Tag Archive for: Trichotillomania

Normal vs. Excessive Hair Loss: Here’s How to Tell the Difference

Happy Head customer brushing his hair after using a custom topical finasteride solution for his hair loss.

Nooooo! Don’t let her use my bathroom. She gets hair everywhere!” screams my son every time my daughter asks to use his tub.  Yes, it’s true. She has long, thick hair and leaves a trail. That’s always been the case, and shedding is the norm for his sister. Is that the case for everyone? How do you know whether the daily amount of hair you lose is normal? After all, determining whether the number of strands you see in the sink is okay can be tricky. You don’t want to be paranoid, but you also don’t want to gloss over the situation if your hair really does need some extra attention. When it comes to normal vs. excessive hair loss: here’s how to tell the difference.   

You Naturally Lose a Certain Amount of Hair Each Day

Your hair goes through a growth cycle that includes a stage when hair rests and then sheds. That’s a fancy way of saying that it falls out. So, losing a certain amount of hair each day is normal. Here’s how your hair’s growth cycle works, along with the approximate timing of each stage:

Growth phase (3-5 years)

About 90 percent of the hair on your head is in a growth phase at any given time. During this stage, hairs push out of the follicles and continue to grow until they’re cut, or they reach the end of their lifespan. 

Transition phase (10 days)

The transition phase comes just after the growth phase. Only a small amount, about five percent, of your hair is in the transition phase at any given time. This is when your hair follicles shrink, and growth slows down a bit. Hair doesn’t shed quite yet.

Resting phase (3 months)

Next comes the resting phase, which affects about 10 to 15 percent of your hair. Your hair doesn’t grow during this phase but doesn’t shed either. That’s why it’s called a resting phase. 

Shedding phase (2-5 months)

Some scientists believe there are three phases of the hair growth cycle rather than four. The reason is that it can be difficult to distinguish between the two stages. People can lose anywhere from 50 to 100 hairs per day when their hair sheds. Yes, that seems like a lot of hair, but it’s completely normal.

There are Times When You Lose More Hair Than Normal, And That’s Okay

Losing hair for any reason is enough to send you to the mirror searching for thinning areas or bald spots. There are some perfectly rational reasons why you could lose more hair than normal, though. On those occasions, you’ll have to try not to panic. Your hair will grow back. When your body goes through any trauma, the hair growth cycle can get disrupted, triggering the resting stage earlier than expected. The disruption can occur if you’ve had COVID-19, the flu, or any other illnesses. Surgery, stress, weight loss, pregnancy, and other events that temporarily shock your body can have the same effect. Not to worry, though. Normal growth patterns will return on their own over time. Stress is one of the primary contributors to hair loss, so try your best to reduce your stress levels when you can.  

Other Times, You’re Losing Too Much Hair

So here’s the big money question. When are you losing too much hair? Let’s start with this. So far, the discussion we’ve been having is about shedding. When your hair sheds, it usually grows back on its own without any intervention. Hair loss is a different story. Hair won’t grow back on its own without intervention or hair growth treatment.  

Woman looking at her part in the mirror, trying to decide if she's losing too much hair.

If you’ve racked your brain and there hasn’t been anything unusual that could have disrupted your hair’s growth cycle, it’s time to schedule an appointment with your dermatologist.  There are many causes for hair loss, and they can help you determine why you may be losing excessive hair.  Some common reasons why include the following:

1. Genetic hair loss

If Mom, Dad, Grandpa, Aunt Betty, or any other blood relative on either side of your family has a history of thinning or balding hair, you may have inherited their hairline. Androgenetic alopecia, a.k.a male or female pattern baldness, is the most common form of hair loss among men and women who have gone through puberty. If this is the case for you, don’t worry. A lot of progress has been made in researching, identifying, and developing effective regrowth treatments.  The most effective oral and topical treatments, including Minoxidil, Finasteride, Dutasteride, Spironolactone (our women’s formula), and other DHT blockers, are available by prescription.  Lower doses of topical Minoxidil are available over-the-counter.  

2. Autoimmune hair loss

Many different types of autoimmune diseases can lead to hair loss. Some people may be more predisposed to autoimmune hair loss if they have other autoimmune conditions such as Hashimoto’s thyroid disease or Lupus. There are many types of autoimmune hair loss. One is alopecia areata which manifests as small, circular bald spots on various parts of your scalp. It’s a tricky condition because it’s unpredictable. Hair sometimes spontaneously grows back. Other times, the condition goes into a long remission and reappears years later. There’s also lichen planopilaris and other types of scarring alopecia that behave exactly like their names. Little scars grow over your hair follicles, cause your hair to fall out, and block new hair from emerging.  

