Hair falling out in clumps can be a distressing experience. A small amount of hair loss is normal in the shower or while brushing your locks — healthy people are expected to shed 50-100 strands per day [1]. However, sudden, excessive hair loss can be alarming and may signal an underlying health issue.
Clumpy hair loss can be triggered by several factors, including stress and anxiety, nutritional deficiencies, hormonal imbalances, or certain medical conditions. If you’re experiencing clumpy hair loss, you’re not alone — and there is hope. In this article, we’ll explore:
There are several conditions and factors that may be causing your clumpy hair loss. Here are some of the most common culprits:
Telogen effluvium is a common cause of temporary hair loss, often triggered by severe stress or significant medical events, such as chronic illness, surgical trauma, high fever, and serious blood loss [2].
This condition drives a large number of hair follicles into the telogen (resting) phase simultaneously, leading to noticeable hair shedding 2-3 months after the triggering event [2]. Telogen effluvium is one of the most common causes of rapid hair loss [3], and up to 50% of the scalp hairs can be affected in severe cases [2].
Will my hair grow back? Generally, yes, most cases of telogen effluvium resolve without treatment in six to eight months [3].
Androgenetic alopecia (male pattern baldness or female pattern hair loss) is the most common cause of hair shedding. It affects up to 80% of men and 50% of women at some point in their life [4].
While androgenetic alopecia doesn’t usually cause hair to fall out in clumps, it can cause sudden and noticeable hair loss in some cases. This condition is influenced by age, genetics and hormones, particularly dihydrotestosterone (DHT) [5].
Will my hair grow back? No, unfortunately hair loss from androgenetic alopecia does not grow back naturally, but your shedding may slow or stop altogether.
Alopecia areata is an autoimmune disorder that can cause hair to fall out in round patches. Your white blood cells mistakenly attack hair follicles, causing clumpy hair loss. In severe cases, it can lead to complete hair loss on the scalp (alopecia totalis) or the entire body (alopecia universalis). This condition affects roughly 2% of people at some point in their lifetime [6].
This condition often resolves on its own. However, alopecia areata can be unpredictable and you may experience periods of hair loss and regrowth throughout your life.
Certain mineral and vitamin deficiencies can contribute to hair loss. Iron deficiency, in particular, has been strongly linked to hair shedding. Low iron levels can contribute to telogen effluvium [7], and research suggests iron deficiency is more common in women with pattern hair loss than in those without [8].
Other important nutrients for hair health include vitamin D, zinc, and biotin. Many people turn to hair growth supplements to address these deficiencies, but further research is needed to determine whether these are an effective treatment for hair loss [9].
It’s worth knowing that some supplements carry the risk of toxicity and may even worsen hair loss [9]. Your hair may return once the nutritional deficiency is corrected, but unfortunately, this is not always the case.
Thyroid disorders can cause hair loss because thyroid hormone plays a key role in growing and maintaining healthy hair follicles. Thyroid dysfunction (both overactive and underactive) can lead to hair loss, as well as changes in hair texture and quality [10].
Patients with thyroid disorders may develop dry, brittle hair. The widespread hair loss associated with thyroid dysfunction can affect the entire scalp and, in some cases, body hair and the eyebrows [10].
Hair regrowth is usually possible when the thyroid condition is treated. However, it may take several months and be incomplete [11].
Certain medications can cause rapid hair loss as a side effect. In addition to well-known chemotherapy hair loss, these include [12]:
In most cases, your hair will start to grow back once you stop taking the medication causing hair loss. If this is not an option, your doctor may be able to suggest a more hair-friendly alternative pharmaceutical.
There are many other factors that can cause clumpy hair loss. Other common causes of hair shedding include:
If your hair is falling out in clumps, you need a diagnosis as soon as possible. Hair doctors use several diagnostic trichology tests to determine the underlying cause of clumpy hair loss, which can reveal the reason your hair is falling out and identify any associated medical conditions.
A thorough scalp examination is the first step in diagnosing hair loss. This may include trichoscopy, a non-invasive technique that gives a magnified view of your scalp and hair follicles. A trichoscopy can help differentiate between types of alopecia and assess how active your hair loss is [19].
The hair pull test is a simple way to assess active hair shedding. A positive pull test (more than 10% of pulled hairs coming out easily) may indicate active telogen effluvium or other types of alopecia [20].
This test involves plucking about 20-50 hairs [21] from different areas of the scalp and examining them under a microscope. It helps determine the proportion of hairs in different growth phases.
A normal result is more than 80% anagen (growth phase) hairs and less than 20% telogen (resting phase) hairs [22]. This test can also identify exclamation point hairs, a sign of alopecia areata [23]. Research suggests that trichogram analysis can be particularly useful in diagnosing telogen effluvium and androgenetic alopecia [24].
