Three months into treatment for weight, there are handfuls of hair in the shower drain and more of it on the pillow. Nothing else about you has changed that you can see. Shedding after a change to the body runs a course with a length to it, and separately there is a list of nine things that get a clinician rather than more waiting. Read your own head against that list and you can tell which of the two you are in.
Shedding that follows a shock to the body — an illness, an operation, childbirth, crash dieting — usually eases over six to eight months and is usually temporary. You may not notice it for weeks to months after the thing that set it off, which is why it can seem to arrive at a point when you feel perfectly well. What changes the answer is anything on the scalp itself, a bare patch or a pattern instead of a spread, or four whole-body symptoms that belong to a thyroid running slow. The first two get looked at. The last gets a blood test.
What is happening to your hair, and how long it runs
What is happening is that a large share of your hair moved into its shedding phase at once: physical or emotional stress may cause one half to three quarters of scalp hair to shed. You may not notice it for weeks to months after the episode that caused it. Shedding then decreases over six to eight months, and while it is usually temporary, it can become long-term. It has a name — telogen effluvium — and saying it on the phone saves you a paragraph of description.
Set that against an ordinary day, which costs you roughly 50 to 200 hairs. What you are seeing is more of something that happens anyway, arriving all at once, rather than something new starting.
What MedlinePlus names as setting it off includes high fever or severe infection, childbirth, major surgery, major illness, sudden blood loss, severe emotional stress, crash diets — especially ones without enough protein — and a number of prescription medicines. Hair loss also sits among the reactions reported most often by people taking one of the FDA-approved products in this class, which means a prescriber has somewhere to put it when you report it.
Which items on that list get a blood test
One item on it gets a blood test: weight gain, intolerance to cold temperatures, or fatigue. Those three are also symptoms of an underactive thyroid, alongside dry or thinning hair, joint and muscle pain, heavy or irregular periods, a slowed heart rate and depression. What settles it is a thyroid blood test, usually starting with the one that measures thyroid stimulating hormone.
Here is the whole list of what to contact a provider about, nine items, so that none of it reaches you as a selection:
- Losing hair in an unusual pattern
- Losing hair rapidly or at an early age
- Pain or itching with the hair loss
- Skin on the scalp under the involved area that is red, scaly or otherwise abnormal
- Acne, facial hair, or an abnormal menstrual cycle
- Male pattern baldness in a woman
- Bald spots on the beard or eyebrows
- Weight gain or muscle weakness, intolerance to cold temperatures, or fatigue
- Areas of infection on the scalp
Every item there is checked somewhere other than the drain. Six of the nine are about where the hair is leaving from and what the skin under it looks like, one is about how fast and how young, and two are about the rest of your body. The one that gets a blood test and the six that get a look at your scalp are the same appointment, so the list travels in one piece.
The findings that point somewhere other than shedding
The findings that point somewhere other than shedding are the ones with a place attached to them. Shedding after a change to the body comes off the whole head, half to three quarters of it, so a bare patch, a receding line, a sore or scaly area, or a gap in a beard or an eyebrow is worth describing by where it is. The amount is not what those items are asking about.
Time is the other one. Shedding decreases over six to eight months, so hair coming out as heavily at nine months as it did at three is the thing to raise rather than keep waiting out, and it is the case the long-term half of the description was written for.
A prescription you already take can be the cause as easily as the weight can, since medicines are on the same list as surgery and illness. Bring everything you already take to the appointment, including what you buy without a prescription, because the person deciding whether to test you is working from what you hand over.
Between now and month eight
- Write down roughly when the change was — the operation, the illness, the birth, the point at which the weight started coming off. Six to eight months is counted from there.
- Look at your scalp in good light, at the parting and at the crown, for redness, scaling, sore spots or a bare patch.
- Check your eyebrows, and your beard if you have one, for bald spots.
- Note whether you have gained weight, felt the cold more, tired more easily or lost strength since the shedding started. Those four travel together on the phone.
- Take the nine-item list with you as a list, rather than raising whichever item you remember first.
- Ask for a thyroid blood test by name if that fourth item fits you.
- Bring the names of everything you take, prescribed or not.
What you are seeing in the drain started weeks before it became visible, so the six to eight months is counted from the illness, the operation or the weight coming off, and not from the first bad shower. Write down roughly when that was, and you have a date to measure against instead of a feeling that this has been going on forever.
