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Hair Shedding vs Hair Loss vs Hair Fall

Updated: Sep 7, 2023

Can you spot the difference between these phrases: "hair shedding", "hair loss", and "hair fall"? As a Philosophy major, one of my courses was the Philosophy of Language. Identifying the use of language and connecting it to meaning and intent should be taught to every physician. These phrases are used by different people, sometimes influenced by cultural perceptions, to convey an experience with hair. Read more...



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Photo: Wix

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Does it really matter if it's hair shedding, hair loss, or hair fall - don't they all just mean that there is less hair than we want?

Losing hair is a very personal experience. How the hair falls out actually tells me a lot about what may have triggered the loss in the first place. The language patients use to express the loss of hair tells me a bit more about their perception, experience, and the impact it has had on them emotionally. So, yes, they all mean less hair but the only way I can help is to get to the bottom of why it's happening in the first place.

Video: Techei

What does "Hair Shedding" mean to you?

Hair shedding suggests cycling change of hair growth whereby the hair shifts to the resting phase out of the active growth phase. The hair sheds after a new hair pushes it out of the follicle with a noticeable whitish bulb at the end of the hair shaft. This is something we notice or witness occurring. The volume of hair loss is less obvious. The amount lost is not necessarily dramatic but more than routine. Seasonality may play a role and the anxiety patients have tends to be less as the experience is not new and past recovery has been noted.

How about "Hair Loss", how is this different?

Ultimately if hair is shedding or falling out, there will be loss of hair. "Hair loss", in my experience, when patients use this phrasing are referring not to how it fell out but what is left behind. They tend to be commenting on the lack of volume and a quality change in the hair left behind that tends to be finer and wispier, less manageable overall.

To diagnose what led to this moment, examining the scalp closely, looking for patterns of hair loss, inflammation, scaling, and stages of residual hair development can give me a sense of possible causes.

What is "hair fall"?

The phrase "hair fall" tends to be something I hear from my patients of South Asian culture. The experience that many of my patients will related when they use this phrase is that of sudden significant volume loss of hair. There tends to be a clear distinction of how much volume of hair was present before versus currently. This phrase is often followed by "I used to have thick hair" and "I'm afraid to wash my hair because it feels like it will just come out so easily".

This is a very upsetting experience given how personal hair is to our sense of self and identity and the concerns that many people may have linking hair loss to a reflection of internal health.

What is actually occurring to trigger the volume loss of hair?

Generally speaking, in the absence of inflammation or other underlying triggers, there is a cycle change in hair growth from the active growth phase to the resting phase. This can be triggered by a natural process or a particularly stressful experience, event, illness, or other stress on the body. Our hair is pretty deeply rooted in the scalp and will stay there for a few months even if not actively growing until new hair growth comes along and pushes out the old hair. The new hair will be fine, wispy, almost peach fuzz like.

This is the point that most people come to see me. This is when the difference in before and after is its most obvious and very upsetting for many people. The irony is that this is technically the recovery phase. This is when new hair is technically growing in. But, this hair is like baby hair and not as obvious in terms of filling in the areas of volume loss.

Hair grows like a blade of grass, it starts off tapered and gets thicker as it grows longer. This is when improvement will be noted.

Is it normal to experience more shedding at certain times (seasons, stress, etc)?

Shedding is commonly noted after a stressful incident. Note the word after, not during. This is what makes it challenging for people to connect the dots from stress to shedding. The delay can be on the order of months adding to stress or concerns as the belief is that the stress is in the past but the loss is current. This is a byproduct of the delay in the release of the hair from the follicle based on new growth pushing it out. Seasonal shedding is well documented as well for a variety of potential triggers. I have come across studies even suggesting vitamin D drops in the fall may be a potential relation although causality has not been established.

How much hair shedding is considered too much?

The best answer to how much shedding is too much is likely whatever you notice as outside of what you are used to. This varies widely. The traditional response is it is normal to lose 50 to 200 hairs a day. Practically speaking, most people note when something is not normal for them. I prefer the gauge of personal perspective because I worry that focusing on numbers makes patients feel that their concerns have been dismissed without recognizing that there is a discernible change in their experience. I also recognize that there is no true way to count the daily loss for the simple fact that it is not lost in the shower or loss on the brush alone. It is a cumulative loss that can be noticed in the shower, on brushes, on our clothes, on our pillow, etc.

Video: Techei

It's hard to know what 100-200 hairs look like, what are other signs people can look for when identifying problematic shedding?

The appearance of 100 to 200 hairs varies based on the length and quality of hair lost. Truly, most people know their day to day normal. If something is not your normal, it is time to talk to your Dermatologist.

When should someone see a doctor?

For prolonged periods of shedding or shedding that leads to a noticeable difference in the appearance of the scalp, it is very reasonable to seek the care of a Dermatologist to verify there are no other causes, triggers, or reversible changes in blood work that should be evaluated. The stress of hair loss leads to more hair loss so even if it is to just get peace of mind, it is worth talking to your Dermatologist.

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