If you’ve noticed that you’re losing your hair, you may be wondering why. There are several potential underlying causes we could talk about, from menopause to genetics. But is stress one of them? The answer is yes.
Chronic stress can affect many aspects of your health, including your hair growth. But why does stress affect hair loss? And will your hair grow back? Fortunately, our guide covers everything you need to know about stress and hair loss.
Three key takeaways
There are three main types of hair loss where stress is a contributing cause: telogen effluvium, trichotillomania and alopecia areata.
Hair loss due to stress will usually grow back once the stressor is resolved.
Stress-related hair loss often doesn’t require any treatment. However, depending on the type of hair loss you have, you may be recommended minoxidil, cognitive behavioural therapy (CBT), immunotherapy, light therapy or steroid injections/creams.
Types of stress-related hair loss
There are three types of stress-related hair loss:
Telogen effluvium
This is the most common type of hair thinning caused by stress.
Stress hormones, named cortisol, have been found to inhibit hair regrowth. As a result, chronic stress causes your hair growth cycle to stall in its resting phase. To understand what this means, we need to go through the three main phases of your hair’s growth cycle:
Anagen: this is the first phase of hair growth. It takes between two to seven years and causes your hair to grow about one centimetre every month.
Catagen this is the second phase of hair growth and occurs when the hair transitions from a growing phase to a resting phase. This takes about two weeks.
Telogen: finally, your hair growth cycle enters its inactive phase, when your hair falls out of your hair follicle. This takes up to four months.
If your hair growth cycle gets stuck in the telogen phase, you may notice your hairs suddenly start to fall out when brushing or washing your hair. On average, a person with this condition might lose up to 300 hairs each day – the average for healthy hair is around 100.
You may not notice hair loss due to telogen effluvium until two to three months after the stressor occurred. This is because the telogen phase takes a few months, so stress-related hair loss doesn’t occur straight away.
Trichotillomania
Trichotillomania refers to the compulsive urge to pull out hair from your scalp, eyebrows or other areas of your body. This is thought to be a way of dealing with difficult feelings, such as stress, tension, loneliness, boredom or frustration.
The urge to pull out your own hair may feel like growing tension that you only get relief from after pulling. It can cause unusually shaped bald patches on your head. Typically, these patches are only on one side of your head.
Alopecia areata
Alopecia areata is caused when your body's immune system attacks your hair follicles. This is thought to be triggered by stress hormones affecting the immune system, as people with alopecia areata can often recall a stressful event a few weeks before they started noticing the hair loss. However, the mechanism behind alopecia areata isn’t entirely clear.
It usually causes very distinctive, small coin-sized bald patches across your scalp, face and body.
Does hair loss from stress grow back?
“Stress-related hair loss often clears up once the stressor is resolved. As a result, treatment isn’t always necessary, as you just need to wait out the hair loss phase until it starts growing back again.
“Telogen effluvium normally resolves within six to nine months. People with alopecia areata also commonly see some regrowth over time.”
If you notice sudden patchy hair loss, or more hair loss than usual when combing or washing your hair, talk to your GP. They will be able to help you identify the cause of your hair loss and develop an appropriate treatment plan.
How to treat stress-related hair loss
The right treatment depends on which type of stress-related hair loss you have:
Telogen effluvium
There is normally no treatment required for telogen effluvium. This is because your hair should start growing back once the trigger of your stress is removed.
However, applying a medication called minoxidil to areas of hair loss on your scalp may speed up your hair growth cycle. Although minoxidil isn’t licensed to treat telogen effluvium, a hair loss specialist may prescribe it if they think it is suitable.
Since, minoxidil is a vasodilator, it widens your blood vessels. It is typically used to treat high blood pressure, but when it’s applied to your scalp as a solution or foam, it widens the blood vessels underneath the area it’s applied to. This allows more nutrients and oxygen to flow to your follicles and stimulate hair growth.
Trichotillomania
Because trichotillomania is psychological in nature, it is most commonly treated using CBT. This is a type of habit reversal training that teaches you to replace a bad habit (like hair pulling) with something that’s not harmful.
This type of therapy usually involves:
recording your hair pulling in a diary
identifying the triggers for your hair pulling and learning how to avoid them
replacing hair pulling with another, non-harmful behaviour, like squeezing a stress ball
Alopecia areata
For alopecia areata, you may be recommended:
Immunotherapy: as alopecia areata is caused by your immune system, it can be treated using immunosuppressant tablets, such as methotrexate, ciclosporin, mycophenolate mofetil and azathioprine.
Steroid injections and creams: steroids (e.g. hydrocortisone) are anti-inflammatory drugs that can be used to treat autoimmune diseases. They can be injected into your scalp, taken as a pill or rubbed into your skin as a cream, ointment or foam.
Minoxidil: minoxidil can also be used to help encourage hair growth if you have alopecia areata.
Light therapy: light therapy can be used in combination with a tablet or cream to encourage hair growth. This involves exposure to UV light two or three times a week for a few months.
How to manage stress and anxiety
There’s no one specific way to manage stress and anxiety, but you can try the following tips and see what works for you:
get regular exercise
take control of the situation that’s causing you stress, if possible
talk to a friend or family member about how you’re feeling
plan time for activities you enjoy or take up a new hobby
make time to relax
spend time outdoors
avoid relying on unhealthy habits, like smoking or drinking
practice good sleep hygiene – go to bed at the same time each night and wake up at the same time each day
practice meditation and mindfulness
learn to manage your time
write down three things you’re grateful for each day
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