Why Is My Hair Falling Out, and Is It Even a Transplant Problem?

Thirty days after a hair transplant, Reddit user u/laskmaciej wrote: "Trying to remain calm, but feel insecured to be honest". Three weeks later they posted that a dermatologist "confirmed it is Alopecia Areata, triggered by high stress factor" (r/HairTransplants, November and December 2022).

So the hair loss turned out to be a different condition. That gap between what hair loss looks like and what's causing it is the subject of this page, which is part of our hair transplant guide.

Hair falls out for many reasons, and a hair transplant is built mostly for one of them: pattern hair loss (androgenetic alopecia) in someone with healthy hair to move. Stress and illness can cause hair loss too.

So can low iron, thyroid problems, alopecia areata and scalp conditions, and each of those is a separate cause. Your own doctor or dermatologist should find yours before anyone talks about surgery.

Below, each cause is described the way a health body, a medical faculty, a paper or a Thai clinic describes it, with a link to the source. None of it can tell you which one you have.

Shedding, patches or breakage: the first split

Bangkok Hair Clinic says hair goes through natural growth and shedding cycles, "typically losing approximately 100-150 hairs per day." The Faculty of Medicine at Chiang Mai University gives "an average of 50-100 strands per day" (our translation).

Bangkok Hair Clinic says that "if you notice excessive hair shedding, significant hair thinning, or losing more than 200 hairs per day," you should seek an evaluation.

The sources describe three shapes.

Diffuse loss thins hair all over. A 2021 review in the Journal of Dermatological Science (Chien Yin and colleagues, PMID 33541773, on PubMed) calls telogen effluvium "a common cause of diffuse non-scarring hair loss."

Patchy loss leaves bare spots. Hairsmith, a Bangkok clinic, describes "hairloss in a circle looking like a coin in one spot" as alopecia areata.

Breakage is the third. The Chiang Mai University page describes hair that is "fragile, breaks or snaps easily" (our translation).

The pattern cause: androgenetic alopecia

Pattern hair loss is the cause a hair transplant is designed around. It runs in families and follows a recognizable shape.

In men, the stages are described on the Norwood scale. We don't repeat them here.

How DHT shrinks the follicle (miniaturization)

Bangkok Hair Clinic calls androgenetic alopecia "a very common one" among the causes of hair loss and says it "is largely influenced by your genes and environmental factors."

Its FAQ explains the mechanism: "a hormone called dihydrotestosterone (DHT) causes hair follicles to shrink (miniaturisation), which leads to thinning hair and eventually hair loss."

HE Clinic in Thonglor, Bangkok, says the same in shorter form: "Androgens play a key role in this type of hair thinning, known as androgenetic alopecia."

The Chiang Mai University page, in Thai, says patterned hair loss "is often caused by male sex hormones and heredity" (our translation).

Male pattern and female pattern

Women get pattern hair loss too. The American Academy of Dermatology (AAD) says female pattern hair loss "is actually the most-common cause of hair loss in women."

The AAD adds: "It's hereditary. You inherit the genes from your mother, father, or both. Because FPHL is more common after menopause, hormones may also play a role."

Candidacy for women has its own page: hair transplant for women.

Why pattern loss is the case a transplant is built for

The AAD's transplant page describes the surgery: "Hair transplant surgery allows the surgeon to move healthy hairs on your scalp to areas with thinning hair."

So a transplant needs healthy hair to move and a scalp that will grow it. Not everyone has both. The tests for both come later on this page.

The "beyond Norwood" causes: hair falling out that isn't pattern baldness

A 2021 review in the Journal of the European Academy of Dermatology and Venereology (Alessandrini and colleagues, PMID 33290611, on PubMed) lists androgenetic alopecia, alopecia areata, telogen effluvium and trichotillomania as common causes of hair loss without scarring.

So pattern loss is only one item on that list. The other causes and conditions are below, with the sources that describe them.

Telogen effluvium: hair shedding after stress, illness or a shock to the body

A 2020 paper in Cureus (Asghar and colleagues, PMID 32607303) calls telogen effluvium "one of the most common causes of alopecia" and "a scalp disorder characterized by excessive shedding of hair."

