Does stress cause hair loss?

Stress and hair loss are closely linked. Many people notice thinning hair or increased shedding during periods of emotional upheaval or physical strain. Understanding how stress affects your hair can help you recognize causes, set realistic expectations for recovery, and take steps to protect your hair’s health.

What is the hair growth cycle?
Hair grows in three main phases:
• Anagen (growth phase): lasts 2–7 years.
• Catagen (transition phase): about 2–3 weeks.
• Telogen (resting/shedding phase): about 3 months.

At any time, about 85–90% of scalp hairs are in anagen, ~1% in catagen, and ~10–15% in telogen. When a hair follicle shifts prematurely into telogen, it sheds, and new growth only starts after a delay.

Acute and chronic telogen effluvium
Chandran & Engelman’s 2017 review describes telogen effluvium (TE) as the principal mechanism of stress-related hair loss. Key points:
• Acute TE: sudden, noticeable shedding up to 30–60% of hairs, 2–3 months after a major trigger (e.g., surgery, high fever, childbirth).
• Chronic TE: mild but persistent shedding for over 6 months, often linked to ongoing stressors (e.g., chronic illness, nutritional deficiencies, prolonged psychological stress).

In TE, hair follicles prematurely enter the telogen phase, causing diffuse thinning rather than patchy bald spots. Most cases are self-limiting: hairs re-enter anagen once the trigger subsides.

How does stress trigger hair shedding?

1. Hormonal response:
   – Stress increases cortisol and adrenaline.
   – High cortisol may disrupt the hair cycle, pushing follicles into telogen.
2. Inflammatory pathways:
   – Psychological stress can elevate inflammatory cytokines.
   – These molecules may interfere with hair follicle function.
3. Nutritional impact:
   – Stress often disrupts appetite and digestion.
   – Deficiencies in iron, zinc, protein, and vitamins can worsen hair shedding.

Types of stress that affect hair
• Physical stressors: serious illness, high fever, major surgery, crash diets, childbirth.
• Emotional stressors: job loss, bereavement, relationship problems.
• Chronic stressors: long-term anxiety, depression, ongoing medical conditions.

Alopecia areata and stress
Alopecia areata is an autoimmune condition causing sudden, patchy hair loss. While not solely caused by stress, psychological or physical stress may act as a trigger in susceptible individuals. Unlike telogen effluvium, alopecia areata can produce round or oval bald patches and may affect scalp and body hair.

Stress, liver disease, and hair loss
Chronic liver disease (e.g., cirrhosis) can indirectly impact hair health. The EASL 2018 guidelines and Tsochatzis et al. 2014 note that advanced liver disease often leads to:
• Malnutrition and vitamin deficiencies (especially fat-soluble vitamins, zinc, and protein).
• Hormonal imbalances.
• Altered metabolism of hair-supporting nutrients.

These factors can compound stress-related shedding, making recovery slower. If you have liver disease and notice hair loss, talk to your hepatologist or primary care doctor about nutritional support and stress management.

Timeline for noticing hair changes
• Trigger event (e.g., stress spike)
• 2–3 months later: increased shedding or visible thinning
• Recovery: hairs gradually return to anagen over 3–6 months after removing the stressor

What you can do now

1. Identify and manage stress
   – Mindfulness, meditation, or breathing exercises
   – Regular physical activity (e.g., walking, yoga)
   – Adequate sleep (7–8 hours per night)
2. Support your body nutritionally
   – Eat a balanced diet rich in lean protein, fruits, vegetables, whole grains
   – Consider supplementation (iron, zinc, vitamin D) only after testing and doctor’s approval
3. Gentle hair care
   – Avoid tight hairstyles or harsh treatments (bleaching, heat styling)
   – Use mild, sulfate-free shampoos and conditioners
   – Limit daily washing to 2–3 times per week
4. Medical evaluation
   – Talk to your doctor about blood tests (thyroid function, iron studies, vitamin levels)
   – Rule out other causes (thyroid disease, hormonal imbalances, scalp infections)

When to seek help
• Sudden, patchy hair loss (could be alopecia areata)
• Shedding for over 6 months without improvement
• Signs of infection on your scalp (redness, itching, pain)
• Associated symptoms (weight loss, fatigue, jaundice, unexplained fevers)

Free online symptom check
If you’re unsure about your hair shedding, consider doing a free, online symptom check for Hair loss to get personalized guidance on possible causes and next steps.

What to expect at the doctor
• Medical history, including recent stressors and health changes
• Physical exam of your scalp and hair
• Laboratory tests to check for deficiencies, hormonal issues, or liver function
• Possible scalp biopsy in unusual cases

Treatment options
• Remove or reduce triggers: stress management, treat underlying illness
• Topical minoxidil: can shorten telogen phase and boost regrowth
• Corticosteroid injections (for alopecia areata)
• Laser therapy or platelet-rich plasma (PRP) in select cases
• Nutritional supplements when deficiencies are confirmed

Setting realistic expectations
• Regrowth takes time—often 3–6 months to see improvement.
• Some thinning may persist; maintaining good hair care is vital.
• Chronic TE may require ongoing stress management.

Key takeaways
• Stress can cause both acute and chronic telogen effluvium, leading to diffuse hair shedding.
• The effect usually appears 2–3 months after the stressor.
• Most stress-related shedding is reversible when the trigger is removed.
• Nutrition, gentle hair care, and stress reduction support recovery.
• See a doctor for persistent hair loss, patchy bald spots, or signs of systemic illness.

Always speak to a doctor about any serious or life-threatening concerns. A healthcare professional can rule out other causes, guide treatment, and help you get back to healthy hair growth.