Subscribe on Apple 

Subscribe on Spotify 

It’s one of the most distressing side effects people can experience during a weight loss journey, yet almost no one warns you about it.

At first, it’s easy to dismiss. You tell yourself it’s probably nothing, or that it will pass. 

Then it starts showing up everywhere: in the shower drain, on your pillow, and in your hands every time you run your fingers through your hair.

In this post, with guidance from dermatologist and hair loss specialist Dr. Katherine Nolan, we’re breaking down why rapid weight loss can trigger shedding, how the hair growth cycle actually works, which labs may be worth asking your doctor about, and when it might make sense to consider treatment. We’ll also talk through some of the biggest myths, including why expensive serums and biotin supplements are not usually the fix people hope they are.

Why Rapid Weight Loss Triggers Hair Shedding

Hair loss after significant weight loss isn't a coincidence. It's your body responding to physiologic stress. When you lose weight rapidly, especially more than two pounds a week over several months, the body essentially goes into survival mode. It starts redirecting resources away from non-essential functions. And unfortunately, hair is one of the first things it deprioritizes.

This is the same mechanism behind postpartum hair loss and the shedding many people experienced after COVID. Any significant stress on the body can trigger it.

Why You Don't Notice It Right Away

This is the part that catches most people off guard. The shedding doesn't happen immediately after the triggering event. It typically shows up about three months later. That's simply how long the hair cycle takes to complete.

There are three main phases to understand:

• Anagen — the active growth phase, where most of your hair lives at any given time
• Telogen — a resting phase that only a portion of hairs are in at once
• Shedding — what happens after the resting phase ends

When the body experiences stress, it can shift a large number of hairs from the growth phase into the resting phase all at once. Three months later, they all start coming out together — which is why it can feel so sudden and alarming.

The good news is that shedding usually peaks somewhere between three to six months and then begins to slow down. After that, most people start to see baby hairs regrowing.

Hair Loss as a Window Into Your Health

One thing Dr. Nolan emphasizes is that hair loss is often the first outward sign that something deeper is going on inside the body. It can signal low iron, thyroid issues, or other underlying conditions that haven't been identified yet.

This is why getting a proper workup matters — not just for your hair, but for your overall health.

The three labs Dr. Nolan recommends checking for any unexplained hair loss are:

• Ferritin — your iron stores. Most standard ranges consider anything above 20 acceptable, but for healthy hair growth, Dr. Nolan looks for levels above 50.
• Vitamin D — ideally in the 40 to 60 range for hair health, not just general wellness.
• TSH — a basic thyroid marker that can reveal hormonal issues contributing to shedding.

If any of these are low-normal, they may be fine for overall health but not optimal for your hair. It's worth having a specific conversation with your doctor about what your levels mean in the context of hair loss.

When to Consider Treatment

The traditional approach to telogen effluvium (the medical term for this type of acute shedding) has always been to identify the cause, remove the stressor, and wait for the hair to recover on its own.

But Dr. Nolan takes a more proactive stance. Watching significant amounts of hair fall out every day is distressing, and there are effective options available. Waiting isn't always the right answer.

The most commonly used medication is oral minoxidil, which works by shifting hairs out of the resting phase and back into active growth. It can help slow the shed before it becomes too severe and support regrowth afterward.

A common concern is whether you have to stay on it forever. For hair loss caused by a short-term event like rapid weight loss, the answer is often no. Once the weight stabilizes and there are no other contributing factors, many patients are able to come off the medication successfully, typically after around six to twelve months.

One important thing to know: don't expect overnight results. Because of how the hair cycle works, it takes at least three months to see any meaningful change, and closer to six months before you'll notice a visible difference as a patient.

For those with an additional hormonal component — female or male pattern thinning — Dr. Nolan may also recommend DHT blockers like finasteride or dutasteride, which work differently from minoxidil by slowing the progression of hormonally driven hair loss. Spironolactone is another option, often preferred for younger women who may want to become pregnant, as it carries a safer profile in that context.

