Hair Loss: who to see and what helps

Hair Loss · Kitchener, Waterloo & Cambridge

Losing 50 to 100 hairs a day is normal. Hair loss beyond that is most often inherited pattern thinning, or a temporary shedding that follows an illness, childbirth, stress, weight loss or low iron by a few months and usually recovers once the cause is dealt with. Finding the cause comes first, and that is work for a Nurse Practitioner or your own physician. At CARESPACE the first visit is with a Nurse Practitioner; a Registered Dietitian or a Naturopathic Doctor can come in once the cause is known.

What hair loss is

The medical word is alopecia, and it covers several different problems. The broadest division is between hair loss that leaves the follicles in place, which is most of it, and the scarring kinds, about 3 per cent of cases, in which follicles are permanently lost.

What the main types look like

• Pattern hair loss. Gradual and inherited. In men, a receding hairline and thinning on top; in women, thinning mainly over the crown. About half of men are affected, and about 40 per cent of women see some thinning by age 50.
• Temporary shedding (telogen effluvium). Hair comes out all over the scalp, in the brush and the shower drain, two to four months after a shock to the system.
• Alopecia areata. Round bald patches, sometimes with hair coming out in clumps. It is an autoimmune condition that about 2 per cent of people have at some point.
• Scarring alopecia. A group of conditions that destroy the follicles, usually on the scalp, and are usually diagnosed by skin biopsy.
• Loss from pulling or tension. Tight hairstyles, or the urge to twist or pull hair (trichotillomania).
• In children, scalp ringworm is a common cause, treated with antifungal tablets.

What causes hair loss

Pattern hair loss comes down to genes and hormones. Temporary shedding has a longer list of triggers: childbirth, an illness (especially one with a fever), surgery, psychological stress, weight loss or an unusual diet, low iron, an underactive or overactive thyroid, and some medicines, among them blood thinners, cholesterol-lowering drugs and hormones. Cancer treatment is another cause. Because the shedding trails the trigger, people often miss the link. In a region with two universities and a college, a brutal exam term or a bad flu in residence can turn up in the hairbrush the following term.

Hair loss can also be one sign of a wider condition: it is on the symptom lists for an underactive thyroid and an overactive one. See Hypothyroidism & Thyroid Conditions and Hyperthyroidism.

How hair loss is diagnosed

Mostly by looking and asking: the pattern on your scalp, when it started, what happened in the months before, your medicines and your family. A clinician may gently pull on a few hairs. Blood tests are targeted: they look for the nutritional, hormonal and autoimmune causes your history points to.

When to see a physician or nurse practitioner

Hair loss has no emergency signs in what we read. HealthLink BC, British Columbia’s health information service, advises seeing a doctor when:

• Your hair loss is sudden, not gradual
• You are shedding large amounts after combing or brushing, or your hair is becoming thinner or falling out
• You think a medicine may be causing it (whether to change it is the prescriber’s decision)
• Your scalp is scaly or has a rash, or there is any other change in your skin or scalp along with the hair loss
• Your hair is gradually thinning and you want to talk about treatment

Scarring hair loss needs a dermatologist’s care. And the NHS adds a practical point: get an idea of the cause from a physician or nurse practitioner before you think about a commercial hair clinic.

