Why Is My Hair Falling Out? A Hormonal Hair Loss Specialist Explains

You first noticed it in the shower. More hair than usual swirling down the drain. Then on your pillow. Then stuck in your hairbrush.

You went to your doctor. They did bloodwork. Everything came back normal.

So why is your hair still falling out?

If that sounds like you, please hear this: you are not imagining it and you are not alone.

As a hair loss specialist who works with women going through hormonal changes, I hear this all the time , my tests look fine, but something is clearly wrong.

Let me explain what might actually be going on.

How Hair Grows , And Why It Sometimes Stops

Here's something most people don't know: your hair is not always growing. Every single strand on your head goes through a cycle , like a little life of its own. There are three stages:

The growing stage: Your hair is actively getting longer. This lasts anywhere from two to seven years.

The transition stage: A short two-week pause where the hair follicle (the tiny pocket in your scalp your hair grows from) starts to let go.

The resting stage: The hair rests for two to four months , then falls out, and the whole cycle starts over.

On a healthy scalp, most of your hairs , around 85 to 90% , are growing at any given time. When your hormones shift dramatically (like during perimenopause, menopause, or after having a baby), this balance gets thrown off. More hairs move into the rest-and-shed stage all at once. That's when you start noticing the extra shedding.

"Normal" bloodwork doesn't always mean nothing is wrong. It means your numbers didn't hit a red flag on a standard chart , a chart that wasn't designed with your hair in mind.

The Most Common Reasons Women Lose Hair Due to Hormones

Estrogen dropping: Think of estrogen as the hormone that keeps your hair in its growing stage longer. When estrogen goes down , as it does during perimenopause and menopause , hair starts cycling through faster. More shedding, less thickness. It happens gradually across the whole scalp.

A hormone called DHT taking over: DHT is made from testosterone. As estrogen drops, DHT gets louder in comparison. For women whose bodies are sensitive to DHT (this is genetic , it's not your fault), the hair follicle slowly shrinks with each cycle. Hairs get thinner and shorter over time, until the follicle stops making hair at all. This usually starts at the crown or top of your head.

Low iron stores (ferritin): Ferritin is what your body uses to store iron. Your hair follicles need iron to work properly , they're some of the most energy-hungry cells in your body. If your ferritin is below 70 ng/mL, it can cause serious shedding. Here's the frustrating part: many doctors only flag low ferritin at 12 ng/mL, which is way too low for healthy hair. So your results look "normal," but your hair is struggling.

Thyroid issues: Both an under active and overactive thyroid can disrupt the hair cycle. The standard thyroid test (TSH) alone doesn't always catch the full picture. A more complete look includes free T3 and free T4 levels , these tell us more about what's actually happening in your body.

Stress shedding (called Telogen Effluvium): Major physical or emotional stress , an illness, surgery, grief, crash dieting, or a long stretch of anxiety , can push a big group of hairs into the shedding stage all at once. The tricky part? The shedding usually starts two to four months after the stressful event. So by the time your hair is falling out, the cause feels long gone.

Why Your Doctor's Tests Might Have Missed It

This is the part that frustrates most of my clients , and it makes complete sense.

Standard blood tests are built to catch disease. They're not fine-tuned for hair health. A ferritin level of 15 ng/mL might not be technically "low" on a lab report, but it's almost certainly contributing to your hair loss. A thyroid number of 3.5 might be "in range," but for hair health, we'd want to see it closer to 2.0 or below.

Beyond blood tests, most doctors don't look closely at your actual scalp. But the scalp is where all the answers are , and seeing it clearly requires tools that most doctors don't have in their office.

That's where a trichoscope comes in. Think of it like a high-powered magnifying camera for your scalp , it makes everything up to 70 times bigger. We can actually see whether your follicles are shrinking, if there's inflammation on your scalp, and which areas are being affected. That's real information you can act on.

What You Can Do Right Now

The most important thing: don't wait. Follicles that are still active respond much better to treatment. The longer you wait, the harder recovery gets. Starting early always gives you more options.

A few things worth looking into:

Ask your doctor for a ferritin test specifically , not just a general iron test. You want to see your ferritin level, and you want it above 70 ng/mL.

Ask about free T3 and free T4 if you're concerned about your thyroid , not just TSH on its own.

Book a scalp assessment with a specialist who uses trichoscopy. What's happening on your scalp tells a story that a blood panel simply can't.

Be honest with yourself about stress. Not just recent big events , but the quiet, constant background stress that has become your everyday normal.

Hair loss almost always has more than one cause. A thorough assessment looks at your whole picture , not just one number at a time.

If any of this sounds like what you've been going through, the best place to start is a clinical scalp assessment. I'm Pamela Mollineaux, a hair loss specialist based in Delray Beach, Florida. I work specifically with women navigating hormonal hair changes , and I'd love to help you get clear on what's happening and what to do next.

BOOK YOUR FIRST VISIT AT PAMELAMHAIRSTUDIO.COM →