Autoimmune hair loss is rare. Yes, we’ve been hearing more about it since celebs started sharing their stories. But, that doesn’t mean that you have it. Let your dermatologist diagnose you rather than using WebMD.  

3. Environmental hair loss

All the hair loss we’ve discussed so far stems from inside your body. Environmental conditions can cause direct damage to the outside of your hair, making it break or fall out. Let’s start with hair styling. Bleach, color treatments, perms, and other chemicals may give you immediate gratification, but over time, they can cause structural damage to your hair. When the outer cuticle gets lifted, the bonds inside your hair weaken and break. Dreadlocks, tight braids, and ponytail holders can cause traction alopecia resulting in temporary or permanent hair loss. Trichotillomania, compulsive hair pulling, can also cause hair loss. If you manage the factors contributing to the damage early enough, your hair can grow back. Deep conditioners, regular trims, and, in some cases, Minoxidil will help.  

Here’s What to Do if You Think Your Hair Loss is Excessive

It never hurts to get a professional opinion if you’re stressed out about the hairballs you’re finding on the shower floor. Don’t worry. Your dermatologist won’t think you’re an alarmist. They’ve seen it all.  If you are losing hair, an early diagnosis and immediate treatment will minimize hair loss and get you on the road to regrowth faster.

Don’t want to wait for an appointment? Let Happy Head help, all of our services are done online and without appointment. Fill out a short questionnaire about your hair loss, and one of our board-certified dermatologists will determine whether you will benefit from prescription-grade hair regrowth formula. You can also skip the pharmacy and have your prescription delivered directly to your front door in discreet packaging.    


Is Your Hair Healthy?

Has your hair been a little drier and frizzier than usual?  Is it less manageable than it used to be?  Figuring out whether or not your hair is healthy can be challenging.  It can be difficult to distinguish between when it’s time for a deep conditioning treatment and a haircut or if something else is affecting your hair.  If you know what to look for, though, assessing your hair’s health is easy.  Here’s a simple guide designed to help.    

How Do You Know When Your Hair is Healthy?

Is your hair smooth and shiny or dull and coarse?  Hair that’s shiny and smooth is deemed more healthy, even when hair is wavy or curly. (01)  As we age, natural graying can make hair seem dull or frizzy, but that doesn’t have to be the case.  Daily conditioners, moisturizing treatments, and shine-boosting sprays can help.

Androgenetic alopecia, a fancy name for male and female pattern baldness, can also change your hair’s texture and appearance.  Sometimes hair becomes finer due to miniaturization of the hair follicles.  Because the hair becomes thinner, it could become curlier.  In other cases, previously curly or wavy hair can flatten and be less able to hold its curls or waves.  

Healthy Hair From the Inside Out

Healthy hair isn’t just what you see on the outside.  What’s on the inside also counts.  Hair is primarily made of keratin, which is a protein.  Keratin is made out of amino acids and other molecules that come from foods we eat.  That’s why eating a balanced diet and ensuring that you have all the right vitamins are so essential.

Your hair grows from a follicle beneath your scalp’s skin.  A hair shaft extends from the follicle.  The shape and angle of your hair shaft are what determines what type of hair you have.  It’s made out of three layers:

  1.  Medullar- Inside layer 
  2. Cortex – Middle layer that determines your hair color and elasticity
  3. Cuticle – Outside layer that makes your hair look shiny

When the cuticle is damaged by the sun, chemicals, blow drying, or other elements, the cells in the cortex can break or unravel, making your hair look dull or brittle. 

What Damages Healthy Hair?

Typically, the hair’s cortex is filled with keratin, and the cuticle is smooth, allowing light to reflect.  When the cuticle is damaged, your hair may seem dry and frizzy.  The ends may be thinner than they used to be, but there is still an opportunity for repair.  A haircut, deep conditioning, and time to regrow usually solve the problem.  When the cortex is damaged, salvaging the hair is more complicated.  At that point, hair is coarse and dull with split ends and some breakage.  

Does Healthy Hair Fall Out?

