I LOOK IN THE MIRROR AND SEE A YOUNGISH FACE. I turn a bit to discover a bald patch on the crown of my head. Today, I want to explore the relationship between stress and hair loss.

First, a brief aside. I enjoy the work of sculptor Roland David Smith. This innovative American abstract expressionist painter and sculptor died in 1965 from a car crash at age 59.

Smith radically altered the terms of sculpture, a medium historically defined by casting, modeling, and carving. He was the first to use industrial welding as a sustained technique for large works.

I love his large abstract steel geometric sculptures. So here’s why my mind went to David Smith: I often most appreciate his sculptures when looking at them from different vantage points. They can be so radically different, depending on where you stand.

This perspective shift may be especially relevant when viewing Smith’s last works, the Cubi sculptures.

Today, most Cubi works are part of well-known museum collections, including the Museum of Modern Art in New York, the Tate Modern in London, and the Art Institute of Chicago.

Back to me and the perspective shift: Look from the side, and I have sufficient hair. From the front, still okay.

Now wander behind me as I sit in a chair, and voila: thinning hair on my crown. Consider me a Cubi (or perhaps Cubus?).

Hair Loss and Shedding

This morning, I read a piece in the New York Times entitled “Can Stress Cause Hair Loss?” I want to share some highlights from the article.

First, how many hairs do you think an average healthy individual sheds daily? According to the American Academy of Dermatology,

Healthy individuals shed approximately 50 to 100 strands of hair daily.

Are you losing more than that amount? You may have a condition with the unwieldy name of telogen effluvium or excessive hair shedding.

Stress

Can stress induce excessive hair shedding (telogen effluvium)? Yes, there are three hair loss types associated with high-stress levels. All have challenging names:

• Telogen effluvium (excessive hair loss). In telogen effluvium (TEL-o-jun uh-FLOO-vee-um), stress pushes numerous hair follicles into a resting phase. Within a few months, affected hairs might suddenly fall out when washing or combing your hair.
• Trichotillomania. Trichotillomania (trik-o-til-o-MAY-nee-uh) is an irresistible urge to pull hair from your scalp, eyebrows, or other areas. Some pull to cope with uncomfortable or negative feelings (such as tension, stress, boredom, frustration, or loneliness).
• Alopecia areata. Various factors are thought to cause alopecia areata (al-o-PEE-she-uh ar-e-A-tuh), including severe stress. With alopecia areata, the immune system attacks hair follicles, resulting in hair loss.

Hair Shedding Risk Factors

The American Academy of Dermatology Association offers that excessive hair shedding is common in people who have experienced any of these stressors:

• Experiencing lots of stress (caring for a loved one who is sick, going through a divorce, losing a job)
• Lost 20 pounds or more
• Given birth
• Had high fever
• Undergone an operation
• Recovering from an illness, especially if it includes a high fever
• Stopped taking birth-control pills

Excessive Hair Shedding — How Common Is It?

The incidence of excessive hair shedding is unclear; many individuals suffering from it never receive a diagnosis.

The condition is more common among women. Pregnancy is associated with excessive hair shedding. Fortunately, this hair loss tends to be temporary.

Writing in the New York Times, Dr. Angela Lamb, a dermatologist at Mount Sinai Hospital in New York City, offers this observation:

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

I was surprised to learn that this form of hair loss can occur after people recover from Covid-19. In a 2022 study, researchers surveyed almost 6,000 Brazilians who had recovered from Covid within the past three months. Nearly half of those who responded reported experiencing hair loss.

Hair Loss Differs from Shedding

Hair loss occurs when something stops hair from growing. For some, inherited genetics are the cause. Others have hair loss because of drugs or other treatments.

Certain hairstyles that pull on the hair can lead to hair loss. Sometimes, the immune system overreacts. In addition, some harsh hair products can be problematic.

Finally, some people have a compulsion to pull their hair.

Hair Shedding — Some Positive News

The good news? The American Academy of Dermatology Association offers this observation:

Most individuals see the excessive shedding stop after the body readjusts. Many see too much hair loss a few months after the stressful event; for example, some women see it peaking roughly four months post-delivery.

Within six to nine months, the hair regains its normal fullness.

On the other hand, if you don’t relieve yourself of the stress, the shedding can be chronic. Those under a lot of stress can see long-term excessive hair shedding.

If the stressor stays with you, hair shedding can be long-lived. People constantly under a lot of stress can have long-term excessive hair shedding.

Hair Loss — Get Input

Unfortunately, if you have hair loss, your hair won’t grow until the cause disappears. In my field of oncology, chemotherapy sometimes causes the loss of lots of hair. When the treatment stops, the hair usually regrows.

Talk to your healthcare provider if you are concerned that a particular medicine might be causing hair loss.

Other hair loss causes need treatment. Those with hereditary hair loss might find help with medicine or other interventions. Treatment can help many, but not all. A dermatologist can be an excellent resource for information.

If you notice sudden or patchy hair loss (or more than usual hair loss when washing or combing your hair), talk to a healthcare provider.

Sudden hair loss can be associated with an underlying medical condition (such as a thyroid problem) requiring management. Your doctor may also suggest treatment options for your hair loss.

Action Plan

Dr. Lamb suggests trying a daily multivitamin with vitamins D and B12 for those losing hair secondary to stress.

The former is involved in hair growth, while the latter might be deficient in some patients with telogen effluvium. Vitamins may be especially important around surgery.

On the other hand, Dr. Lamb does not recommend over-the-counter products high in biotin.

Such supplements have been shown to alter thyroid hormone test results, and the drugs sometimes cause acne flare-ups.

Many benefit from over-the-counter topical minoxidil treatment, such as Rogaine. Others get hair growth from prescribed medicine.

Minoxidil can accelerate shedding for several weeks or months before the shedding slows. Then, you may see re-growth. If shedding continues beyond three or four months, please check in with a valued healthcare professional.

Reduce Stress

Here are five ways that I reduce my stress levels:

1. I stay active. I love physical activity, whether walking or weightlifting.

2. I try to eat a healthy diet.

3. I have recently been better about regular meditation.

4. I love laughing.

5. I try to get at least seven hours of sleep (often coming up short by five to 15 minutes, alas).

Oh, my bald patch is the result of inherited genetics!