The 2021 Chien Yin review says it "is usually precipitated by physiological stress such as childbirth or sudden weight loss."

The Chiang Mai University page links sudden diffuse shedding to illness, "especially diseases like influenza (the flu), dengue fever" (our translation). HE Clinic says "Stress and illness often lead to hair loss."

Hairsmith's page on behaviors gives a reason for stress: "the body releases a hormone called Cortisol more than usual, resulting in weaker hair and shorter hair life cycle."

One r/Hairtransplant poster described it from the inside: "So first week of January I got Covid and a couple of weeks after that I started shedding sooo much hair, like I've lost 50% of my hair in the first month and then it slowed down" (r/Hairtransplant, u/Powerful-Rope5847, 18 May 2024).

Their doctor "confirmed that it's most likely TE and she had me do a blood test."

Low iron

HE Clinic lists iron among the causes: "Other factors like thyroid issues, lack of iron, or not enough protein can also lead to hair falling out."

The Chiang Mai University page includes iron in a longer list of nutrients whose lack "can cause hair loss" (our translation).

One Mumsnet poster linked two episodes to illness and iron: "I've had it twice - once after a serious viral bug and once after a period of iron deficiency" (Mumsnet, MissKittyFantastico84, 25 August 2024).

So whether your iron is low is for your doctor to check.

Thyroid problems

HE Clinic names "thyroid issues" in the line quoted above. Its Thai-language page adds that "Changes in nutrition or high stress levels can make the problem worse" (our translation).

Hairtran Clinic's Thai knowledge section carries an article titled "PCOS, thyroid, menopause: how are they connected to hormone hair loss?" (our translation).

Hairsmith's alopecia areata page also links that condition with "thyroid disease". A thyroid question is a medical one for your own doctor.

Crash dieting and rapid weight loss

Hairsmith's page on weight loss points to protein, "an essential component of the hair and if our body does not get enough protein, it may result in hair loss more than usual."

The same page names exercise as a second route: "Some people want to get skinny quickly so they exercise harder until the body doesn't have time to rest and that may cause stress to build up which can result in hair loss as well."

A Mumsnet poster remembered it years later: "I had it many years ago after a severe diet. I remember my chair at work being covered in hair, and people commenting" (Mumsnet, NotTerfNorCis, 24 August 2024).

On r/Hairtransplant, one person planning surgery wrote: "Going through it now, pre HT, due to rapid weight loss, thankfully HT is still about a year out" (u/go_get_your_hyung, 3 April 2026, same thread as above).

Low protein and missing vitamins or minerals

Hairsmith warns about diets that cut out fruit and vegetables, which "may cause the body to lack certain vitamins and minerals such as vitamin E, beta-carotene, zinc and B vitamins, etc."

The Chiang Mai University page gives its own list: "vitamin B, vitamin D, biotin, iron, zinc, copper, selenium and others" (our translation).

These are causes the sources name. Ask your own doctor before you start any treatment for them.

Alopecia areata: the coin-shaped patch

Hairsmith says the exact cause "is still unknown but it is believed to be caused by a malfunction of the Autoimmune system." It adds that the condition "can occur in both men and women" and "at any age."

The Chiang Mai University page says it "is caused by an abnormality of the immune system that destroys hair roots, ranging from a single patch of loss to total loss of the whole head or the whole body." Locally, it says, people may call it "maeng kian" disease (our translation).

Both describe an immune problem, a different condition from pattern hair loss. A dermatologist is the person to diagnose it, as u/laskmaciej found.

Hormonal shifts

The AAD says female pattern hair loss "is more common after menopause," so "hormones may also play a role." Hairtran's article title above groups PCOS, thyroid and menopause under hormone-related hair loss.

Patients raise these too. "Peri menopause affects it too," one Mumsnet poster wrote (LivelyGoldOrca, 25 August 2024).

Trichotillomania, heat and chemicals

Trichotillomania is on the 2021 Alessandrini list of common causes.

