Is Stress Stealing Your Hair? Here’s What to Do About It.
Fact: Too much worrying can actually cause strands to fall out—but there are ways to fight back.
About 5 years ago, Carrera Alvarez was going through a tough time. She was in the middle of a tumultuous divorce, and rather than letting her stress go, she found herself internalizing it, day after day. As her stress level intensified, so did other health problems. Taking a shower one day, Alvarez looked at the drain and was stunned by the large clump of hair she saw there.
But it wasn’t until Alvarez, 41, a hairdresser herself, was in another stylist’s chair that she learned just how much of her hair was gone. “The stylist said, ‘Carrera, your hair has changed so much, it’s very thin, and you’ve got patches missing,” recalls the Los Angeles native. “And I said, ‘What?’ Her advice—you really need to figure out what’s going on—made me realize how bad it was.”
Alvarez was losing dime-size areas of hair at a time, leaving bald spots around her head. “I was already going through such an emotional, traumatic point in my life, and this was not at all helpful to how I felt as a female,” she says. “It was really scary for me. I didn’t know if it was permanent or what.”
Your Hair on Stress
Telogen effluvium, a medical condition that causes excessive hair shedding and is associated with stressful physical or psychological experiences, is well-documented, says David M. Pariser, M.D., a professor of dermatology at Eastern Virginia Medical School in Norfolk and dermatologist at Pariser Dermatology Specialists. It’s different from straight-up hair loss, a.k.a. anagen effluvium. In both cases, chronic illnesses like hypothyroidism and psoriasis may play a part. (You can also have both issues—hair loss from stress and a medical condition.)
The bottom line: If you’re stressed, you can lose your hair. And with the world we live in, you’re probably not surprised to hear that this condition is common, happening to more than 200,000 people annually in the U.S. In fact, a July 2020 national survey found that 20% of women had experienced increased hair loss or thinning since the pandemic began; of those, half named stress as the likely cause.
And what about those who actually got COVID? One in four list hair loss as a side effect of the infection, according to a patient-reported survey also conducted at the Indiana University School of Medicine in Indianapolis. Experts say this hair loss could be caused by stress—then again, it could also be due to the illness itself or the high fever that can accompany the virus. Actress Alyssa Milano brought the topic to national attention after posting a video of herself on Twitter in August 2020, brushing out clumps of her hair. “One brushing,” she says, holding up at least 50 strands or more of wet, dark blonde hair. “This is my hair loss from COVID-19.”
“COVID negatively impacts hair health, but it impacts people differently,” says Craig Ziering, D.O., a dermatologist and hair transplant surgeon in Beverly Hills, CA. “Some patients who are recovering from COVID are experiencing significant loss from the virus itself, while in others it’s related to the stress of whether or not they’ll have a job and the social stresses of not being able to interact.”
Why Hair Loss Happens
To understand stress-related hair loss, you have to first consider the three-step hair-growing cycle. “Anagen is the hair’s growth phase, catagen is the resting phase, and telogen is the shedding phase,” says Ziering. “When you have stress, trauma, or sickness, it disrupts that normal cycle and causes the hair to remain in the shedding phase longer and the growth phase becomes shorter.”
During a normal hair cycle, people shed 50 to 100 strands a day as hair grows and separates from each follicle (the structure under the skin that holds each hair in place). Essentially, new anagen hair pushes out old telogen hair. But if you’re losing far more than 100 strands, you should be concerned, experts say.
To add a layer of trickiness to your hair situation, hair loss caused by stress take two to four months to materialize (a full growing and shedding cycle). So someone who contracted COVID several months ago may only now be experiencing hair loss. Once the stressor or illness is resolved, it take your hair about nine months to grow back to its full potential.
If your hair is still not back to usual by then, there could be another issue, like a genetic hair loss condition or an underlying inflammatory disorder. See a hair loss specialist or dermatologist to explore other potential causes. “Early intervention is the key,” says Ziering. “You want to be consistent with a hair loss prevention treatment plan.”
Other Hair Loss Culprits
While stress and sickness are the two primary suspects when it comes to sudden thinning of your hair, there are other possible reasons you’re going insta-bald. Under the umbrella of “alopecia,” the Greek word for hair loss, you’ll find multiple conditions. This list is not exhaustive, but these are some other most common reasons for hair loss:
Androgenetic alopecia: This type of hair loss affects 50 million men and 30 million women in the U.S., according to the American Academy of Dermatology. Commonly known as male and female pattern hair loss, it’s genetic and can be a natural part of the aging process but can also occur in younger people. Treatments include medications like Rogaine (minoxidil), surgery such as follicular unit transplantation, laser, or even stem cell therapy.