According to the American Academy of Dermatologists, losing about 50 to 100 hairs per day is normal as part of the hair’s growth cycle. (02)  So, even if your hair is healthy, you might still see a few strands in the sink.  When you lose more than that, there’s a problem.  Hair loss due to physical defects is unusual compared to other types of alopecia.  Here are four of the most common ones:

  1. Loose anagen syndrome – When hair is loose and easily pulls out of the follicle because the root sheaths are not fully formed.  More common in children than adults.  
  2. Traction alopecia – When hair is pulled out of the follicle by tight hair bands, braids, or any other styling habits.
  3. Trichotillomania – A type of obsessive-compulsive behavior when people pull out their own hair.
  4. Overprocessing – Straighteners, perms, bleach, and dyes use harsh chemicals that can break down your hair’s fiber.  Using these harsh chemicals too often or incorrectly can irreversibly damage the hair’s fiber.  

Other Reasons for Hair Loss

If you are losing your hair, and it’s not due to a physical defect, it may be due to alopecia.  Here are some examples:

  • Telogen effluvium is a temporary form of hair loss that can happen after sudden illness such as Covid, surgery, or a stressful occasion.  Hair spontaneously regrows after a few months.  
  • Androgenetic alopecia (male or female pattern baldness) is the most common form of alopecia.  Although it commonly occurs during middle age, people in their 20s may have this type of hair loss due to an overproduction of Dihydrotestosterone (DHT).  Minoxidil, Finasteride, Dutasteride, and Spironolactone are prescription DHT blockers often prescribed to reverse hair loss caused by male and female pattern baldness.
  • Alopecia Areata is an autoimmune condition that causes circular bald patches about the size of a quarter.  In addition to Minoxidil and Finasteride, immunosuppressants have recently been found effective in helping people with alopecia areata regrow their hair.  

How to Keep Your Hair Healthy

Want your hair to look shiny and healthy?  Here are some tips to help you keep your hair in top condition:

  • Diet – Eat a well-balanced diet with plenty of vegetables, fruit, and plenty of protein
  • Vitamins – Check your vitamin levels, especially biotin, iron, vitamin C, niacin, and zinc.  Work with your dermatologist to supplement if any levels are low 
  • Exercise – Regular exercise not only helps manage your weight and keep your heart healthy, but it also reduces stress which has been proven to affect your hair
  • Habits – Quit smoking and only drink in moderation
  • Sun protection – Wear a hat when you’re in the sun to prevent damage from ultraviolet rays
  • Chlorine – Wear a swim cap when swimming, or rinse your hair before or after swimming to get all of the harsh chlorine out
  • Wet Hair – Use a wide-tooth comb and treat wet hair gently
  • Condition – Use a quality conditioner each time you wash your hair
  • Styling – Watch heat styling, eliminate or minimize chemical treatment, and avoid tight hairstyles (ponytails, braids, buns, etc.)

No matter your age or gender, having healthy hair is a confidence booster.  If you have questions about your hair’s health or are concerned about hair loss, let us know.  One of our board-certified dermatologists will review the information you provide and let you know if you would benefit by using one of our customized prescription medications.



(01) https://pubmed.ncbi.nlm.nih.gov/18004288/

(02) https://www.aad.org/public/diseases/hair-loss/insider/shedding#:~:text=It%27s%20normal%20to%20shed%20between,this%20condition%20is%20telogen%20effluvium.


Does Stress Cause Hair Loss?

Guy losing his hair because of stress and thinking about a solution to regrow his hair. Happy Head's dermatologists can help you get your hair back with custom-made topical treatments. Our topical treatments are prescription and made for you.

“I was so stressed I was losing my hair.” 

“All these bills have me pulling out my hair.” 

“This new job has my hair falling out.”

People often joke around about how stress causes hair loss, but for many people, it’s no laughing matter. So does stress really cause hair loss? Yes, stress can cause you to lose your hair. And when you’re trying to keep as much hair on your head as possible, managing stress becomes a top priority. 

Stress: The Good and the Bad

When you feel your heart rate rise because you’re running late or you start to sweat during a work presentation, what you’re feeling is stress. This emotional and physical tension is part of the body’s natural response to potentially dangerous or new situations. 

Known as the body’s stress response or the “fight-or-flight” response, stress can be positive. This emotion keeps you alert and driven, pushing the body to work harder and think faster. Stress works well for short periods, giving you enough energy to power through a challenging event. Long-term (chronic) stress, however, compromises your well-being – and may cause you to lose your hair. (01)

The Physiological and Psychological Effects of Chronic Stress

The stress response comes from your body’s autonomic nervous system, the same system responsible for your heart rate, vision changes, blood pressure, and breathing. 