Hairsmith says that "Using the heat on your hair regularly can dry out your hair and scalp, making your hair more fragile and more likely to shed." It notes heat "doesn't affect your hair follicle cells", but done often "it may be another cause of hair loss and thinning hair."

The Chiang Mai University page describes hair that is "fragile, breaks or snaps easily," often from "the use of chemicals, perming, straightening or dyeing hair" (our translation).

Scalp conditions: dandruff and fungal infection

Medthai, a Thai health site, separates the two. It says dandruff "is a skin reaction to a fungus, and it does not cause hair to fall out in patches or spread to other parts very much" (our translation).

A scalp fungal infection is different, it says: the fungus can cause "red patches, severe itching, thick scales, and possibly hair falling out in circles or patches, because the fungus destroys the hair follicles."

Hairtran's Thai page on dandruff says the clinic's doctor "will recommend that you treat the dandruff until it heals first before you can have a transplant" (our translation). Our page on psoriasis and dandruff covers candidacy with a scalp condition.

Scarring hair loss

The Chiang Mai University page lists scarring (cicatricial) hair loss as its own category, linked to inflammation of the scalp and hair roots. It's one for a dermatologist to assess.

The causes side by side

Is it even a transplant problem?

For every cause above except pattern hair loss, the first step is finding the cause with your own doctor. A transplant comes into the picture only once that's done.

The three tests: enough donor hair, a scalp that can grow it, realistic expectations

The AAD lists two things a candidate needs: "Enough healthy hair on your scalp that can be transplanted to the area that needs hair" and "The ability to grow hair on the thinning area of your scalp."

It says a dermatologist consultation and a "thorough scalp exam" establish both.

Bangkok Hair Clinic adds its own list: "Candidacy depends on several factors, including the type and extent of hair loss, quality and quantity of donor hair, age, hair characteristics, and realistic expectations."

The full checks are on our am I a candidate page.

When the hair is still shedding

Telogen effluvium is usually set off by a stressor, according to the 2021 Chien Yin review. The AAD asks for a scalp that can grow hair in the thinning area.

Hairtran's Thai dandruff page says that while the scalp symptoms are active, "we will not yet recommend coming to consult a hair-transplant clinic" (our translation).

If your hair is still coming out fast, tell the surgeon. Timing is a call for them and your dermatologist to make together.

Early loss: what Hairsmith says

Hairsmith's behaviors page puts it this way: "Hair loss in the early stage may be easily treated with medication, treatment or using low level laser therapy (LLLT), but if you don't take care of the hair loss problem soon, the condition will be worsen to the point of baldness and there will be no hair root left."

That's one clinic's view. Ask your own doctor whether any treatment suits you.

What a transplant does and doesn't treat

Hairsmith goes on to say that at that stage it "must be treated by hair transplantation", which it calls "a way to solve the symptoms not the root cause but it gives the most obvious result."

HE Clinic's Thai page makes the same point from the other side: "Identifying these causes is important for a strategy of new hair-growth that succeeds" (our translation).

What to do next: rule out the other causes first

The AAD warns that "Other causes of hair loss can look like FPHL, so it's important to rule out these causes."

Hairsmith's weight-loss page says: "you should see a doctor to find out the true cause because the more the treatment can be done in a timely manner, you will also be able to keep your thick hair for as long as possible."

Find the cause with your own primary care doctor or a dermatologist before you plan surgery.

Which checks to run is your doctor's call

One r/Hair poster wrote: "The doctor said it's most likely stress that's causing it, but I'm also underweight and have low iron" (r/Hair, u/BeeBea27, 22 August 2023).

Which checks you need depends on what your doctor sees and on your health history. Tell them when the shedding started and what changed in your health and life around then.

When to see a dermatologist

Bangkok Hair Clinic's line for an evaluation at the clinic is more than 200 hairs a day, significant thinning or "excessive" shedding.

For scalp problems, Hairtran's Thai page draws a line: if peeling or dandruff-like symptoms won't heal "no matter what you do," it recommends "a skin doctor in the dermatology department at a leading hospital" (our translation).