The Biggest Myths Around Hair Loss

The hair loss product market is enormous, and it's easy to get pulled in when you're desperate for a solution. Dr. Nolan sees this regularly in her practice, with patients arriving with bags full of serums, supplements, and devices they've spent a fortune on.

The hard truth is, most of it won't address what's actually causing the shedding. Because this type of hair loss is driven internally, external products can only do so much.

Biotin is probably the biggest myth of all. Despite being heavily marketed for hair growth, there's very little evidence that high-dose biotin supplementation helps unless you have a severe deficiency, which most people don't.

Another common fear is that washing or brushing your hair will make the shedding worse. Dr. Nolan is clear on this: the hairs that are going to shed are going to shed regardless. Avoiding washing your hair won't stop it, it just delays the inevitable. Continue your normal routine, and avoid anything that puts unnecessary additional stress on the hair, like very tight hairstyles or intense heat styling.

Practical Steps You Can Take Now

While treatment is sometimes necessary, there are things you can do to support your hair during a weight loss journey:

• Prioritize protein. Aim for at least 80 to 100 grams per day, or up to around one gram per pound of body weight. Protein is essential for hair structure and growth.
• Aim for gradual weight loss. Keeping loss to around one pound per week or less seems to significantly reduce the severity of shedding compared to faster rates.
• Support your iron levels. Focus on iron-rich foods like red meat, spinach, and lentils, and consider taking iron alongside vitamin C to improve absorption.

If you're going through this, try not to panic. I know though that's much easier said than done. The types of hair loss associated with weight loss are almost always temporary and non-scarring. The hair follicles remain healthy, and the hair can fully grow back.

The biggest mistake Dr. Nolan sees is people waiting too long to seek help. By the time many patients come in, they're already significantly progressed. If you're noticing more shedding than usual, don't be too quick to dismiss it. Get your labs checked, see a dermatologist who specializes in hair loss, and know that there are real, effective options available to you.

You don't have to just wait it out.

Want to hear our full conversation? Listen to the complete episode with Dr. Katherine Nolan for an even deeper dive into hair loss, treatment options, and what to do next.

You can also connect with Dr. Nolan at www.carabelladermatology.com — she offers virtual consultations and is licensed in most major states across the US.

TRANSCRIPT:

Disclaimer: The transcript below is provided for your convenience and may contain typos, errors, or grammatical inconsistencies, as it has not been professionally edited or proofread. Please enjoy it as-is and read at your own discretion.

Please note: The content shared in this podcast and blog post is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider for personalized medical guidance.   

