Not all hair loss is alopecia
If you have made it this far, you have probably noticed more hair in your brush, in the shower or on your pillow and you are wondering whether it is something temporary or the beginning of something more. It is one of the most frequent concerns we see in our aesthetic and hair medicine practice in Bogotá, and the answer is almost never a single one: hair loss has several possible causes and it is not unusual for two or more to overlap in the same person.
Losing hair every day is normal. Each strand goes through a cycle with growth, transition and resting phases, and at the end of that cycle it sheds to make way for a new one. What really matters to us in the medical evaluation is not so much how many hairs you lose, but whether there is a real loss of density, whether the hair is thinning, whether areas without hair are appearing and whether you have scalp symptoms such as itching, burning, pain, flaking or redness.
So-called seasonal shedding: what applies and what does not in Bogotá
You have surely read that hair falls out more in autumn or in spring. That idea comes from countries with marked seasons and does not translate well to Bogotá, where we do not have that cycle. There may be some variability across the year in the proportion of hair in the resting phase, but it is a subtle and still debated phenomenon, and it should not be the default explanation for shedding that worries you.
Put another way: if you notice a marked increase in shedding, the prudent thing is to look into it, not to wait for the season to pass. A mild, temporary increase can be normal; heavy or sustained shedding, or shedding accompanied by thinning, deserves a review.
Telogen effluvium: when the body sends a signal
Telogen effluvium is a diffuse shedding that appears when many follicles enter the resting phase early and in a synchronized way. There is almost always a trigger: intense physical or emotional stress, surgery, an infection with a high fever, the postpartum period, restrictive diets or rapid weight loss, iron deficiency, thyroid disorders, or starting or stopping certain medications.
There is one detail that causes a lot of confusion: the shedding does not appear on the same day as the event, but some time afterwards, often a couple of months later. That is why part of the work in the consultation is looking back over your history, even at things you had already ruled out as too far in the past. The good news is that acute telogen effluvium tends to recover once the cause is corrected. The caveat: if the trigger persists, the shedding can drag on, and in some women the episode brings to light a female pattern hair loss that had already been progressing silently.
Female pattern hair loss: the thinning that goes unnoticed
It is the most frequent form of alopecia in women and, at the beginning, the hardest to recognize. Here the follicle does not disappear from one day to the next: it gradually miniaturizes and produces hairs that are ever finer, shorter and less pigmented, so density drops little by little and often without noticeable shedding.
The usual pattern in women is diffuse thinning in the central and upper area of the scalp, with a widening part line and, generally, with the frontal hairline preserved. It is not the same as the male pattern. That is why the terminology changed: although androgens are involved, many women with this condition have normal hormone levels, so explaining everything through dihydrotestosterone is an oversimplification. When there is also persistent acne, increased hair growth in unusual areas or irregular menstrual cycles, it is indeed worth studying the hormonal axis. And in perimenopause and menopause it is common for this pattern to become more evident.
Other causes worth ruling out
Before assuming a diagnosis it is worth reviewing other possibilities, some of which need prompter attention:
- Alopecia areata: loss in rounded patches, of rapid onset, which sometimes involves the eyebrows or eyelashes.
- Scarring alopecias (such as lichen planopilaris or frontal fibrosing alopecia): they can cause recession of the frontal hairline, loss of eyebrows, itching, burning or smooth, shiny areas. These are the ones that can indeed leave permanent loss, so they are the most urgent to assess early.
- Traction alopecia: associated with very tight hairstyles, braids or extensions worn over time.
- Trichotillomania and other causes related to hair manipulation.
- Scalp problems: severe seborrheic dermatitis or psoriasis, which add inflammation and flaking.
- Systemic causes and medications: thyroid, anemia, autoimmune diseases, changes to or discontinuation of contraceptives and other drugs. Never stop a medication on your own: that is reviewed with whoever prescribed it.
What we do in the medical evaluation
The consultation begins with a detailed clinical history: when it started, how it has evolved, family history, pregnancies, surgeries, diets, medications, styling habits and scalp symptoms. That interview usually gives more direction than any test.
Next comes the scalp examination and trichoscopy, which is observation under magnification. There we assess the variability in the thickness of the shafts, the signs around the hair, whether the follicular openings are preserved and how the loss is distributed. Standardized photography can also be used to compare objectively over time, and in selected cases a scalp biopsy.
Tests and supplements: with judgment, not as a trend
Lab tests are ordered according to what your case shows, not as the same list for everyone. Depending on the context they may include a complete blood count and ferritin, thyroid function, vitamin D and, only if there is clinical suspicion, a hormonal workup.
About supplements, an important warning: taking them without a demonstrated deficiency does not improve the hair, and some excesses, such as vitamin A or selenium, can make shedding worse. Biotin without a deficiency is not indicated and can also alter the results of several lab tests. The sensible thing is to correct what is documented and not to self-medicate.
Management options according to the diagnosis
In telogen effluvium, the main thing is to treat the cause: correct the deficiency, control the underlying condition, adjust nutrition and support stress management, with the scalp well cared for while the cycle reorganizes itself.
In female pattern hair loss there are topical and oral treatments with evidence behind them, always prescribed and monitored by a doctor. Three things worth being clear about from the start: changes are seen over months, because they depend on the hair cycle; management is ongoing, since stopping it means losing what was gained; and some oral medications are contraindicated in pregnancy and breastfeeding and require contraception and follow-up. The realistic goal is to slow the progression and improve quality and density, not to go back to the hair you had years ago.
Hair PRP consists of obtaining platelet-rich plasma from your own blood to apply it to the scalp; it works through the growth factors in the platelets and does not contain stem cells, even though it is sometimes promoted that way. It can be considered as an adjunct within a plan, bearing in mind that the evidence is still limited, the protocols are not standardized and the response varies from person to person.
Hair transplantation is evaluated in selected cases. In women, the quality of the donor area is decisive and diffuse thinning often limits candidacy. It also does not stop the progression of the alopecia, which is why medical treatment usually continues before and after the procedure.
Signs to book an appointment soon
- Heavy shedding that does not let up after several weeks or that recurs in episodes.
- A part line that is widening or hair that is visibly finer at the top of the head.
- Patches without hair or loss of eyebrows and eyelashes.
- Scalp symptoms: itching, burning, pain, flaking, redness or smooth, shiny areas.
- Recession of the frontal hairline or a change in the shape of the hairline.
- Other associated symptoms: fatigue, weight changes, intolerance to cold or heat, or irregular menstrual cycles.
What to expect realistically
Consulting early does not guarantee results, but it does widen the options: it is easier to keep what you have than to recover what has already been lost. And be wary of any promise of immediate or guaranteed results: hair responds to a biological rhythm, not a commercial one.
This content is informational and does not replace an individual evaluation. If you want to go deeper, you can read more about alopecia, look at what hair PRP involves and find out when a hair transplant is considered.
If you feel that something has changed in your hair, the best step is to put a name to what is happening. We invite you to book an evaluation to review your case calmly and define a plan that suits you.