You may need a scalp biopsy if noninvasive methods don’t provide a clear diagnosis. This involves removing a small section of scalp skin to be examined under a microscope. This type of test is often required for scarring alopecias and other complex hair loss conditions [25].
Blood tests for hair loss can help identify medical conditions that may be causing your hair to fall out [26]. These may include:
Hair transplantation can provide a permanent solution after severe hair loss. It involves moving hair follicles from areas of the scalp with dense growth to areas with thinning or no hair. After several months, these transplanted hairs grow naturally in their new location for a lifetime.
A hair transplant is not the solution when hair is actively falling out in clumps. They are performed when hair loss has stabilised, not during the period of excessive hair loss. A transplant can be considered after the acute hair loss phase is over and when its cause has been established.
Skilled surgeons can perform a natural-looking hair transplant, so it’s possible to get a hair transplant without anyone knowing. This procedure is usually recommended in the following scenarios:
If you have stable androgenetic alopecia and your symptoms have not improved enough with other medication or other treatments, you may be a candidate for hair restoration. Hair transplants are permanent and offer natural-looking results for people with pattern baldness [27].
If you have severe hair loss, you may not be able to achieve a sweeping head of hair with a transplant. However, hair restoration can significantly improve your appearance if you have enough donor hair for harvesting.
A hair transplant may be suitable if your scalp is scarred due to burns, injuries, severe traction alopecia [28], previous surgery, or scarring alopecia. Hairs transplants into scar tissue from burns may be more successful than other types of scarring, possibly because burn scar tissue is usually less deep than other scar types [29]. Artificial hair transplants can also be a good option for scalp scars and burns.
Hair transplantation is generally not recommended if you have active, rapidly progressing hair loss, insufficient donor hair, or highly unpredictable conditions such as alopecia areata that may relapse at any time. A thorough assessment by a hair transplant surgeon is needed to determine whether you’re a good candidate for the procedure.
While a hair transplant can be a great option for severe hair loss, many cases can be managed with non-surgical treatments. These options are often the first line of defence against hair loss and can be used alone or alongside hair restoration for best results.
In cases where a transplant is unsuitable, such as alopecia areata, non-surgical treatments are your best bet. These include:
Minoxidil is a medication that can boost hair growth and slow hair loss for men and women with androgenetic alopecia (and certain other hair loss conditions) [30]. Originally developed as an oral medication for high blood pressure, minoxidil was discovered to increase hair growth when applied topically.
This medication, mainly used for male pattern baldness, works by lowering the levels of DHT in your blood. A long-term study showed that finasteride can effectively prevent hair loss and promote regrowth in men with androgenetic alopecia [31]. It is not approved for use in female pattern hair loss.
Low-level laser therapy devices use red light to stimulate hair growth by increasing cellular activity within hair follicles [32]. These lasers encourage hair follicles to move into the growth phase of the hair cycle, promoting hair growth.
Research suggests it is a safe and effective treatment for hair loss in men and women [32]. LLLT is suitable for most people with non-scarring hair loss, such as androgenetic alopecia.
PRP hair treatment involves injecting a concentrated fraction of platelets from your own blood into your scalp. PRP has been shown to boost hair growth and prevent premature hair loss [33] — 84% of research into PRP for androgenetic alopecia shows a positive result [33].
This treatment has no recovery period, so you can return to your daily activities straight away. However, despite PRP’s high success rate, it is not a permanent treatment for hair loss and ongoing sessions are needed for maintenance every 4-6 months.
For this reason, many people prefer a hair transplant. PRP can be combined with hair restoration surgery to promote quicker recovery and better outcomes [34]
In some cases of severe clumpy hair loss, regrowing your hair may not be possible. However, that doesn’t mean all hope is lost. Scalp micropigmentation (SMP) involves tattooing pigment into the scalp to create the appearance of a fuller head of hair.
While not a treatment for hair loss itself, it can greatly improve its appearance. On a completely bald head, SMP creates the impression of a closely shaved head of hair. Combined with a hair transplant, it can fill areas of low density to give the impression of even more coverage [35].
Seek professional help as soon as possible if your hair is falling out in clumps. Whether you notice diffuse thinning, hair breakage at the crown or increased shedding in the shower, a trichologist can provide expert guidance.
Once you have a diagnosis, our experts can explore solutions with you. These range from non-surgical approaches to hair transplant procedures such as follicular unit extraction (FUE) or follicular unit transplantation (FUT).
The Wimpole Clinic works with some of the best hair transplant surgeons in the UK, who will explain the hair transplant recovery process, hair transplant success rate, and potential hair transplant side effects. They can also provide before and after hair transplant photos to showcase their expertise. Book a consultation at one of our convenient UK clinic locations to learn how you can regain thicker, healthier locks.
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