 Welcome back to the podcast everybody. I'm really excited today to have on a really amazing dermatologist. Just to give background here, 'cause I always explain why I bring someone on in my world, I really work a lot with patients going through significant weight loss. Often they're on GLP one medications and one of the most emotional side effects that they experience is hair loss. And I know that we have the saying in that, well, I hear this a lot, that time is hair, one thing that I see is that people are not getting help soon enough. And by the time they're bringing it up to me in a visitor or something's happening they're pretty progressed with their hair loss. I'm bringing on Dr. Nolan today to help us understand what even is the hair life cycle, maybe when should you get treatment? What are some options? Just really talk through this so that you can all be more educated where you're listening, and then you can get the right help that you potentially need. Dr. Katherine Nolan. She's a clinic owner of Carella Dermatology and Carmel, Indiana, and she's here today to help us deep dive on hair loss. Can you start out by introducing yourself a little bit and letting us know how you like to help patients? Sure. Well thank you so much for having me here. Super excited to join you. I am Dr. Katherine Nolan. I'm a board certified dermatologist and I focus in hair loss. I have my own practice here in Carmel, Indiana, but I'm also licensed in most major states in the United States for telemedicine. And I do a lot of virtual hair loss consultations as well. And I have a special interest in hair loss. I had worked, at University of Miami with Dr. Anton Atsi, who's one of the big hair loss experts, in the world. And I also have a personal interest in it. I had experienced really severe hair shedding after having my second daughter, so. After that I really, connected with a lot of patients suffering from this and wanted to help as many people as I could. Yeah, thank you for sharing that. Not only your training, but also your experience. In your practice, what are the most common reasons you see for hair loss? So especially maybe in someone that is going through maybe a big weight change. 'cause that's a lot of who's listening. Yes, absolutely. So definitely we see a lot of patients with severe shedding after any sort of real stress on the body. Like I mentioned, the postpartum time is a really common time. We see people struggling with severe hair shedding. The type I went through. We also saw a lot with COVID, so it's interesting to see the journey I've seen with my practice with this. We would actually see often about three months after we would have these spikes of COVID, we would also see people with really severe shedding would all start to come into clinic. And then just when we were starting to get past the COVID hair loss, we're now seeing a lot of people who are doing amazing with the GLP one medications and. So happy with, the way they're looking and with their health overall after losing weight, but now they're struggling with. Losing hair, shedding hair. So we definitely keep us busy. All these different types of hair shedding we see with, any sort of, stressor on the body. Can you going more into that 'cause I know so stress can really be anything from what you're describing. Can you walk us through, so what actually, what happens with the hair growth cycle during that time? So, 'cause I think patients tend to think it's like a week or two, but I don't really think they understand how many months or what's happening with it. Right. So it's really interesting. So a lot of people think of, just stress traditionally like, oh, I'm stressed out. And so people often associate that with hair loss and hair shedding. But really when I'm talking about stress, I'm talking about more like physiologic stress on the body. So something like a major weight loss, like more than two pounds a week over several months, or like a. Fever, hospitalization, surgery, something like that. And it's also really hard because patients often may not even remember what the particular event was. It could have triggered it because how the hair cycle works is there's three main phases. There's the growth phase of the hair cycle called antigen. And this is what most of our hairs are in like right now. So just the growth phase can last several years. And then there is a resting phase, which. Only part of our hairs are in called telogen, and then the hair is shed after that. And so whenever there's any sort of physiologic stress on the body, it can shift hairs from this normal antigen growth phase into this resting phase at the same time. And then the part that's a little confusing for a lot of my patients. Is, it doesn't happen just right after the event. So say you had COVID, the hairs wouldn't fall out right after you recovered. It would actually be often about three months after that because that's how long the hair cycle takes just to complete. And so then all the hairs then start to fall out at the same time, that three month window after the event. Wow. Okay. So three months later, potentially. How long, let's say that the stressors gone and now they're doing okay. How long and we're gonna assume 'cause we'll get more into this, we're assuming like no micronutrient deficiencies or anything else that's problematic going on. How long is it until they can expect to start to see some regrowth or, and is it normal to get all the regrowth or is there a certain percentage that doesn't come back? I know there's probably lots of variables. Yeah, no, that's a great question. That's the question that so many PE people wanna know the answer to. So I would say generally the timeline is there's this physiologic stress in the