It may feel like it, but this kind of hair loss isn't the end of the world.

By Taylyn Washington-Harmon
June 25, 2020
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When you have thick, curly hair like mine, it’s totally normal to lose more than your fair share while washing and detangling it. But lately I’ve noticed more than my typical hair loss at the bottom of my shower. Trying not to panic, I thought back to changes to my hair habits recently, such as washing my hair less and wearing it in a bun more than I’d like to admit.

Another thing that changed recently: my stress level. I've had plenty of "hair-raising" financial, health, work-related worries these days, so losing my hair because of stress didn't seem so farfetched. After talking to two dermatologists, I learned that this really is possible. 

“Our bodies perceive mental stress the same way it perceives physical stress, and any dramatic stressor on the body can cause hair growth to become arrested,” Michelle Henry, MD, a dermatologist based in New York, tells Health. “And when hair growth is arrested, it sheds.” This process is known as telogen effluvium, says Dr. Henry, or the excessive shedding of hair induced by stress. 

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How does stress cause hair loss? 

When we feel stressed, the stress hormone cortisol is released. Cortisol in turn can affect the hair follicle cycle and lead to hair loss, Angelo Landriscina, MD, a Washington, DC-based dermatologist, tells Health. This shedding won’t typically occur until roughly three months after a stressful event. "Many times it's unexplained why telogen effluvium happens, but it has been linked to significant stressful life events, physically stressful events like being acutely ill or having surgery," says Dr. Landriscina. Stress literally "shocks" your hair into falling out, he adds.

“If you had COVID and were admitted to the ICU, there's a chance you could develop telogen effluvium, but it would develop three months later," says Dr. Landriscina. Emotional stress is also a trigger. "If everything going on with racism emotionally and psychologically affects you, in three months you may see hair thinning.” 

Preventing stress-related hair loss starts with preventing stress. “Stay connected to the people that you love, because isolation and depression can have a direct effect on your overall well-being, and that presents as mental stress,” says Dr. Henry. She also encourages maintaining a healthy sleep, eating, and exercise schedule to avoid and ease stress.  

How can I treat stress-related hair loss?

Roughly 10% to 15% of your hair strands are in the telogen phase at any given time, where they’re preparing to fall out, says Dr. Landriscina. Unfortunately, once those hairs are lost, they’re gone. But that doesn’t mean new strands won't grow back in. Both dermatologists recommend minoxidil, a vasodilator that improves circulation around the hair bulb at the base of the hair follicle, and one of the few FDA-approved remedies for hair growth. 

Dr. Henry is a fan of Nioxin’s System 2 Hair Care Kit for Natural Hair with Progressed Thinning ($45; amazon.com) and Nioxin System 4 Hair Care Kit for Colored Treated Hair with Progressed Thinning ($45; amazon.com), featuring a shampoo, conditioner, and leave-in treatment including minoxidil to promote hair growth. Both are available over the counter.

“Most people are cleansing, conditioning, and using an after treatment on their hair, so it's easy to swap out what you're using,” says Dr. Henry. Unlike other minoxidil products, Nioxin looks at hair as a whole, she says, keeping strands healthy, moisturized, and strong while addressing the scalp and getting rid of dirt and debris that could make hair loss worse.

I actually used Nioxin products at my local salon after my hairstylist also recommended the brand; she noticed about four years ago that I had mild hair thinning around my temples (mostly from my stressful college years). I've used it at the salon several more times since then, and my hair has grown back noticeably—though I don't know if it was because of the Nioxin products or my own better hair care habits.

When should I see a dermatologist about stress-related hair loss?

As Dr. Landriscina says, “time is hair.” As soon as you notice that you're losing hair, he suggests seeing a dermatologist to find a course of professional treatment, and to make sure your hair loss isn't due to something more serious. “It's difficult for the average person to know the difference between excessive shedding and scarring hair loss that's permanent,” says Dr. Landriscina. An in-person examination of the scalp is ideal, he says, but you can still have a successful telehealth visit. 

Whether you’re treating your hair loss with the help of a dermatologist or at home, Dr. Henry encourages you to be kind and patient with yourself during your hair journey. “Patience is critical,” Dr. Henry tells Health. “Treatment works, but it takes time.” 

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