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Everything You Need to Know About Stress-Related Hair Loss

It's time to take your (hair) power back
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It feels like every article starts with an anecdote about what a dumpster fire of stress this year has been. Which, to be fair, it has. Sadly, all that stress adds up — which can in turn lead to health concerns. You've probably heard that stress can cause things like sleep disorders, TMJ and acne. It can also, unfortunately, cause hair loss.

If you've noticed extra hair falling out in the shower or when you brush your hair... well, it's basically the epitome of, "OMG, what now, 2020!?" Luckily, there are solutions. We reached out to Dendy Engleman, M.D., board-certified dermatologist at Shafer Clinic in New York City; and Mona Gohara, M.D., board-certified dermatologist and associate clinical professor of dermatology at Yale School of Medicine, to get a handle on stress-related hair loss and how to keep it under control.

Image via Imaxtree

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A quick recap on how hair works
Hair typically grows in three phases: anagen (hair growth), catagen (a "resting" phase), and telogen (shedding). According to our derms, on a typical scalp 80-90 percent of the hairs on your head are in the anagen — or growth — phase at any given time, with 10-20 percent of hairs in either catagen or telogen phases. "It's normal to shed about 100 hairs a day," explains Dr. Gohara. So, that accounts for most of the hair we normally see in our brush or the shower drain.

But when stress takes its toll, it propels hairs normally in the growth phase into the shedding phase, which means profuse amounts of hair starts falling out, a condition known as telogen effluvium. There: your new hair nemesis now has a name.

Image via Veronique Beranger/Getty

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Why does this happen?
Doctors aren't exactly certain, but they suspect cortisol, the hormone secreted due to stress, has a lot to do with it. "If you're in a time of stress, your hair and nails are not considered to be vital organs," explains Dr. Engleman. This means that resources earmarked to grow nails and hair suddenly shift toward vital organs to keep you alive during perceived danger.

It's an old lizard brain function of the human body: when we used to have to outrun predators, growing long hair and nails isn't as important as, say, running for your life. The human body hasn't evolved with current technology: your brain can't discern between outrunning a sabre tooth tiger and answering emails from your boss, news coverage, or hours of social media. It's just doing what it does to keep you alive.

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All types of stressful events can cause it, even 'good' ones
But what they do know is that any perceived trauma to the body can cause hair to fall into telogen effluvium. "It can be physiologic or emotional stress, and it may not be due to a bad thing," says Dr. Gohara. "It could be something joyful, like a wedding, giving birth, or moving somewhere. Pregnancy can also be a physiologic stress on your body." But, as she explains, illness and negative life stress like divorce or loss of a job also kick it into gear. "It can be anything that poses some type of physiologic or emotional stress on you, from general anesthesia to having a really bad flu, stress related to COVID, or just the stress of living right now."

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It's also not immediate
Here's the kicker: it takes time to grow hair, right? Which also means the resulting telogen effluvium you're experiencing is probably from something that happened three-to-nine months ago. "When you're pregnant, you've got great hair," explains Dr. Engleman. "Once we give birth, it can be three-to-nine months postpartum that hair starts to shed. "It's why patients with a nine-month-old child can't figure out why their hair is falling out. "It's a snapshot of what happened in the past." Which means a stressful event in the past could be causing the hair loss you have now.

Also, the amount shed is profound by the time you notice it. "The reality is, people often have to lose about 50 percent of their hair volume before they detect they're losing hair, which is a lot to lose," Dr. Engleman warns. "Patients often notice their ponytail isn't as thick; they're perceiving a significant reduction, which is real: a patient has to lose a lot (of hair) before they notice they've lost it."

But you aren't alone: both our dermatologists have seen a massive uptick in stress-related hair loss cases this year. "I've had more tears shed in my office over hair loss than even skin cancer because it really is so emotional for people," says Dr. Engleman, whose patients bring in bags of lost hair or photos depicting shower drains filled with it. "It's so psychologically stressful."

Dr. Gohara agrees the uptick in telogen effluvium patients is across the board "People are scared out of their minds," she observes, noting people will come in afraid to take showers and/or wash their hair for fear of their part getting wider.

Image via Luka Svetic/EyeEm/Getty

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