body. And then in about three months we start to see the shedding that often will last several months. So I would say usually in the window around. Three to six months, we see the shedding continue and it's usually around towards the end of that when patients are coming in to see me, they are done with this, really hoping things are gonna get better. And at that point, usually things start to recover. The shedding starts to slow down and then we'll start to see little baby hairs short, regrowing hairs start to come in. So I would say the whole thing in total is usually about a six month period. But as you mentioned, if there is. Continuing stress on the body. So if say somebody has really low iron levels or they're anemic or some sort of thyroid issue that we haven't identified, then patients can enter into something called chronic telogen of flum. So this is a chronic shedding phase and a lot of people, especially a lot of women, are actually in this chronic telogen effluvium for years. And so that's why it's super important to work up the hair loss to try to get an answer to what's going on so we can hopefully treat that to get the hair growing again. It's interesting that you bring that up. 'Cause I don't think we realize how much our day-to-day life is affecting us and what we're eating and drinking and doing and just all the things. And then we end up with something that's actually affecting us and we, we Okay. Reframe That was like really dumb. No, that's good. Think we're good Because I'm like, do I bring up, do I bring up how I see you? I was like, I don't know. Is that weird if I bring that up? Are you okay with that? I think it's personal. I think it's good. Okay. I still mention I like to talk about how like hair can be a window into body, the overall health. So I think we be kinda interested. Let's do it. Let's, okay. I wanna go there. So, you know something I forgot to say in the beginning of the episode, and I, I think you said you're okay with me disclosing this, but I actually see you as a patient. And that was one of the things that we identified with me was this chronic ness to what was going on with my hair. 'cause with me, when I started medical school, I'll never forget this, I. We were, I don't know, like maybe three, four months in. It was before the winter break. Right. And I think, you start school in like, I don't know what August. I remember looking in the car window and it was like, oh my gosh. In the front. It was like so much hair was gone. And I just thought, oh, well, you know, like whatever. Maybe I didn't know, had it always been happening, was it new? And I realized that was the start of it. And I just, I didn't know to, to get help at the time. But anyway, it's, I think, what were you saying with kind of the hair being like a window into the body? Yeah, so I think what's so interesting about hair loss is that it often is the first thing that we see outwardly, that there's something going on the inside. So I have had patients who notice shedding or thinning. And then when we do a little bit more workup, we can often find out that maybe they have some sort of, very low, iron levels or they're having some sort of thyroid problem. I even had a patient who was getting some sort of arsenic poisoning who came in me for a hair shedding. And so it's really, I think, fascinating. It seems like the body, whenever there's. Like a stress on the body. It shunts resources away from the hair. It's like, the hair isn't important, let's keep you alive, let's keep you protein elsewhere in the body. So I think unfortunately with weight loss, when it's intentional the body doesn't really know the difference. It's oh, maybe we're in a famine. Let's try to re redistribute our resources to other things. But I think it's really interesting because it can sometimes be also like a good signal for somebody to maybe seek out medical care to maybe get some blood work done and it can identify, obviously the hair is super important, to a lot of women and to everybody in general. But it can also be, a signal to kinda look for other things that may be going on in the body. Definitely. And you said you, you've mentioned a few different kind of medical conditions and things. If we thought about labs for a second, are there, and of course everybody listening, this is not comprehensive, talk to your medical doctor, but are there just a few basics where you're like, we gotta make sure, thyroid, iron, are, what are the few labs that you feel like no matter what type of hair loss it probably these labs should get checked? Absolutely. So I would say the big three ones we look at are ferritin. So this is markers of iron stores in the body. I would say that one's number one, we want levels to be over 50 for that. So what's interesting about the ferritin is the levels that we want for just like making red blood cells and just like for overall health is usually above 20. But we actually want the levels to be a little bit higher for ideal hair growth. So whenever the levels are a little bit low, like I was saying before, the body starts to shunt away from the hair. And so I would say also another lab that's super important is vitamin D levels. So we ideally want, the vitamin D levels to be around 50. I would say the 40 to 60 range, but again, it's not like low normal levels can be okay for overall health, but not great for hair health. Okay. And the third one that we look for is usually like a TSH or thyroid level. So those are always the big three that I check for any patient with unexplained hair shedding, hair thinning, some patients, wanna get a lot of additional labs done, like hormone labs, all this. And I think there definitely can be a role for other types of health conditions, but usually