Increased hair loss during this time of stress and upheaval is a common issue for women, myself included. During the first two weeks of lockdown in NYC where our careers, family life and any sense of normalcy was turned on end, my hair started falling out like crazy.
I found myself looking at our floors, seeing my hair everywhere and thinking, “Didn’t we just vacuum yesterday?” Never mind the growing mass in the shower drain with each shampoo.
Can you relate? Nothing like seeing your hair falling out at a frightening rate to make a girl trying not to stress well, stress out quite a bit more.
Your stress hormones, cortisol and adrenaline, will lead to hair loss both directly and indirectly as cortisol influences all of your other hormones. This post will cover the why behind stress related hair loss, how long it lasts and what you can do about it.
First though, a bit about how your hair normally grows so you can understand better the factors that disrupt that process and make it fall out too soon.
Your Hair Growth Cycle
Your hair goes through specific phases where it is growing (anagen and catagen) or resting (telogen). The initial growth phase (anagen) can last anywhere from 2-7 years before moving to the shorter catagen growth phase which only lasts a few weeks. During this phase the hair growth slows way down, it starts to detach from its blood supply and then gets ready for the telogen phase or resting phase. During this last resting phase, the hair doesn’t grow but it sits in the follicle while the new hair below it begins to grow pushing the older hair out and then it is eventually shed. This resting phase lasts 2-3 months.
There are multiple ways stress can impact your hair loss or lack of growth but right at the follicle, a stressful event triggering high cortisol directly impacts this delicate cycle of growth and rest.
Cortisol Directly Causes More Shedding & Decreased Growth
Your hair follicles are very sensitive to your stress hormones. When your stress is high, cortisol disrupts the finely tuned processes in the hair follicle by damaging key components of the skin and extracellular matrix (specifically hyaluron and proteoglycans) creating changes to the normal hair growth, rest and shed cycle. (1)
Cortisol impacts those growing hairs in the anagen phase causing them to prematurely enter the resting (telogen) phase.What this will look like for you is a sudden, but relatively short bout of hair shedding with decreased hair growth.
This is known as Telogen Effluvium and perhaps the worst news here is that the resting phase your hair just entered too soon lasts 2-3 months. This means it can take up to three months for you to recover the hair lost in a bad bout of stress.
Please don’t stress reading that! There are a lot of things you can do to stop stress related hair loss from getting worse and they are all laid out for you at the end of this post. Hang in there.
Stress Can Worsen Other Causes of Hair Loss Too
If you already are dealing with underlying hormonal or immune issues causing hair loss, stress can quickly make those worse in addition to its direct impact on hair loss just mentioned. Yikes right?
Stress is well known for disrupting female hormone balance. Typically progesterone will fall first, with estrogen falling next during prolonged stress and cortisol release.
Progesterone is our soothing, calming hormone and it’s very important for uterine, breast and brain health but it doesn’t impact hair as much as estrogen. Estrogen keeps hair in the growth (anagen) phase longer, meaning you shed less.
Basically, if you’ve got plenty of estrogen you keep more hair and shed less hairs than normal. Think second and third trimester of pregnancy and all that thick, luscious hair and then the drastic shed about five weeks after delivery when all that extra estrogen is gone.
If estrogen becomes lower with more chronic stress that eventually disrupts ovarian function or ovulation, you can certainly see a decreased amount of time hair stays in the growth phase and increased shedding.
If you have low estrogen related hair loss, you always want to address the cause of the low estrogen or problems with ovulation, which in this case is the stress. However, you may have been dealing with low or borderline low estrogen already and noticing increased hair shedding as your periods became more spread out or disappeared, were much lighter or you don’t seem to be ovulating as well and then stress has likely made that issue worse. Again, get to the root cause which may be at least in part stress and other problems with ovulation such as hypothalamic amenorrhea, PCOS or perimenopause should be tended to as well.
Hypothyroidism causes a similar pattern of hair loss to estrogen, which is an overall increased shedding vs. patchy loss or loss at the temple or crown.
Thyroid hormone essentially turns on metabolism of each cell, basically helps that cell whatever it is a muscle cell, cell lining your blood vessels (endothelial cell), a nerve cell (i.e. a brain cell or other neuron), a cell in your ovary (i.e. a follicular cell to make estrogen) or cells of the hair follicle – do their job. This is why most every symptom of low thyroid is a slow down: constipation, fatigue, slow reflexes, sluggish metabolism and hair loss.
Your main thyroid hormone, T4 up-regulates the proliferation of keratinocytes in your hair matrix (i.e. you make more of these cells) and the turnover or normal cell death of these cells is slowed down by adequate thyroid hormones (both T4 and T3, the more active form of thyroid hormone). As well, T4 keeps hair in the growth (anagen) phase longer as some research shows hair follicles themselves may convert T4 into T3. This means without adequate thyroid hormone your hair will grow slower and fall out quicker. (2)
And you guessed it: cortisol and stress will absolutely impact thyroid hormone levels from production (making mainly T4 in the thyroid gland) to conversion (to the active T3 form from T4) to deactivation into unusable forms (increased reverse T3), not to mention stress negatively impacts digestive health which plays a role in both thyroid and estrogen hormone metabolism as well as nutrient absorption.
As with estrogen, you may have been running borderline or overtly low thyroid before and a bout of stress puts you right over the edge and you start seeing more low thyroid symptoms including hair loss. Lab testing is important here but you can start by taking stock of your low thyroid symptoms with my free quiz.
