuse thinning, visible scalp, smaller ponytail diameter.
It’s not just "testosterone" causing this. It’s how your specific follicles react to it. Some people have high testosterone and a full head of hair; others have very little and lose it all by twenty-five. Genetics is the dealer here, and you’re just playing the hand you were dealt.
Nutrition: Are You Starving Your Scalp?
You can’t build a house without bricks. You can’t build hair without the right nutrients. I’ve seen so many people try expensive serums while they’re barely eating enough protein or iron. Your hair is made of a protein called keratin. If you aren't eating enough protein, your body decides that keeping your hair is a luxury it can’t afford.
Iron deficiency is a massive, often overlooked reason for what makes hair fall out, especially in women.
Ferritin is the protein that stores iron in your body. If your ferritin levels are low (even if you aren't technically "anemic" yet), your hair growth can stall. You need that iron to carry oxygen to the cells that repair and stimulate your follicles. Then there’s Vitamin D. Most people in modern offices are deficient. Research published in the journal Dermatology Practical & Conceptual suggests that low Vitamin D levels are linked to Alopecia Areata and other forms of shedding.
Don't just start popping pills, though. Too much Vitamin A or Selenium can actually cause hair loss. It’s a delicate balance. Get a blood panel. Know your numbers before you buy a random gummy vitamin from an Instagram ad.
The Immune System’s Friendly Fire
Sometimes your body gets confused. In the case of Alopecia Areata, your immune system literally attacks your hair follicles. It thinks they are foreign invaders, like a virus or bacteria.
This usually shows up as perfectly smooth, round bald spots.
It’s unpredictable. Sometimes it’s one spot that grows back in a few months. Sometimes it spreads. According to the National Alopecia Areata Foundation, this affects millions of people regardless of age or gender. It’s often linked to other autoimmune issues like thyroid disease or vitiligo.
Treatment here isn't about "hair vitamins." It’s about calming the immune response. Dermatologists often use corticosteroid injections directly into the bald spots to tell the immune system to back off. It’s a medical issue, not a cosmetic one.
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Traction and Style: The Silent Killer
We need to talk about braids, buns, and extensions.
Traction Alopecia is caused by constant, localized pulling. If your ponytail gives you a headache, it’s probably killing your hair. Over time, that constant tension scars the follicle. Once a follicle is scarred, it’s done. It won't grow hair again.
This is especially common in communities that favor tight protective styles or for people who use heavy hair extensions year-round. The weight of the extension pulls on the natural root. Day after day. Week after week. Eventually, the root just gives up.
Switch it up. Wear it down. Give your scalp a break. If you notice tiny bumps or soreness at the hairline, that is your early warning sign. Listen to it.
The Thyroid Connection
The thyroid is the master regulator of your metabolism. When it’s out of whack—either too fast (hyperthyroidism) or too slow (hypothyroidism)—your hair reflects that.
Both conditions can cause widespread thinning across the entire scalp.
The hair often feels different too. Hypothyroidism can make hair dry, coarse, and prone to breaking. Hyperthyroidism might make it feel incredibly fine and soft, but it falls out easily. Usually, once the thyroid medication is balanced, the hair starts to return, though it takes a long time. Hair grows slow. Patience is the hardest part of the recovery process.
Medications You Might Not Suspect
You’d be surprised how many common pills list hair loss as a side effect. It’s rarely the first thing doctors mention.
- Beta-blockers: Often used for blood pressure or anxiety.
- Blood thinners: Like warfarin or heparin.
- Antidepressants: Specifically some SSRIs.
- Acne medication: Isotretinoin (Accutane) is a known trigger for some.
- Cholesterol drugs: Certain statins.
If you started a new med and noticed a shed about two to four months later, there might be a connection. Never just stop taking your heart meds because of your hair, but definitely bring it up with your doctor. Often, there’s an alternative drug that won’t mess with your follicles.
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Scalp Health: The Soil Matters
You can't grow healthy plants in toxic soil.
Seborrheic dermatitis—basically "super dandruff"—isn't just itchy and flaky. The inflammation associated with it can actually damage the hair follicle. If you have a thick, oily buildup on your scalp, it can trap bacteria and cause folliculitis.
Inflammation is the enemy of growth.
Using a ketoconazole shampoo (like Nizoral) or a tea tree oil treatment can help clear the "debris." Some studies even suggest that ketoconazole might help block DHT on the scalp surface, giving you a double benefit. Keep the scalp clean. Avoid heavy silicones that clog pores if you’re prone to breakouts on your head.
Environmental Factors and Aging
Let’s be real: aging is part of it. As we get older, our hair follicles naturally spend more time in the resting phase and less time in the growth phase. The strands themselves get thinner. This is "senescent alopecia."
Environmental pollution also plays a role. Smoke, UV rays, and hard water minerals can oxidize the hair shaft and weaken the structure. It makes the hair look like it’s falling out because it’s snapping off mid-way. That's breakage, not shedding, but the result looks the same in the mirror.
Actionable Steps to Take Right Now
If you are worried about what makes hair fall out, don't just sit there and worry. Panic raises cortisol, and cortisol... well, it makes hair fall out.
- Get a Full Lab Panel: Ask for Ferritin (iron stores), Vitamin D, Zinc, and a Full Thyroid Panel (TSH, T3, T4). Don't let them tell you "it's within range" if you're at the very bottom of that range. For hair growth, you often need "optimal" levels, not just "surviving" levels.
- Check Your Protein: Aim for at least 0.8 grams of protein per kilogram of body weight. If you're active, you need more.
- Lower the Heat: Stop the daily 450-degree flat iron sessions. You're cooking the protein bonds in your hair.
- Massage Your Scalp: It sounds woo-woo, but mechanical stimulation can increase blood flow to the follicles. Do it for four minutes a day while you’re watching TV.
- See a Specialist: If you see "scarring" (smooth skin where pores used to be), get to a dermatologist immediately. Scarring alopecia is a race against time.
The most important thing to remember is that hair loss is rarely caused by one single thing. It’s usually a "perfect storm" of stress, nutrition, and genetics. Address the low-hanging fruit—your diet and stress—while you investigate the deeper medical causes with a professional. Most people wait too long to act. Early intervention is the difference between a temporary shed and a permanent change.