not super high yield for the hair. So I would say usually just a simple three lab panel is enough for most types of hair loss. Okay. Awesome. And if someone came in and let, we're assuming that their hair loss is because of rapid weight loss, they're on a GLP one, something like that. Is there a time and a place to use medications to help with that, or is that something where watch and wait or you have tips for them during that time? What's your approach there? Yeah, absolutely. So I would say initially when somebody is having significant shedding of the hair, or a condition called telogen effluvium, which is basically just a really fancy word for, cute shedding of the hair the conventional thinking is that we first just try to identify what's going on, remove whatever potential physiologic stressor we have going on, and that the hairs will recover. However, having personally experienced some of this is part of the reason I got very interested in this topic is it's very easy to tell patients, oh, you know, don't worry your hair is shedding it will get better. And the wisdom is that this will recover. It is a temporary condition. However, it's very distressing when you are seeing hairs all over your car, all over your shower, all over your floors. I mean, you can lose, 30, 40, 50% of your overall hair during this period of time. So I definitely am an advocate for intervening a little bit earlier with patients with this type of shedding. We are now using a medication called Minoxidil. So this is the medicine that is in. Rga people use this over the counter, but we are also using low dose oral minoxidil. So this can help shift the hairs out of the resting phase back into antigen or the growth phase. So this can help patients to stop the shed before it becomes too severe, and then also help the hairs to grow back. Also a lot of women, myself included, also have some female pattern thinning as well. So there's often more than one thing going on, and so a medication like the Minoxidil can also work on that. So that will help to just thicken the individual hairs because when somebody is getting severe shedding, it can sometimes now unmask a thinning that they already had. They may not have even noticed, but all of a sudden now that we're losing some of the density of the hair as well, all of a sudden we start to notice that fitting a lot more. Yeah. Oh, this is really good. One question I have is, I feel like, like back in the day, folklore was always, if you're using Minoxidil, you can never stop it. Are they able, let's assume that the other patterns aren't involved and it's just, from weight. Are they able to use Minoxidil during their weight loss and then stop it a few months later? Or do they have to be on it for life? No. So that's a really good question. It comes up a lot. So I think there's a lot of, just like you're saying for folklore related type minoxidil, I think there's a lot of concern that if you stop the medication, then all of a sudden you'll wake up the next day and kind of all the hair that you had grown will come out. So none of that is really the case. With Minoxidil and specifically the oral minoxidil, it definitely will stimulate hair growth, help to thicken the hairs when you're on the medication and then like pretty much any other medication. Once you come off, you will eventually over several months. Start to gradually go back to what your normal baseline would be off the medication. However, if the type of hair loss is due to some sort of more short-term event, like recent weight loss, then once the weight loss is stabilized and if there is no other issues going on that could contribute to hair thinning or hair loss. You should be able to get off the medication. And so I have had a number of patients like this where we have them on the oral minoxidil, maybe for just like a, you know, six month, sometimes like one year window. Just to get that over kind of the hump with, um, the cute hair shedding. And often patients do really great off of the medication and they can continue to regrow the hair. So, really good question. And something that people are always asking about a lot. Definitely How long when they, let's say that someone starts oral mono. Well, I have two questions. Number one, what's the efficacy difference? If you know the difference between using like topical versus oral and then once you start oral, how long do you have to be on it until you could expect to either see results or see some change? Like what are we looking for in the beginning essentially? Yeah, absolutely. So yeah, so Topical Minoxidil has been around for a long time. Um, you know, I would say, um, sometimes we're limited a little bit by absorption on the scalp, and this really varies a lot. And we don't, I think we don't fully understand why some people respond a lot better than others to the topical minoxidil. I think some of it honestly is just. Even the hassle of doing it every single day. I have some patients who are very, very diligent and use it religiously once or twice a day and they, often do get a very good result. Maybe not quite as good as the oral minoxidil, but mm-hmm. They do get a pretty good response. But I would say the oral monoxide overall seems to be more potent, in most patients. The downside is sometimes then you grow hair, not just on the scalp, all a little bit, but most people are so happy with how great the hair is growing on the scalp. That pretty minimal side effects. Otherwise, in terms of the timetable, so that is also a really good question because it, is not instant. Unfortunately so because of the nature of the hair cycle, just like how we mentioned, it takes about three months to see the hair shedding start after some sort of event that stresses the