Hair loss: when to stop buying products and see a dermatologist

The hair care category has a structural conflict of interest: every product in it is sold by someone who benefits from you not seeing a doctor. This article is written against that interest. Its purpose is to describe the point at which thinning stops being a cosmetic matter and becomes a medical one, so that you spend the money on a consultation rather than a fourth bottle.

It is a cosmetics brand saying this, and that should not make it less true. A single dermatology appointment costs less than three months of the wrong product and produces a diagnosis, which no product can.

Nine signs to book the appointment

1. Shedding that has lasted more than six months without easing. Telogen effluvium from a single trigger resolves in that window; shedding that does not has another cause.
2. A widening centre parting, or a crown that shows more scalp than it did in photographs from two years ago. This is the female pattern of androgenetic thinning, and licensed treatments exist for it.
3. A receding hairline or thinning crown in a man. Same condition, same point: treatments exist, and they work better started early.
4. Smooth, completely bald patches, round or oval, of any size. This is not a shedding pattern and needs prompt assessment.
5. Scalp symptoms alongside the thinning: pain, burning, itching that does not resolve, scaling, redness, pustules, or areas that look shiny and smooth. These suggest inflammation or scarring, and scarring is time-critical.
6. Loss of hair elsewhere: eyebrows, eyelashes, body hair.
7. Thinning with systemic symptoms: fatigue, weight change, feeling cold or hot, changes in your periods, nail changes, a rash. These point to a thyroid, iron, hormonal or autoimmune cause.
8. Sudden onset with no identifiable trigger three months earlier.
9. It is affecting how you live. Distress is a sufficient reason on its own. You do not need to meet a threshold of severity to deserve an answer.

Dermatologist, trichologist, or GP

If the choice is between a trichologist and a dermatologist, and money is a constraint, the dermatologist is the one who can tell you what you have. A trichologist may be a useful adjunct afterwards. Be wary of any clinic, of either kind, that sells its own product line in the consultation room.

What happens in the first appointment

A dermatologist will take a history: when it started, what happened in the months before, your medications, your family history, your diet, your styling. They will examine the scalp, usually with a dermatoscope, a handheld magnifier that shows the follicle openings and the calibre of individual hairs. Pattern thinning shows as variation in hair diameter; telogen effluvium shows as uniform hairs with empty follicles; inflammation and scarring have their own appearances.

They may perform a pull test (gently tugging a small bundle of hairs to see how many release) and will often order blood tests. In uncertain or possibly scarring cases they may take a small scalp biopsy under local anaesthetic, which is the definitive way to see what the follicles are doing. The whole appointment usually takes 20 to 30 minutes.

What to bring

• Photographs. Ideally of your parting and hairline from one, two and five years ago, and a set taken this week in the same light. Memory is unreliable about gradual change; photographs are not.
• A timeline. The month the shedding started and everything that happened in the four months before: illness, surgery, a birth, a diet, a new medication, a bereavement.
• A list of everything you take, including supplements. High-dose vitamin A, selenium and biotin are all relevant.
• Family history. Hair loss in parents, grandparents and siblings, on both sides.
• Recent blood results if you have any.
• The hair from your brush for a day, in a bag, if you want to. Some dermatologists find it useful to see the roots.

What treatment can look like

This is deliberately not a treatment guide. A diagnosis determines the treatment, and the options are prescribed and monitored by the doctor. Broadly, androgenetic thinning has licensed topical and oral treatments with decades of data; telogen effluvium is treated by addressing its trigger; alopecia areata and inflammatory conditions have their own pathways; and scarring conditions are treated to halt progression, which is why speed matters.

Everything in the cosmetic category, this brand included, sits alongside these treatments rather than in place of them. A good cleanser and a calm scalp are compatible with every medical treatment for hair loss. They are a substitute for none of them.