Most hair loss in adults is androgenetic alopecia, and it is common enough to be unremarkable: up to about half of men and half of women are affected, and it is the most common cause of hair loss there is.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. That does not make it a cosmetic footnote. It is a progressive condition with a known mechanism, a recognisable shape and a timeline that can be described in advance.
What follows is the hair cycle and what goes wrong with it, how a shedding episode differs from a pattern, what a doctor assesses, and the correctable causes worth ruling out first. It is written for women and for men, because female pattern hair loss is the most common cause of hair loss in women and looks nothing like the male version.Source 6: Thinning hair and hair loss: could it be female pattern hair loss? American Academy of Dermatology Association.
Why does hair fall out at all?
Because shedding is how hair works. Every follicle runs a cycle of its own: a long growing phase, a brief transition, a resting phase, and then the old hair is pushed out as a new one grows in beneath it.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. Losing between 50 and 100 hairs a day is normal, and most of it goes unnoticed.Source 1: Hair loss. NHS, United Kingdom. Page last reviewed 24 January 2024.
The growing phase, anagen, is the one that decides how long hair gets. It runs for two to six years, and at any given moment roughly 80 to 90 percent of scalp hair is in it.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. The resting phase is a matter of months. Because the follicles are not synchronised with one another, the turnover is spread thinly across the whole scalp and stays invisible.
How can you tell ordinary shedding from a pattern that will continue?
By timing, by distribution and by what happened three months earlier. Shedding, or telogen effluvium, is diffuse, comes on relatively abruptly, and follows a trigger by about three months, with a range of one to six.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024. Pattern loss is gradual, follows a shape, and has no single event behind it.
- Telogen effluvium. Hair comes out across the whole scalp rather than in one region, usually after a fever, a severe infection, major surgery, childbirth, an underactive thyroid, crash dieting or iron deficiency.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024. It is a reactive process, it is self-limiting, and by definition the acute form runs its course in under six months.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024.
- Androgenetic alopecia. The loss follows a distribution. In men it starts at the temples and the crown; in women the frontal hairline is typically spared while density falls across the top of the head and the central parting widens.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. It arrives over months and years, not weeks, and it does not stop by itself.
There is a crude but genuine measure of the first one. Collecting every hair shed over 24 hours and finding 100 or more suggests telogen effluvium rather than ordinary turnover.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024. Repeated weekly, it shows whether the shedding is settling.
The two are not alternatives, which is the part that catches people out. A shedding episode frequently unmasks a pattern that was already quietly underway, particularly in women.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. Hair that does not recover its density in the months after one is worth a proper assessment rather than another year of waiting.
What does pattern hair loss look like in women?
Not like the male version, which is the single reason it goes unrecognised for so long. Female pattern hair loss is the most common cause of hair loss in women, and the hairline usually stays where it is. What changes is the parting, which widens, and the density across the top of the scalp, which falls.Source 6: Thinning hair and hair loss: could it be female pattern hair loss? American Academy of Dermatology Association.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024.
It most often begins in midlife, in a woman’s forties, fifties or sixties, and it can begin earlier.Source 6: Thinning hair and hair loss: could it be female pattern hair loss? American Academy of Dermatology Association. Its incidence rises noticeably after menopause.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. It is progressive, so women do tend to keep losing hair, but they do not go completely bald the way some men do.Source 6: Thinning hair and hair loss: could it be female pattern hair loss? American Academy of Dermatology Association. In the United States alone it is estimated to affect around 30 million women.Source 7: Androgenetic alopecia. MedlinePlus Genetics, National Library of Medicine, National Institutes of Health.
Two things follow. A widening parting is a clinical finding rather than a vanity. And the female picture carries associations the male one does not: androgen-related hair loss in women is linked with polycystic ovary syndrome.Source 7: Androgenetic alopecia. MedlinePlus Genetics, National Library of Medicine, National Institutes of Health. A doctor assessing a woman is therefore looking at more than the hair.
Why does acting early matter more than acting hard?
Because of how the condition damages a follicle. Androgen receptor activation shortens the growing phase a little more on each successive cycle, so the follicle miniaturises: every hair it makes is finer and shorter than the last, until what it produces no longer reaches the surface in any visible way.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. Follicles are not lost in an event. They fade, over years, on a schedule nobody feels happening.
Alopecia divides into two groups, and the division decides everything. In non-scarring alopecia, which is by far the more common, the follicles are preserved and the loss is potentially reversible. In scarring alopecia the follicles are irreversibly destroyed and the loss is permanent.Source 4: Syed HA, Zito PM. Alopecia. StatPearls, NCBI Bookshelf. Last updated 26 February 2024. A follicle still making a hair, however fine, is a follicle that still exists. An area of scalp that is fully bald has nothing left underneath it.
None of that is an argument for alarm. It is an argument for a date. Loss that has been running for two years is a different assessment from the same loss at three months, and the difference is not effort. It is how much was still there when somebody looked.