body. It also will take at least about three months to really see any change with starting a medication for hair loss. So I would say it's usually at about that three month window that I'll be able to see in a patient. And usually I look up close at the scalp with something called dermoscopy, so looking under specialized light on magnification. And so at that three month mark, I'll start to see little tiny baby hairs start to come in. However, as a patient, you may not start to notice it until maybe closer to the six month mark, because that's how long it takes just for the hairs to get long enough that they're a little bit more visible. Interesting. Yeah. When you bring that up, it's like you have to have some commitment that you are willing to stick with this for a while, right? Absolutely. Absolutely. Yeah. So I do definitely have some patients who will try, the oral monoxide or something like that, maybe for like a couple weeks, a month, and then they're like, this isn't working and wanna stop it. But it's really important to explain from the beginning that this is gonna be more of a longer term treatment and we have to be a little bit patient to see the ideal results that we want. Are there other medications that would be used for hair loss? Because I, I feel like I hear a lot about like Spironolactone or Finasteride, other ones. Are there other, medications that are commonly used for hair loss with that? Yeah, so I use a couple other medications pretty commonly. So the other big class of medications we use for hair loss is the DHT blockers. So these are ones that are more treating female pattern or male pattern hair loss. So those are driven by, androgen kind of testosterone type hormones in the body. And so these medications, the most common ones are Finasteride or Propecia, and then also dutasteride that we use off label. So these help to basically push pause on the progression of these types of, female pattern, male pattern thinning. And so a little bit different from the type of hair loss we see with, the weight loss medications telogen, flum or acute shedding. However, I would say a lot of people have a overlap going on. And so if I do see that in a patient, we will often add one of these medications as well. And so it works in a different mechanism. They usually have very minimal side effects. People do really well with them. And that can really help to thicken the hairs as well if there is a component, hormonally as well. Amazing. And is Spiron Lactone ever used? Yeah, so Speral Lactone is also, A DHT blocker. It has some anti-androgen properties. It's funny, a lot of these are all originally weight loss medica, or sorry, originally, blood pressure medications. And so they. Are all used off label a little bit. Basically they were given for high blood pressure and then we started to see all these, properties like people growing their hair back. But in terms of Speral, lactone, I use it a lot for like acne and other indications. I use it sometimes for hair loss. So it's used often in women who are a little bit younger. And so we will often use it in women who are not postmenopausal just because it's a little bit safer medication. The finasteride do are a little bit stronger, effects on the hair and the DHT, but, they aren't great sometimes for women who are wanting to get pregnant or have, kids just because, it can cause sometimes, some issues with like birth defects if they were to get pregnant. So sometimes people use speral Lactone as a little bit of like a like safer option for somebody who is wanting to have kids in the near future. I'm glad that you brought that up because I don't think if people are not medically trained that they realize how significant, when we have young women, it is totally different medication that we're using for them. Just like across the board, like blood pressure medicines, like everything, we always need to think about a potential pregnancy. And that's just interesting 'cause I feel like sometimes I'm only hearing people say spironolactone and in my mind I. Wait, why are we only talking about that? And now I'm realizing it's the younger patients that are telling me that, so, so this makes sense. Yeah, yeah, yeah. It's interesting. Yeah, and I feel like this prolactin, it definitely can help a little bit, but it's not quite as strong. I haven't seen as good results with that, as with some of the other medications. And I feel like it's a really interesting topic. I feel like there needs to be definitely a lot more research into young women. And treatments for them and what could be safe, during pregnancy, breastfeeding, because that's a whole category nobody really wants to study, I guess, it's a kind of a high risk area, but we definitely need even more treatments for young women with hair loss. Definitely. This gets to like a bigger issue, which is women have not been studied. We won't open that worms, but I'm like, we need to actually be taken into account in studies. So absolutely. But coming back to this, are there any common myths or misconceptions about hair loss where you just see it online and you're just like, gosh, I just wish that patients would understand this. I. Yes, absolutely. And I think having experienced this myself, I can definitely relate to some of 'em. So a big one that comes up a lot is when patients are having really severe shedding, they become extremely afraid to even wash their hair, brush their hair style, their hair. And I can definitely relate to it. It's really scary, like when you take a shower and you're seeing clumps of hair come out. And so I have a lot of patients who will just completely avoid shampooing their hair or showering for, sometimes even like a week or two, just because that's when they're seeing