Losing hair is one of the most distressing things that can happen to a person's appearance — and one of the most misunderstood. Most people reach for supplements or expensive shampoos before they understand what is actually causing the loss. The cause determines the treatment entirely. Getting that wrong means months of wasted money and effort while the underlying problem continues. This is everything you need to know — starting with how hair actually grows.

How Hair Actually Grows

Every strand of hair grows from a hair follicle — a tiny organ embedded in the scalp that produces, nurtures, and eventually sheds each hair. The follicle is alive and active, surrounded by blood vessels that deliver nutrients and hormones.

Hair growth follows a cycle with three phases:

  • Anagen (Growth Phase) — the follicle is actively producing a new hair shaft, which grows approximately 1 to 1.5 cm per month. This phase lasts 2 to 7 years. About 85 to 90% of your hair is in this phase at any given time. How long your anagen phase lasts is largely genetic — it determines how long your hair can grow.
  • Catagen (Transition Phase) — the follicle shrinks and detaches from the blood supply. The hair stops growing. This phase lasts about 2 to 3 weeks. Only about 1% of hairs are in this phase at any time.
  • Telogen (Resting and Shedding Phase) — the old hair rests while a new hair begins growing beneath it. After 3 to 4 months, the old hair is shed and the new one emerges. About 10 to 15% of hairs are in this phase at any time.

Shedding 50 to 100 hairs per day is completely normal — these are telogen hairs completing their cycle. Hair loss becomes a problem when more hairs enter the resting phase than the growth phase, when the growth phase shortens, or when follicles are permanently damaged.

Type 1 — Androgenetic Alopecia (Pattern Hair Loss)

The Most Common Cause — Genetics Plus a Hormone

Androgenetic alopecia is responsible for about 95% of hair loss in men and is the most common cause in women too. Despite the name, it is not purely about having high testosterone — it is about how sensitive your hair follicles are to DHT (dihydrotestosterone).

DHT is made from testosterone by an enzyme called 5-alpha reductase. In genetically predisposed individuals, DHT binds to receptors in hair follicles on the scalp and gradually causes them to miniaturise — each successive hair grows thinner, shorter, and lighter until eventually the follicle stops producing visible hair altogether. This process is called follicular miniaturisation.

The pattern differs by sex:

  • Men: Typically begins with recession at the temples and thinning at the crown. These two areas eventually merge into the classic horseshoe pattern. The sides and back of the scalp are generally spared because those follicles are less sensitive to DHT — which is why hair transplant surgery works (transplanted follicles from the sides and back retain their resistance to DHT).
  • Women: Usually presents as diffuse thinning across the top and crown of the scalp, widening of the central parting. Complete baldness is rare in women with this condition. It often accelerates after menopause when oestrogen levels drop and the relative influence of androgens increases.

Androgenetic alopecia is progressive and permanent without treatment. The follicles are not dead — they are miniaturised. This is why treatments work best when started early, before miniaturisation is complete.

Type 2 — Telogen Effluvium (Stress-Induced Shedding)

Telogen effluvium occurs when a significant physical or emotional shock pushes a large number of hair follicles simultaneously out of the growth phase and into the resting phase. About 2 to 3 months later, those hairs all shed at once — causing alarming, diffuse hair loss across the entire scalp.

Common triggers:

  • Childbirth — postpartum hair loss is almost universal and often distressing for new mothers
  • Severe illness, high fever, or major surgery
  • Sudden significant weight loss (including crash dieting)
  • Iron deficiency anaemia
  • Thyroid disorders — both overactive and underactive thyroid cause telogen effluvium
  • Major emotional trauma or prolonged severe stress
  • Stopping the combined oral contraceptive pill
  • Certain medications — anticoagulants, retinoids, some antidepressants, beta-blockers

The key characteristics that distinguish telogen effluvium from androgenetic alopecia: it is diffuse (thinning all over, not in a pattern), it has a clear trigger 2 to 3 months prior, and it is usually reversible once the trigger is addressed. Hair typically regrows fully within 6 to 9 months after the cause is resolved.

A 32-year-old woman in Kumasi gives birth in January. In March and April she notices large amounts of hair coming out when she showers — handfuls on the floor, clumps on the pillow. She is convinced something is seriously wrong. Her doctor explains this is postpartum telogen effluvium — entirely normal, triggered by the hormonal shift after delivery, and will resolve on its own. By July her hair density is returning to normal. She did not need any treatment — just reassurance and time.

Type 3 — Alopecia Areata (Autoimmune Hair Loss)

In alopecia areata, the immune system mistakenly attacks hair follicles as if they were foreign invaders, causing them to stop producing hair. It presents as sharply defined, usually circular patches of complete hair loss on the scalp or elsewhere on the body — beard, eyebrows, eyelashes.

The follicles are not permanently destroyed — they are suppressed. Spontaneous regrowth occurs in about 80% of cases within one year, though the condition may recur. In severe cases (alopecia totalis — complete scalp hair loss, or alopecia universalis — loss of all body hair) regrowth is less predictable.