Alopecia areata: This is the autoimmune disease that attacks the hair follicles, causing hair to fall out in round patches the size of a quarter (it may grow back or not). If you have alopecia totalis, you lose all your hair on your head (which is uncommon). If you have alopecia universalis, you lose all the hair on your body (also rare). Treatment can help hair possibly regrow, but there’s no cure.
Hypothyroidism/Hashimoto’s: Hair loss from this thyroid condition and the autoimmune disease that can cause it is pretty common, Ziering says. Researchers still don’t know why it happens, but it often resolves with thyroid hormone replacement therapy.
Lupus: Hair loss is a common side effect of this autoimmune condition. The medications used to treat lupus, including steroids and immunosuppressives, can cause hair to become brittle and thin; it’s possible that if you taper off these meds, hair might grow back. But if you’ve experienced extensive scarring on your scalp, that might be challenging. Talk to your doctor about ways of regrowing your hair with this condition.
Psoriasis: Scalp psoriasis can lead to hair loss. The American Academy of Dermatology advises gently combing and brushing away the scale on the scalp, keeping your fingernails short to prevent loosening hair from scratching, and letting your hair air dry to not further damage the already dry scalp with hot air from a blow dryer.
Infections: Tinea capitis (also called scalp ringworm) is a fungal scalp infection that commonly happens in children, causing hair loss in patches. It can lead to bald spots that grow bigger. The scalp may itch and have sores or blisters that ooze. Treatment is an oral antifungal medication that, if caught early, can help the hair regrow without issue.
Preventing Hair Loss
Stress reduction is key in preventing telogen effluvium, but ironically, it’s tough to stay calm when you’re losing your hair, says Rochelle Walsh, LSCSW, a licensed counselor in Topeka, KS. Hair is so tied to ideas about beauty, and masculinity and femininity, that losing it is traumatic.
Stress managements is key though, and you can give it shot with things like deep breathing exercises, yoga, and meditation. “Deep breathing strategies help to activate the vagus nerve and trigger a parasympathetic ‘rest and digest’ nervous system response,” Walsh says. “This relaxation is just what we need to combat stress on a daily basis. The more we practice relaxed states, the greater we benefit both mentally and physically.”
For Alvarez, losing her hair was the wake-up call she needed. She began using a hair product treatment regimen (Nioxin) and seeing a therapist. She learned how to manage her stress through therapy and meditation. After years of cutting and coloring other people’s hair, she’s happy to report that her own started growing back just three months after she began addressing the issue.
“I was very fortunate that my hair came back,” she says. “I have no patches anymore. It’s a huge change—my hair now is the longest it’s ever been.”
- Explaining Telogen Effluvium: Journal of Clinical & Diagnostic Research. (2015). “Telogen Effluvium: A Review.” ncbi.nlm.nih.gov/pmc/articles/PMC4606321/
- What Is Anagen Effluvium: DermNet NZ. (2019). “Anagen Effluvium.” dermnetnz.org/topics/anagen-effluvium
- Shedding Vs. Loss: American Academy of Dermatology Association. (2020). “Do You Have Hair Loss or Hair Shedding?” aad.org/public/diseases/hair-loss/insider/shedding
- COVID Long-Haulers and Hair Loss: Indiana University School of Medicine. Lambert, N. J. & Survivor Corps. (2020). “COVID-19 ‘Long Hauler’ Symptoms Survey Report.” dig.abclocal.go.com/wls/documents/2020/072720-wls-covid-symptom-study-doc.pdf
- Milano Video on COVID Hair Loss: CBS News. (2020). “Alyssa Milano Says She Is Losing Her Hair After Long Battle with COVID-19.” cbsnews.com/news/alyssa-milano-suffers-hair-loss-covid-19/
- All About Aopecia Areata: National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2016). “Alopecia Areata.” niams.nih.gov/health-topics/alopecia-areata#tab-overview
- Reasons for Thyroid Hair Loss: International Journal of Trichology. (2013). “A Descriptive Study of Alopecia Patterns and their Relation to Thyroid Dysfunction.” ncbi.nlm.nih.gov/pmc/articles/PMC3746235/
- Lupus Hair Loss: Lupus Foundation of America. (2020). “Hair Loss and Lupus.” lupus.org/resources/hair-loss-and-lupus
- Scalp Psoriasis: American Academy of Dermatology Association. (2020). “Scalp Psoriasis: 10 Ways to Reduce Hair Loss.” aad.org/public/diseases/psoriasis/treatment/genitals/scalp-hair-loss
- Hair Loss Treatment: Mayo Clinic. (2020). “Hair Loss.” mayoclinic.org/diseases-conditions/hair-loss/diagnosis-treatment/drc-20372932