the hair's coming out. And so what I do try to explain to these patients is that these hairs that you're seeing coming out, unfortunately they're gonna come out regardless of what you do. They're already in this shedding phase and so. Any sort of, touching the hair, washing the hair, they're gonna come out regardless of what we do. So not to be afraid to continue to, you wash the hair as you normally would, every couple days. Not to be afraid, brushing the hair, normal styling of the hair. I do usually tell patients to be a little bit more cautious with any sort of like. Tight hairstyles or, things that would maybe put a little additional stress on the hair, like intense heat styling and things like that. But generally there's not much you can do to the hair that's gonna worsen this type of hair loss. It's more internal what's going on. Another really common one that comes up is, patients will bring in just bags of like, they've spent a fortune on just so many. Over the counter serum. I was gonna ask you about all this, so I'm glad you're, I'm glad you're talking about this. Yeah, yeah, exactly. So, yeah, so they just, you know, there's such a market out there. I mean, I think it's like billion dollar plus market for all these, um, over the counter kind of hair loss products. And, you know, obviously I can't speak to everything, but I would say the vast, vast majority of things are not gonna really get to the root cause of what's causing this acute shedding or even female pattern thinning. So I would say try to, if you're gonna conserve your energy and money, I would try to, focus on the things that are more high yield. Like trying to get a, dermatologist to take a look at what's going on and come up with a good plan to get the hair thickened up and help with the shedd. And a lot of these shampoos, everything is more external and unfortunately 'cause a lot of these types of hair loss are more internally driven. There's not a lot that's gonna make a huge difference. Okay. 'cause I was gonna ask you about like the microneedling and the red light caps and all these kind of things, so you're not sitting there routinely thinking that it's supplemental to something else for them to be doing it. Yeah, well, I mean, so there is, I think some data with some of these types of procedures and devices. I will sometimes do some things like, like platelet-rich plasma injections, PRP. I think that can be helpful in some cases for acute shedding as well as women with female pattern thinning. So I have seen that helpful. I would say in patients with really severe shedding or thinning though it would be probably in addition to doing like an oral medication as well, I wouldn't want patients to waste their time and money on something that may not be enough for them., On its own. I would say the red light calves, I think we are getting a little bit more data. I think again, in a role as an adjuvant to additional therapies, I think can be helpful or maybe for patients with. More mild female pattern thinning, it can be used and helpful. The microneedling, there is a little bit of data. I think how it works is basically little micro traumas like on the scalp can help the body, and just kinda stimulate a little bit some of the healing. And there's some properties with that to, to help with certain types of hair loss. But you know, definitely a lot of, there's just so much like hair vitamins. I, biotin is a big one that comes up a lot where patients will be taking these mega, mega doses of biotin and unfortunately I, there's really not a lot of data that biotin can help with. You know, hair shedding or hair thinning. Unless you're really like severely deficient, which most people are not so yes, so just interesting, to a lot of patients, buy a lot of stuff. They're just desperate. They're just trying to find anything that may help a little bit. But, unfortunately I would say some of that stuff may be a little bit, not the best use of time and resources. I'm definitely the person that wants to believe all the ads. And so there was a microneedling ad the other day and I was like, I was like, maybe I was gonna buy it right. And then she says in the ad, within three weeks, she's throwing around all this luscious hair. She's like, within three weeks it was thicker and fuller and longer. And I'm just thinking, okay, now you're lying. Like we know within three weeks it can't change that much. So I know it's too good to be through sometimes it's, unfortunately. Definitely. So if you think if, do you think there's, are there tips like maybe two, three tips that you. Maybe they got on a medication or not, but that you give to, uh, to people when you're treating their hair loss, like maybe even from a nutritional standpoint or other things that matter as far as routines. Yes, absolutely. So, um, you know, kind of going to patients who are dealing with this, on like a weight loss journey, um, I would say there's a little bit of evidence to suggest that more gradual weight loss can be helpful. So. If possible, and I know this is maybe easier said than done, but trying to aim for more like one pound of weight loss per week or even a little bit less than that. Just so it's a little bit more gradual process. Usually patients who are able to not lose more than two pounds a week don't seem to get the same degree of severe hair shedding. It seems like that's the breaking point where the body just, is comfortable with that, type of weight loss and they don't become more stressed physiologically and have more shedding. I would say another thing too, just in terms of the nutrition is and I'm sure you talk about a lot of this in your other podcasts as well, but protein is super important, so there's a lot of data on this. Trying to