Treatment options include corticosteroid injections into affected areas (most effective), topical immunotherapy, and newer JAK inhibitor medications (baricitinib, ruxolitinib) which have shown significant success in severe cases.

Type 4 — Nutritional and Medical Causes

  • Iron deficiency — the most common nutritional cause of hair loss, particularly in women with heavy periods. Hair follicles require iron for the energy-intensive process of hair production. Even sub-clinical deficiency (low ferritin without anaemia) can cause significant shedding. A serum ferritin level below 30–40 ng/mL is associated with hair loss even when haemoglobin is normal.
  • Thyroid disorders — both hypothyroidism (underactive) and hyperthyroidism (overactive) cause hair loss. Thyroid hormones are essential for normal hair follicle cycling. Treatment of the thyroid condition resolves the hair loss.
  • Vitamin D deficiency — vitamin D receptors are present in hair follicles and play a role in the hair cycle. Deficiency is associated with alopecia areata and general thinning.
  • Protein deficiency — hair is made of keratin, a protein. Severe protein deficiency reduces hair production. More common with crash dieting or very restrictive eating.
  • Zinc deficiency — zinc is essential for hair tissue growth and repair. Deficiency causes hair loss and slow regrowth.
  • Scalp conditions — tinea capitis (fungal infection of the scalp, common in children in Ghana) causes patchy hair loss with scaling. Requires antifungal treatment. Seborrheic dermatitis causes scaling and can contribute to diffuse thinning.

Treatments — What the Evidence Actually Shows

Minoxidil — The Most Accessible Evidence-Based Treatment

Originally developed as a blood pressure medication, minoxidil was found to cause hair growth as a side effect. It is available as a topical solution or foam applied directly to the scalp, and as an oral low-dose tablet.

It works by prolonging the anagen (growth) phase and increasing blood flow to follicles. It does not block DHT — it stimulates follicles regardless of the cause of loss, making it useful for both androgenetic alopecia and telogen effluvium.

  • Effectiveness: Slows or stops hair loss in about 80% of users; regrowth in about 40%
  • Important: Must be used continuously — stopping treatment causes any regrown hair to shed within 3 to 4 months
  • Available in Ghana without prescription at major pharmacies (Rogaine, generic brands)
  • Side effects: Scalp irritation, unwanted facial hair growth (particularly with oral minoxidil in women at higher doses)
  • Results take time: Allow 4 to 6 months minimum before assessing effectiveness

Finasteride — For Men With Pattern Hair Loss

Finasteride is an oral tablet taken daily that blocks the enzyme 5-alpha reductase, preventing the conversion of testosterone to DHT. By reducing DHT levels, it slows and stops the follicular miniaturisation process of androgenetic alopecia.

  • Effectiveness: Stops hair loss in about 90% of men; significant regrowth in about 65%
  • Requires prescription
  • Side effects (in a minority of users): Reduced libido, erectile dysfunction, reduced ejaculate volume. These are generally reversible on stopping. A rare persistent post-finasteride syndrome has been reported.
  • Not for women who could become pregnant — finasteride causes birth defects; women should not even handle crushed tablets
  • A higher dose (5mg) is used for benign prostate enlargement under the name Proscar

Other Options

  • Low-level laser therapy (LLLT) — laser combs and helmets that stimulate follicles with low-energy light. Modest evidence of benefit; useful alongside minoxidil.
  • Platelet-Rich Plasma (PRP) — blood is drawn, spun to concentrate growth factors, then injected into the scalp. Growing evidence of effectiveness for androgenetic alopecia; requires trained clinic.
  • Hair transplant surgery — the most definitive treatment for androgenetic alopecia. Follicles from DHT-resistant areas are transplanted to affected areas. Results are permanent. Expensive and requires an experienced surgeon.
  • Spironolactone (for women) — an anti-androgen medication that reduces DHT's effects. Used for female pattern hair loss, particularly effective in women with elevated androgens.

Things That Do Not Work — Save Your Money

  • Biotin supplements — widely marketed for hair growth but evidence shows benefit only in people with confirmed biotin deficiency, which is rare. No benefit in people with normal biotin levels.
  • Most "hair growth" shampoos — shampoo contacts the scalp for seconds before being washed off; cannot meaningfully affect follicle biology
  • Onion juice, castor oil, egg masks — no clinical evidence of effectiveness
  • Collagen supplements — see the supplements article; dietary collagen is broken down and does not preferentially go to hair

Hair loss is almost always treatable when you know what is causing it. The most important step is not buying a supplement — it is getting a diagnosis. A blood test can rule out iron deficiency, thyroid disease, and vitamin D deficiency in one visit. A dermatologist can distinguish pattern loss from telogen effluvium by examining the pattern and taking a brief history. Treating the right cause with the right treatment produces results. Treating the wrong cause wastes time and money while the real problem continues.