What the evidence says about treating hair loss

• Where this comes from. A Cochrane review of treatments for female pattern hair loss, a 2019 review of vitamins and minerals, the key recommendations of a 2024 review for family physicians, and Canadian and UK health information.
• Temporary shedding usually ends by itself. It tapers back to normal over six to nine months in most cases, and regrowth is usual once the trigger is gone, though for some people recovery is incomplete. Treatment means finding and correcting the trigger.
• Minoxidil works for pattern hair loss. In the Cochrane review, about twice as many women using minoxidil as using a placebo reported at least moderate regrowth (six studies), and the 5 per cent strength did no better than the 2 per cent (four studies). Side effects were mostly mild, such as itching and hair growing in other places. It should not be used in pregnancy or while breastfeeding, and it works only for as long as you keep using it.
• Finasteride is mainly for men, for whom it is a first-line prescription. In women it was no more effective than placebo in three studies, and the NHS says women should not use it; the Canadian Dermatology Association notes it is sometimes prescribed for women in adapted doses.
• Alopecia areata often regrows within a year. Steroid injections into the patches are a usual treatment, on evidence the family-physician review rates as inconsistent; a newer prescription tablet, baricitinib, has consistent trial evidence.
• Correct a deficiency; do not supplement on a guess. Most authors treat low iron stores and low vitamin D in people with hair loss, although there is no agreed “normal” ferritin level. Screening for zinc is not recommended. Biotin deficiency causes hair loss, but there are no evidence-based data that biotin supplements promote hair growth.
• Some supplements cause hair loss. Too much vitamin A or selenium can do it. High-dose biotin also interferes with some laboratory tests, thyroid tests among them.
• Laser combs. In two studies with 141 women, users rated a laser comb no better than a sham device, although hair counts favoured it.
• Hair pulling. Behavioural therapy is effective for trichotillomania; the evidence for medicines is insufficient.

What a doctor may offer

Prescriptions for pattern hair loss, such as finasteride for men or spironolactone for women, need monitoring by the prescriber. A dermatologist may offer steroid injections or other treatments for alopecia areata, and manages scarring alopecia. Hair transplantation is a surgical option for some people with pattern hair loss. No treatment is 100 per cent effective.

How each CARESPACE service helps with hair loss

Nurse Practitioner

A Nurse Practitioner in Ontario can diagnose, order and interpret tests, prescribe medicines and refer you to a specialist. For hair loss that can mean examining the scalp, deciding which blood tests your history calls for, checking your medicines for a possible cause, treating what turns up, whether that is iron deficiency or a thyroid problem, and referring you to a dermatologist when the pattern suggests alopecia areata or scarring. Your own physician can do the same.

See our nurse practitioner team →

Naturopathic Medicine

A Naturopathic Doctor comes in after a physician or nurse practitioner has looked for the cause, not before. Ontario’s naturopathic regulator lists clinical nutrition and lifestyle counselling among the profession’s therapies. Its members can also requisition laboratory tests from a set list that includes ferritin, thyroid-stimulating hormone and vitamin D; ask when you book whether the Naturopathic Doctor you see orders laboratory tests. A low ferritin or an abnormal thyroid result goes to a physician or nurse practitioner, who looks for the reason and sets the treatment: see Iron Deficiency. Be wary of hair formulas: biotin has no proven benefit for hair growth, and too much vitamin A or selenium can cause hair loss.

See our naturopathic medicine team →

Nutrition

Weight loss, an unusual diet and nutritional deficiency are all on the list of shedding triggers, and enough protein and iron is part of the standard advice. A Registered Dietitian can look at whether your eating covers those, which matters most after weight loss or on a restricted diet.

See our nutrition team →

Other services people ask about

Counselling. Hair loss can be distressing, and the NHS notes that counselling may help if it is affecting your wellbeing. Behavioural therapy is the treatment with evidence for hair pulling; ask when you book for a counsellor trained in it. Acupuncture and massage. We found nothing in these sources to support either for hair loss, and one advises against scalp massage during temporary shedding.

Where most people start

With a Nurse Practitioner or your own physician, who can work out which type of hair loss you have and look for the cause. Once that check is done, a Registered Dietitian or a Naturopathic Doctor can help with the food side.

How your team works together

The first visit, with a Nurse Practitioner or your physician, is about the type of hair loss and what set it off. If the trigger is nutritional, a dietitian can take on the food side. If it is medical, the Nurse Practitioner or your physician treats it or refers you on.

Browse by service: nurse practitioners, registered dietitians and naturopathic doctors.