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Historically, hair loss has been included in the litany of symptoms of iron deficiency, however not all research points to low iron being a cause of hair loss. (3) Clinically however, many women in my practice are borderline low iron or overtly iron deficient anemic and many have hair loss that resolves with restoring iron levels. That said we are also often working on multiple other issues that impact hair loss such as inflammation, stress response, sleep, thyroid issues, etc.
Hair follicles, like most cells and organs in your body, need a steady supply of oxygen to function normally and iron is a vital part of oxygen delivery via the protein hemoglobin. As well, iron is an essential component of an enzyme called ribonucleotide reductase that helps with cellular growth. In this case the cells that make up both the hair follicle and the hair itself can be impacted.
Like low estrogen and low thyroid, low iron hair loss looks like increased shedding and a slow regrowth of your hair.
How is low iron related to stress?
Low iron can be from heavier periods due to estrogen dominance (i.e. low progesterone and/or poor estrogen metabolism) and both of those issues can worsen with stress. As well, stress negatively impacts digestion on multiple fronts including decreased secretion of digestive enzymes, increased stomach acid and histamine (which could play a role in development of an ulcer which can bleed) and a disruption in your intestinal bacteria (microbiome) and this can lead to poor absorption and assimilation of nutrients including iron from your food.
Interestingly, your thyroid needs adequate iron to make thyroid hormones and both issues may have some common root causes such as digestive issues and stress, so a thorough blood panel to assess both issues is wise.
This guide covers hormonal testing and thyroid patterns and will show you how to suss out the Hormonal Dealbreakers of inflammation, anemia and blood sugar problems.
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Note: please do not supplement with iron unless you have guidance and blood testing that warrants supplementation as too much iron can cause serious health problems. As well, you always need to find the source of the low iron: heavy periods, other bleeding issues, poor absorption or low intake.
Finally, other nutrients especially minerals such as zinc and B vitamins such as biotin are key for healthy hair so check for general nutrient deficiencies as well.
Androgenic Hair Loss
One of the most common causes of hair loss for women is androgenic alopecia (this is common for women with PCOS). This type of hair loss is less an issue with increased overall shedding but more a loss of hair at the temples or crown and is due to elevated androgens (testosterone and DHEA) or problems with androgen metabolism.
As well, some women with PCOS have overly sensitive hair follicles when it comes to androgens, so they experience acne or hair loss from even normal levels of testosterone or other androgens.
Typically though with androgenetic alopecia there is an increase in testosterone conversion to DHT (di-hydrotestosterone, a very active androgen) via the enzyme 5α reductase. You can have this metabolite tested and this pathway evaluated with a DUTCH test, contact my office for more information.
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DHT then binds to androgen receptors in the hair follicle, which results in the shortening of the anagen or growth phase and simultaneous prolongation of the telogen phase (meaning less growth phase and more rest phase), combined with a literal shrinking of the hair follicle.
Again, this tends to occur at the crown and temples or maybe a widening hair part and you’ll see both increased shedding in those areas as well as thinner hair with any regrowth as the hair diameter begins to decrease thanks to the shrinking follicle. Unchecked, new hair growth will be non-existent, slow or be these smaller, thinner, unhealthier hairs grow but break easily.
Issues with testosterone metabolism and androgen excess can be addressed largely via diet and lifestyle. Blood sugar is a vital part of this process as androgen metabolism is impacted by both excess androgen production and insulin resistance, such as with PCOS. Nutrients that support androgen metabolism include zinc, chrysin, saw palmetto and zinc and they are all found in this product.
How does stress impact this? Remember that insulin lowers blood sugar and cortisol will raise it. So when you’re under stress your blood sugar highs and lows will be more pronounced and you will have more insulin spikes which spur activity of DHT via 5α reductase. And when it comes to blood sugar rises and insulin spikes, who hasn’t reached for more sugar or processed starchy foods when under high stress?
Again, back to the root cause here which is stress management and blood sugar balance. More about how to do that at the end of this post.
Autoimmune Hair Loss
Alopecia areata is an autoimmune disorder characterised by patches of hair loss. Hair loss in this case can extend beyond the head. It can develop from patches to complete loss of hair on the scalp (alopecia totalis) or loss of all body hair (alopecia universalis).
In this case, cortisol and high stress can drive inflammation and widespread hormone imbalance which can quickly worsen immune balance and autoimmunity.
Stress & Hair Loss Is Often a Vicious Cycle
Finally, stress related hair loss begets more stress related hair loss. You get stressed, start seeing tons of hair loss and that of course is stressful! So it’s easy to get caught in a perpetual cycle of stress and hair loss so managing your stress becomes job one.
There are some stresses you can eliminate (i.e. get more help, balance your blood sugar, fix your thyroid, etc.) and others you can’t. If you can’t eliminate the stress such as a new job, a new baby, going through a breakup or a pandemic, then you have to learn to better manage that stress with meditation, perspective shifts, etc. More on all of that in the next section.
What You Can Do To Slow The Stress Shedding
Getting blood work as well as targeted hormone testing (i.e. the DUTCH test) can help you pinpoint the root cause – and there may be more than one – so you can address the issue at its core. I highly recommend this vs. just starting to pop prenatals or some hair-skin-nails formula. Although they can certainly be helpful in terms of providing nutrients to any hair that’s trying to grow. Contact my office to get more info.
However, with stress being a main issue behind hair loss learning to decrease or better manage your stress is job one. I’ve talked about this in many articles so see all of these for more support:
And don’t forget blood sugar management especially if you have androgenic related hair loss:
As well stress management is a foundation of the program found within Hangry, so check that out and get a customizable and comprehensive approach to management not only your stress hormones and insulin but thyroid and your female hormones as well.