What else causes hair loss, and what should be ruled out first?
A great deal, and several of the causes are correctable, which is why a careful doctor rules them out before treating anything as a pattern. The NHS lists illness, stress, cancer treatment, weight loss and iron deficiency among the causes of temporary hair loss, as distinct from the permanent patterned kind.Source 1: Hair loss. NHS, United Kingdom. Page last reviewed 24 January 2024.
The recognised triggers for a shedding episode are specific enough to ask about directly:
- An acute febrile illness or a severe infection.
- Major surgery, or severe physical trauma.
- The hormonal change after childbirth.
- An underactive thyroid.
- Crash dieting, or a persistently low protein intake.
- Iron deficiency.
- A number of ordinary medicines, including some blood pressure tablets and anticoagulants.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024.
Rapid or extreme weight loss sits squarely on that list, which is one of several reasons medical weight loss is supervised rather than improvised. Somebody losing weight quickly and shedding hair at once may be looking at one problem wearing two costumes.
The most useful fact in this article is also the most easily left out by anyone selling hair care: hair loss caused by a medical condition usually stops, and usually grows back, once that condition has been treated.Source 1: Hair loss. NHS, United Kingdom. Page last reviewed 24 January 2024. An assessment that goes straight to treatment has skipped the part that mattered.
What does a doctor actually assess?
History, distribution and timeline first, then tests only where the history points at something. Androgenetic alopecia is usually a clinical diagnosis, made from a gradual onset after puberty, a recognisable pattern and often a family history; a biopsy is rarely needed.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024. In practice a consultation covers six things.
- How long it has been going on, and whether it started abruptly or drifted.
- Where it is: temples, crown, parting, or spread evenly across the scalp.
- What happened one to six months before it started. An illness, an operation, a birth, a period of severe stress, a sharp change in diet.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024.
- Family history on both sides. A man whose father balded carries roughly five to six times the relative risk.Source 2: Ho CH, Sood T, Zito PM. Androgenetic Alopecia. StatPearls, NCBI Bookshelf. Last updated 7 January 2024.
- Whether the scalp itself looks normal, or is itchy, sore, scaling or scarred.
- Blood tests where they are indicated: thyroid function, a full blood count, and iron studies including ferritin. A low ferritin confirms iron deficiency, though a normal one does not rule it out.Source 3: Hughes EC, Syed HA, Saleh D. Telogen Effluvium. StatPearls, NCBI Bookshelf. Last updated 1 May 2024.
At Carisma Medical that happens in a 20-minute video consultation with a doctor registered with the Medical Council of Malta, who has read the free pre-assessment and the photographs of the hairline, crown and parting before the call begins. Nothing clinical is abbreviated; what is removed is the travel and the waiting room. How the appointment works sets out the sequence, and seeing a doctor online in Malta covers it end to end.
When does hair loss need to be seen in person instead?
When the scalp itself is abnormal, when hair has come out suddenly in patches, or when the hair is one symptom among several. Online assessment suits gradual patterned loss, where history, distribution and photographs carry the diagnosis. It does not suit a scalp that needs examining, swabbing or biopsying.
Alopecia areata is the classic sudden and patchy presentation. The immune system attacks the hair follicles, and hair falls out in small round patches roughly the size of a coin, usually with no rash, redness or scarring on the bare skin.Source 5: Alopecia Areata. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. It can begin at any age, though most people develop it in their teens, twenties or thirties.Source 5: Alopecia Areata. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. It is a different condition with a different course.
The scarring alopecias are the other group that must not wait, because the damage they do cannot be undone. Their early signs are often felt rather than seen: itching, burning or tenderness over the affected area.Source 4: Syed HA, Zito PM. Alopecia. StatPearls, NCBI Bookshelf. Last updated 26 February 2024. In one multicentre review of more than 3,000 diagnoses made at specialist hair clinics, 27 percent were scarring rather than non-scarring.Source 4: Syed HA, Zito PM. Alopecia. StatPearls, NCBI Bookshelf. Last updated 26 February 2024. That is not a rare category, and a sore scalp is not a small detail.
What does seeing a doctor about hair loss cost in Malta?
A consultation is €59, and the online pre-assessment before it is free. Care that continues is €29 a month, and it starts only once the patient has been seen. The fee is paid whether or not the doctor decides treatment is appropriate, because what is bought is a doctor’s time and a doctor’s answer.
Hair growth is sold as a 3, 6 or 12-month course, and three months is the shortest. Hair answers slowly, and selling it a month at a time invites people to conclude that nothing is happening long before there is anything to see. A course comes to €146, €233 or €407 in total, with photograph reviews at three, six and twelve months.
Every figure is set out in full on the pricing page, and what the care involves is on the hair growth page. It is for adults aged 18 and over in Malta and Gozo, and where hair loss is not the right thing to bring here, a doctor will say so rather than find something to sell.