What usually causes it
Iron deficiency is the leading candidate, and heavy periods make it common in exactly this group. Ferritin can be low enough to affect hair while a standard full blood count looks unremarkable, which is why the specific test matters.
After that: thyroid dysfunction, telogen effluvium from a shock three months earlier, polycystic ovary syndrome, restrictive dieting, and traction from years of tight styling. Early pattern loss occurs too, and is under-recognised because it is assumed to be a later-life condition.
Why it gets missed
Young women reporting hair loss are told it is stress more often than any other group. Sometimes it is. But "stress" is a diagnosis of exclusion that gets used as a diagnosis of first resort, and it delays the tests that would settle the question.
If you have been told it is stress without anyone checking ferritin and thyroid function, that is worth pursuing rather than accepting.
What to do
- Ask specifically for ferritin, not just haemoglobin.
- Thyroid function, particularly with fatigue, cold intolerance or weight change.
- Note whether the part is widening or density is dropping evenly — they point in different directions.
- Photograph the same spot in the same light monthly.
- Review styling: tight ponytails, braids and extensions cause traction damage that becomes permanent if sustained.
Common questions
Is it normal to lose hair in my twenties?
Some shedding is normal at any age. A sustained increase, or a visibly widening part, is worth investigating rather than waiting out.
Could the pill be causing it?
Starting or stopping hormonal contraception can trigger shedding. It is worth mentioning as part of the timeline.
Should I stop wearing my hair up?
If it is tight enough to be uncomfortable or to cause loss at the hairline, yes. Traction damage becomes permanent once the follicle scars.
Is early loss more serious?
It has more years to progress, which is an argument for establishing the cause sooner rather than for alarm.
Can PCOS cause hair loss?
Yes, and it often presents alongside irregular periods and other androgenic signs. Worth raising if that pattern fits.
What an assessment establishes
- 1.Which process is causing the loss
Pattern loss, telogen effluvium, traction and scarring alopecia look similar in a mirror and behave nothing alike. The examination separates them, because the answer decides which routes are worth discussing at all.
- 2.Whether it is stable or still moving
Loss that is still progressing changes what any treatment can hold. It is the difference between planning around a fixed area and planning around one that will keep widening, and it is judged from history and examination rather than a single photograph.
- 3.Which routes are available to you, and which are not
Donor supply, scalp condition, skin type and how the loss is behaving each rule options in or out. You leave knowing what is on the table and what is not, without a price attached to the conversation.