Can stress cause hair loss?

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I’ve been really stressed out at work lately and have noticed that my hair is thinning and clumping in the shower. Is it true that stress can make your hair fall out?

Healthy people shed around 50 to 100 strands of hair each day, according to the American Academy of Dermatology. But if you’re losing more than that, it could be a sign of a condition called telogen effluvium, or excessive hair shedding.

And telogen effluvium can certainly be induced by stress, said Dr Antonella Tosti, a dermatologist who treats hair loss at the University of Miami Miller School of Medicine.

Experts don’t know exactly how common telogen effluvium is, in part because many people are not diagnosed with it. But women may be more likely to experience it than men, as it can be set off by pregnancy-related changes in the body, said Dr Angela Lamb, a dermatologist at Mount Sinai in New York City.

This excess hair shedding can involve the loss of “up to a third of your hair volume,” she added. But the good news is that it is usually temporary.

People often develop telogen effluvium between six weeks and three months after a stressful event such as a major surgery, a chronic or short-term illness (especially if it involved a fever), a pregnancy or a death in the family — basically, “anything that causes a stress or shock to your system,” Lamb said.

That’s because stress increases levels of cortisol in the body, Lamb said, a hormone that has been shown to disrupt hair growth.

Research suggests that this kind of hair loss can occur after people recover from Covid-19. In a 2022 study, for instance, researchers surveyed nearly 6,000 people in Brazil who had recovered from Covid within the past three months. Nearly half of those who responded reported experiencing hair loss.

“If your hair was fine, and then you had Covid, and then six to 10 or 12 weeks later you’re losing a ton of hair in the shower — that’s telogen effluvium,” Lamb said.

Telogen effluvium can develop in response to chronic everyday stress, too, Tosti said, such as work or relationship stress.

Tosti said that stress could also cause or worsen other conditions that lead to hair loss, such as alopecia areata, a disease in which the immune system attacks and destroys hair follicles, and lichen planopilaris, a rare inflammatory condition that can cause scalp scarring and hair loss. But Lamb noted that there is no definitive research tying stress to these two conditions.

If you have been losing hair because of stress, Lamb recommended taking a daily multivitamin containing vitamin D, which is involved in hair growth, and vitamin B12, which has been shown to be deficient in some patients with telogen effluvium — though the data on this is limited. Vitamins may be especially important for people recovering from major surgery, she said, as deficiencies can be more common during this time.

Lamb doesn’t recommend over-the-counter supplements specifically marketed to treat hair loss that contain high doses of biotin, such as those sold by Vegamour, Nutrafol and Viviscal. Biotin supplements have been shown to interfere with the results of thyroid hormone tests, and they can sometimes cause acne flare-ups, she said.

If you want to try to accelerate hair growth, you could try an over-the-counter, topical minoxidil treatment such as Rogaine, Tosti said. Or you can ask your doctor for a prescription for oral minoxidil or oral finasteride, which are often covered by health insurance, Lamb said.

These treatments could “help kick-start the hair to grow in faster,” Lamb said. But most of the time, she added, stress-induced hair loss dissipates and hair regrows on its own.

“You’ll go through that shedding phase, usually for several weeks, maybe a few months, and then it will slow down,” she said.

That said, if shedding continues after three or four months, she added, you may want to see a doctor.