What’s Stressing You
Paradi Mirmirani, MD, a dermatologist with the Permanente Medical Group in Vallejo, Calif., says it all depends on what type of stress you’re talking about.
“Stress because you’re late to work or you’ve got a heavy workload is not going to cause you to lose hair,” she says. Short-term, everyday stress is not going to affect your body in such a way that your hair falls out. It takes something larger to do that. Something that causes you to lose sleep,” Mirmirani says, “or changes your appetite and raises the level of stress hormones.”
“There has been, for my entire life, this mythical connection between stress and hair. It’s absolutely ridiculous.” There is no evidence to support the idea that just because you had a few stressful days last week your hair will fall out this week. “It doesn’t even work that way,” she says.
Stress and Hair: The Hair Cycle
A normal head of hair contains about 120,000-150,000 strands of hair.
Usually, at any one time, about 90% of those hairs are in a growing phase, growing by about 1/2 inch each month. This phase lasts for two to three years.
At that point, a hair will go into a resting stage. This “rest” lasts for 3 to 4 months before the hair falls out and is replaced by a new one.
“Typically, people shed about 100 hairs a day,” says Carolyn Jacob, MD, founder and medical director of Chicago Cosmetic Surgery and Dermatology. “Most people don’t even notice.”
Sometimes, a significant stress of some sort may spark a change in your body’s routine physiological functions, Jacobs says, and cause a disproportionate number of hairs to go into the resting phase at the same time. Then three to four months later, sometimes longer, all those resting hairs are shed. The effect can be alarming. The types of events that disrupt the normal hair cycle, Jacob says, can be caused by the substantial physiological stresses on your body.
But, according to Amy McMichael, MD, professor of dermatology at Wake Forest Baptist Health in Winston-Salem, N.C, physiological stress is not the same as emotional stress. Hair loss can be one way the body responds to significant physiological stress that may be brought on by diet, medical, or lifestyle changes.
“Only those things that cause physiological stress can cause a hair loss event,” McMichael says. The good news is that the hair loss from these kinds of events is usually temporary, as long as the stress event is temporary. Once the stressor is addressed or goes away on its own, hair grows back and the normal hair cycle resumes.
Stress and Hair Loss: What Causes Hair Loss?
A variety of stressors may cause your body to undergo hair loss. It happens, McMichael says, when there’s some type of physiological change in your system. “For instance,” she says, “you go on or off an oral contraceptive. Or you lose more than 15 pounds of weight. Things like this change the physiological balance in your system.”
Other stressors, according to McMichael, could include:
- A strict low-calorie diet
- Lower estrogen levels after childbirth
- Severe illness
- High fever
- Major surgery
- Severe infections
Mirmirani says that hair shedding can also result from certain medications, thyroid disease, and nutritional deficiencies such as vitamin D or too much vitamin A.
Pinpointing the actual cause of the shedding isn’t always easy. That’s because, Mirmirani says, there’s a three- to six-month lag time between the stressful event and the hair loss. In order to determine the cause, you need to look back at what was happening three, six, or even nine months before the hair loss began.
Stress and Hair Loss: The Physiological & Emotional Connection
Emotional stress can also lead to physiological stress. For example, McMichael says, “if you’re going through a severe divorce, you might not be eating properly; you might lose weight or not sleep well. You may go off and then back on your oral contraceptives.” All of these things cause physiological stress and an imbalance in your system. “The point is,” she says, “there are a lot of other things that are physiological going on. You’re not losing your hair because you hate your ex-husband.”
McMichael says that women have a number of things that happen on a regular basis that they may not recognize as stressors. “You start out your life and you’re fine,” she says. “You’re 20 years old and get married. You get on some oral contraceptives. Well, that causes shedding.”
When a woman decides to have a baby, if she is taking oral contraceptives, she’ll stop taking them. “Maybe you have a little bit of shedding related to that. And then you get pregnant.” Pregnancy causes the body to keep the hair that normally would fall out as part of the regular hair cycle. So a woman may notice her hair feels extra thick and fuller during that time. After giving birth, all the hair that would have fallen out is shed three to six months later.
Also, many women try to lose weight after having a baby. “Someone in the family dies and, because you’ve heard that stress causes hair loss, you say, ‘Oh my God, I’m losing my hair because someone died.’ But that’s not it,” McMichael says. “You’re losing hair because you lost 30 pounds.”
Every person is different. “Not everyone gets these episodes of hair loss. Some women go on and off of contraceptives and never have shedding. Some have seven children and have no hair loss related to it.” Once you have shed hair in response to a physiological stress, however, you are likely to do it again, McMichael says.
McMichael says that because people have repeated the myth of a direct connection between emotional stress and hair loss for so many years, many people now believe it. “There’s no way to predict who’s going to lose hair and who’s not. If you’re a shedder, you’ll shed,” Jacob says. She also says there’s no scientific evidence that points to specific emotional stresses that might trigger the physical stress that can lead to hair loss.
Seeing a Doctor About Hair Loss
Unlike other types of hair loss that are more often permanent, hair loss during the normal hair growth cycle happens suddenly. It also doesn’t normally cause bald spots or follow a pattern like genetic or autoimmune-related hair loss. Instead, it’s diffuse and causes thinning of the hair across the scalp. That’s because each of the 120,000-150,000 hair follicles is independent of other hair follicles and is in its own cycle of growth. Some are growing while others fall out.
You may notice after washing your hair that handfuls of hair have fallen out. “But,” says Mirmirani, “usually by the time someone notices the shedding, the hair is already growing back. Whatever caused it happened three months or more before. The new hair growing in is pushing the resting hair out.”
It’s true that hair loss can be an early sign of about 30 different diseases. But don’t jump to conclusions – you could be perfectly healthy and still have some hair loss.
Talk to your doctor and ask for his or her perspective and guidance. Jacob says that products on the market, such as over-the-counter minoxidil and various supplements that are sold for hair loss, can actually cause problems if they’re not truly needed and not used properly. It’s important, she says, to discuss the use with the doctor first.