aim for at least, like 80 to a hundred grams of protein, or even more like up to around one gram per pound of body weight. This seems to be really helpful for supporting the hair and helping to avoid the shedding that can occur. And then I think I mentioned a little bit previously, but on the, iron vitamin D so definitely encouraging patients to have iron rich foods. Red meats if you eat them, spinach, lentils. Also taking with vitamin C, so I often recommend, a supplement, which is like a combined iron, vitamin C. There's a few formulations like that, but that can really help with absorption as well. Yeah. Love that. It's, gosh, it makes such a difference in the labs that I see for patients when we put vitamin C with it, it's like night and day as far as I'm concerned. I dunno why everyone isn't doing it. So this is really great. You've shared so many amazing, tips and things to look out for. Do you think there's anything that we didn't talk about in this category? I know there's always so much more, but that we didn't talk about that you think the listeners should hear. Yeah, so I think a big one is if you're experiencing this type of hair shedding, it can be super scary and there's a big emotional component with all this. I have had patients even as dramatic as literally shaving their head because they were just so upset by how much hair was coming out. We've seen that especially like after like COVID, hair shedding can be really dramatic, but I think the big thing is just not to panic. So this type of hair shedding is almost always completely temporary, and so the hairs that are coming out all will regrow. And so I think the big thing is just to not, stress too much. I know easier said than done when you're going through this and having gone through it myself, but we have. A lot of really great treatments now for this if you need it. And worst case scenario, the hair almost always will completely come back on its own. So, the hair follicles are very healthy. There's several different types of hair loss I deal with, but the ones we talked about today, these are all completely nons scarring. They don't involve any damage. The hair follicles are still completely healthy, and so the hairs can completely grow back. Oh, this is really encouraging. Thank you for offering that. I, I think people need to hear that, and I do like, like how you're like, get evaluated because I really, even when I'm seeing patients in clinic and I suspect it's X, Y, Z, I still want a dermatologist to weigh in because it's just too important for us to get it wrong. You know what I mean? Like it's just something where we don't, we really want that secondary input. Can you tell everybody how can they find you, your website let us know roughly what states you see and all of that just so people can get a little bit of a sense of that. Yeah, absolutely. Yeah. So I, my practice name is Carella Dermatology, and on my website, www.carelladermatology.com, you can make appointments directly through there. You can do your own online scheduling on the website. And so yeah, I see patients in most major states in the United States, you know, including Florida, Texas, California. I'm licensed in close to 20 states. I also see patients in person in Carmel, Indiana. And so, yeah, I, do a lot of hair loss consultations through there. Often patients can send photos over in addition to doing the video consultation, so we can just see a little bit better what's going on. And also a great way to determine the kind of, the type of hair loss is patients can even do what's called like a little hair pull test. You just gently tug on the hairs and we see how many hairs come out, and that can be a really good indicator if you are having like an acute, shedding event going on. What would, just from the last thing you just said, so how do you, so what's significant when you do that hair pull test? Yeah, so when I see a patient in clinic and evaluate them for an acute shedding or hair thinning that's going on, we'll do something called a hair pull test. So what I'll do is just grab, it sounds kinda a little weird. Basically we just tug gently on the hair and we see if more than like one to two hairs comes out. If you start to see more than five hairs coming out, that often is a red flag that there is an acute shedding event going on. And then also I'll look up close on a patient's scalp with something called dermoscopy. So we look with a specialized magnification tool and then looking at the hair follicles themselves, we can get a lot of information. Often patients who are just getting a shedding or telogen of flum, the hair follicles all look about the same size. However, when somebody is also having female pattern thinning or male pattern thinning, you'll actually see something called hair shaft variability. So some of the hairs are normal and thick, but you'll also see some of these really thin hairs or miniaturized hairs, and so that's a red flag that there is more of, a hormonally driven hair loss going on as well. Yeah. This is so fascinating. I know you did all this to me and everybody, it doesn't hurt when she tells the podcast, but it's, it was so fascinating when you took a look and you're like, here's what I'm seeing with the pores and all that. Like, it, it was just so fascinating. So thank you so much for coming on today. Everybody who's listening, we will have. The link to her website. Did everything listed below right where you're listening, or if you go to reia dot tia clinic.com and you click on podcast. We have a whole, we have all of this written up, all the information with links to everything. Just thank you again for taking the time. I know that everyone's gonna learn so much today. No, thank you so much for having me.