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Guide

Hair loss: when it's normal and when to be concerned

Everyone loses hair — the question is how much, for how long, and in what pattern. This guide helps you distinguish physiological shedding from a sign that warrants medical assessment.

Clinically reviewed by Dr Fátima Garcês, Clinical Director of Replace Clinic — 20 years dedicated to hair restoration.

Key points

  • Up to 100 hairs a day is considered normal

  • Shedding that lasts more than 3 months warrants assessment

  • The pattern of loss (diffuse or localised) guides the diagnosis

The hair cycle

Each follicle alternates between three phases: anagen (growth, 2 to 7 years), catagen (transition, a few weeks) and telogen (rest and shedding, around 3 months). At any given time, 85% to 90% of hairs are in the growth phase.

Shedding becomes a problem when the proportion of follicles in telogen increases, or when the hairs that grow back are progressively finer.

Warning signs

These signs indicate that shedding has gone beyond normal and warrant a consultation:

  • Visibly increased loss for more than three consecutive months
  • Scalp more visible in light, or a progressively wider parting
  • Thinner, more brittle hair, or hair that doesn't reach its usual length
  • Bald patches, redness, flaking, pain or itching
  • Shedding accompanied by fatigue, weight changes or menstrual changes

What tests to run

Assessment begins with clinical history and trichoscopy. Depending on the picture, blood tests are requested, including full blood count, ferritin, thyroid function, vitamin D, zinc and, in women, hormone profile.

Identifying a deficiency or thyroid dysfunction completely changes the treatment plan — which is why treating without diagnosing rarely works.

Available treatments

Once systemic causes have been corrected, targeted hair treatment includes hair mesotherapy, PRP, topical or oral therapy and photobiomodulation. In cases where no viable follicle remains, FUE hair transplantation restores density permanently.

In every case, progress is assessed with standardised photography at 3, 6 and 12 months — not by how many hairs seem to end up on the hairbrush.

Hair loss in women

In women, hair loss rarely creates bald patches: it's noticed mainly through a widening parting, a thinner ponytail and diffuse thinning at the top of the head. The most frequent causes are telogen effluvium (post-partum, restrictive diets, surgery, stress), iron deficiency, thyroid dysfunction and female pattern hair loss, which worsens during perimenopause.

Since two causes often coexist, effective treatment first corrects the systemic factor and only then — or in parallel — addresses the scalp itself.

Seasonal shedding and stress-related shedding

There's a physiological increase in shedding in autumn and, to a lesser extent, in spring: more follicles enter their resting phase at the same time. It lasts a few weeks and doesn't reduce overall density.

Stress-related shedding has a characteristic delay of two to three months between the triggering event and when the hair actually falls out — which is why many people don't connect the two. It's reversible once the trigger resolves.

What to do at home (and what's not worth it)

Some habits help, but none replace a diagnosis when shedding is persistent.

  • Maintain a diet with enough protein and correct deficiencies confirmed by blood tests
  • Wash your hair as often as needed — washing less doesn't reduce shedding, it just builds it up
  • Avoid tight hairstyles, excessive heat and repeated harsh chemical treatments
  • Be wary of shampoos, ampoules and supplements that promise to stop shedding without a diagnosis
  • Photograph the scalp under the same light and angle month to month to assess it objectively

Frequently asked questions

Is hair loss in autumn normal?
Yes. There's a physiological seasonal increase in shedding in autumn, which lasts a few weeks and doesn't reduce overall density. If it persists for more than three months, it should be assessed.
Is hair loss in women treatable?
Yes. Treatment starts by identifying the cause — iron, thyroid, hormones or an androgenetic component — and combines correcting the systemic factor with mesotherapy, PRP or therapy prescribed in consultation.
Does washing your hair every day make it fall out more?
No. Washing simply releases hairs that had already detached from the follicle. Spacing out washes concentrates the shedding into a single day, giving the false impression that it has worsened.
How many hairs is it normal to lose per day?
Between 50 and 100. Above that, sustained for more than three months, it warrants assessment.
Is post-partum hair loss normal?
Yes. It's a telogen effluvium triggered by the post-partum hormone drop and usually resolves between 6 and 12 months. If it persists, it should be assessed.
Do vitamins fix hair loss?
Only when there's a documented deficiency. Supplementing without a deficiency doesn't increase density and can even be harmful in excess.
Can I have hair loss treated in an online consultation?
The first assessment can be carried out by videoconsultation, including reviewing photographs and requesting tests. Some treatments then require an in-person visit to the clinic in Lisbon.

An assessment with Dr Fátima Garcês

In person in Lisbon or by video consultation, with a treatment plan and 18 months of follow-up care.

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