What to expect at your first visit

1. Bring any recent blood test results, and a note of every medicine and supplement you take, hair formulas included.
2. You may be asked when it began, what the months before were like, and about hair loss in your family.
3. A look at your scalp and the pattern of loss, and perhaps a gentle pull on a few hairs.
4. Blood tests may be arranged where your history points to a cause.
5. You leave with a plan.

What you can do at home

• Handle shedding hair gently: no vigorous combing or brushing.
• Choose hairstyles that do not pull on the hair.
• Eat enough protein and iron, with plenty of fruit and vegetables.
• If your hair has thinned, protect your scalp from the sun with a hat or a sunscreen of SPF 30 or higher.
• Talk to a pharmacist, physician or nurse practitioner before starting a hair supplement, and mention biotin before any blood test.
• Colouring, hair spray and frequent washing do not make inherited hair loss worse.

Outlook

It depends on the type. Temporary shedding settles over six to nine months in most cases. Pattern hair loss is permanent: treatment can help some hair grow back and prevent more from falling out, for as long as it is used. In scarring hair loss the follicles that are lost do not come back.

Hair loss treatment in Kitchener, Waterloo and Cambridge

A physician or nurse practitioner looks for the cause of hair loss first; nutrition and naturopathic medicine come after that check.

Kitchener. Nutrition in Kitchener and Naturopathic Medicine in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nurse Practitioner in Waterloo, Nutrition in Waterloo and Naturopathic Medicine in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutrition in Cambridge and Naturopathic Medicine in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Will my hair grow back?

After temporary shedding, usually. With alopecia areata, often within a year. Pattern hair loss does not reverse without treatment.

Does biotin help with hair loss?

The 2019 review found no evidence-based data that biotin supplements promote hair growth, and high doses can distort blood tests, including thyroid tests.

What blood tests should I have for hair loss?

That depends on your history; the family-physician review speaks of targeted testing. For shedding, DermNet says to correct any abnormality in thyroid function, iron, vitamin B12 or folic acid, while the 2019 review found too few studies to recommend screening for vitamin B12 or folate. The physician or nurse practitioner who examines you decides.

Can stress really cause hair loss?

Yes. Psychological stress is a recognised trigger of temporary shedding, two to four months later. See Stress.

Is hair loss after having a baby normal?

Childbirth is a recognised trigger of temporary shedding. In most cases it tapers back to normal over six to nine months. The reasons to be seen that are listed above apply after a baby too.

Where can I see someone about hair loss in Cambridge?

A physician or nurse practitioner looks for the cause first. Nutrition and naturopathic medicine, which come after that check, are offered in Cambridge; our location there is on Hespeler Road. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

• van Zuuren EJ, Fedorowicz Z, Schoones J. Interventions for female pattern hair loss. Cochrane Database of Systematic Reviews, 2016, Issue 5. (We read Cochrane’s summary.)
• Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The role of vitamins and minerals in hair loss: a review. Dermatology and Therapy, 2019;9(1):51–70.
• Dakkak M, Forde KM, Lanney H. Hair loss: diagnosis and treatment. American Family Physician, 2024;110(3):243–250. (We read the abstract and the key recommendations.)
• Canadian Dermatology Association. Alopecia (hair loss). Updated January 2026.
• HealthLink BC. Hair loss. Current as of March 2023.
• NHS (UK). Hair loss. Reviewed January 2024.
• DermNet (New Zealand). Telogen effluvium. Updated November 2019.
• British Thyroid Foundation. Diets and supplements for thyroid disorders. Updated November 2026. (For biotin and thyroid blood tests.)
• College of Naturopaths of Ontario. Ordering laboratory tests (updated March 2025) and Core competencies (amended October 2021).
• College of Nurses of Ontario. NP Practice Resources. Viewed November 2026.

Related conditions

Hypothyroidism & Thyroid Conditions · Iron Deficiency · PCOS · Stress · Postpartum Recovery

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Book online with a Nurse Practitioner, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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