If it IS a transplant problem: what a Thailand transplant looks like

Once a doctor has confirmed pattern hair loss, the AAD says "the outcome still depends largely on the surgeon you select."

In Thailand, you can look up a doctor by first name and surname on the Medical Council's register at checkmd.tmc.or.th. Our consultation questions page covers what to ask.

Plan for a long wait to judge the result. The AAD says: "Most patients see results between six and nine months after surgery. For some patients, it takes 12 months."

For a second opinion, a dermatologist is the route u/laskmaciej took.

Thailand hair transplant prices

These are budget pointers, not quotes. Your graft count and a clinic's written quote decide the real number.

Patients report paying ฿36-123 ($1.09-$3.71) per graft across five Bangkok clinics (reports and quotes, 2023 to 2026). Most reports at Absolute, Bangkok Hair Clinic and Hairsmith fall at ฿65-90 ($1.96-$2.72) per graft.

Hairsmith publishes ฿80 ($2.41) per graft as its 2025 pricing (read 23 September 2026).

At ฿65-90 a graft, 2,500 grafts comes to ฿162,500-225,000, about $4,900-$6,790. That's our arithmetic on the patient reports above.

Dollars at ฿33.14 = $1 (European Central Bank reference rates, 22 September 2026).

Which Thai clinics publish on causes of hair loss

We compare what these clinics publish. We haven't visited them or had treatment at any of them.

The Chiang Mai University Faculty of Medicine, which is not a clinic, publishes a page that sorts hair loss into patterned, patchy, diffuse, scarring and hair-shaft breakage.

Post-transplant shedding: is it even a transplant problem?

Some hair loss after surgery is expected. The AAD says "between two and eight weeks after the surgery, the transplanted hair will fall out. This is normal."

Nearby native hair can shed too. A 2026 review in Frontiers in Medicine (Romera de Blas and colleagues) says this "typically occurs within 2-8 weeks after surgery, with regrowth usually beginning around 3 months postoperatively. Reported incidence varies widely, ranging from 0.15 to 15%."

The same review adds: "Although typically temporary, a permanent reduction in native hair density may occur, particularly in follicles nearing the end of their growth cycle or already miniaturized." So it doesn't always grow back.

Our shock loss page covers this in full. If shedding after a transplant doesn't look like what your surgeon described, the opening story shows the next step: a dermatologist.

If a doctor has confirmed pattern hair loss and you want help comparing Thai clinics, you can contact us.

Frequently asked questions

Will my hair ever grow back after heavy shedding?

That depends on the cause, which is why a diagnosis comes first.

Pattern hair loss, alopecia areata and scarring hair loss are different conditions. Only your own doctor or dermatologist can tell you which one you have.

Every time I wash my hair the drain is full. Is that still normal?

Bangkok Hair Clinic suggests an evaluation above 200 a day or with significant thinning. A drain full of strands can't tell you the cause on its own, so if you're also seeing thinner hair, see your doctor.

Can I get a hair transplant while my hair is still shedding?

The AAD says a candidate needs enough healthy donor hair and a scalp that can grow hair in the thinning area. Hairtran says its doctor "will recommend that you treat the dandruff until it heals first before you can have a transplant" (our translation).

If your hair is still falling out fast, tell the surgeon. Timing is for them and your dermatologist to decide.

Is patchy, coin-shaped hair loss the same as balding?

Usually not. Hairsmith describes coin-shaped patches as alopecia areata, and Chiang Mai University's Faculty of Medicine names alopecia areata as the commonly found cause of patchy loss. Both describe an immune system problem. That's a different condition from pattern hair loss.

A scalp fungal infection can also cause patches, according to Medthai. A dermatologist can tell them apart.

This guy had 5,000 grafts, so how can it all fall out?

We can't judge a stranger's case from a post. The AAD says transplanted hair falls out between two and eight weeks after surgery, and "This is normal."

A 2026 review adds that nearby native hair can sometimes thin for good. Hairsmith says a transplant treats the symptom, not the root cause. The surgeon who examines the scalp is the one to say what happened.