During a stressful situation, you may experience the following: 

  • Increased heart rate
  • High blood pressure
  • Faster breathing
  • Sweating
  • Tremors

With chronic stress, you can see these additional symptoms: 

  • Headache
  • Muscle tension or pain
  • Chest pain
  • Restlessness
  • Insomnia
  • Fatigue
  • Stomach upset

Chronic stress can lead to health problems like high blood pressure, skin conditions, obesity, and heart disease. (01)

Why Stress Causes Hair Loss

To understand why stress causes hair loss, you first need to know the basics of hair growth. Hair grows in a cyclical pattern, with new hair growth to replace older hair once it falls out. Every healthy strand of hair typically grows in three primary stages: 

  • Anagen Phase
  • Catagen Phase
  • Telogen Phase

Anagen Phase 

The anagen phase is also known as the “Growth Phase.” During this phase, a strand of hair grows from the hair follicle. As it grows, sebaceous glands condition and lubricates the hair. Hair grows at an average rate of six inches a year for most people. At any given time, about 80% of hair is in the anagen phase. This phase of rapid growth usually lasts about 2 to 8 years. 

Catagen Phase 

Unlike the anagen phase, the catagen phase lasts only briefly. The catagen phase lasts about ten days, though some people may have hair that remains in the catagen phase for up to 4 weeks. This phase accounts for about 1 to 2 percent of a person’s hair. It is at this point that growth stops, and the hair follicle shuts down to rest. (02

Telogen Phase

Hair falls out of the follicle during the telogen phase. The telogen phase is aptly named the “resting phase” because the hair follicle shuts down for a short rest. During this phase, the follicles no longer supply nutrients, which causes the air to fall out. 

The hair that’s lost is usually hairs that are at the very tail end of the telogen phase, called the exogen phase. Approximately 15% of hair is in the telogen phase at any given time. The scalp sheds an average of 100 hairs a day. With about 100,000 hair follicles on the scalp, the daily loss of 100 hairs is negligible. (03)

Hair Loss and Stress 

Hair growth is determined by the stem cells within the follicles. Chronic stress affects the adrenal glands. A recent study published in the journal Nature–with support from the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), showed how the hormone corticosterone is impacted by the adrenal glands, which respond to stress. (04

Stress increases corticosterone levels. Corticosterone prevents the stem cells within hair follicles from activating hair growth. Instead, hair follicles remain in an extended resting phase – in the telogen phase. 

Telogen Effluvium

Telogen effluvium is the primary condition responsible for hair loss during stress. Stress can cause a greater than usual amount of hair to suddenly shift to the telogen phase all at once. During telogen effluvium, many strands stop growing, and hair follicles become dormant. Fortunately, hair typically regrows within 6 to 9 months. (05)

Signs of Telogen Effluvium 

With telogen effluvium, hair loss is often abrupt. However, hair loss may begin only a few months after experiencing significant stress. Hair follicles prematurely enter the telogen phase, and the follicles may take up to 3 months to start regrowing hair. 

Unlike other hair conditions, like alopecia areata, the hair loss pattern typically experienced by individuals with telogen effluvium is diffuse hair loss. In other diagnoses like female pattern hair loss or alopecia areata, hair falls off in a patchy pattern, or they may experience a widening of the hair part. In telogen effluvium, hair loss occurs throughout the head resulting in an overall thinning rather than bald spots. (05)

Other Hair Loss Conditions Caused by Stress

Telogen effluvium is the second most common type of hair loss for men and women, but it’s not the only hair loss condition due to stress. Chronic stress may also indirectly cause the following conditions:

Alopecia Areata

Although alopecia areata (AA) is an autoimmune disease, It results in hair loss. In alopecia areata, the immune system mistakenly targets hair follicles, causing patchy hair loss throughout the scalp. Stress may be a trigger for the immune sustain, resulting in further hair loss. There’s no cure for AA, but some prescription hair medications can help manage hair loss. (06)


During a bout of trichotillomania, known as “hair pulling disorder,” an individual may feel compelled to pull or tug at their hair. People with trichotillomania have episodes of the disorder during times of significant stress. Trichotillomania causes patches of bald areas where the hair pulling occurred. (07)

Does stress cause male pattern baldness? 

Male pattern baldness, also known as androgenic alopecia, is not caused by stress. The condition is caused by genetics. Unlike telogen effluvium, androgenic alopecia is not temporary. With early treatment, however, individuals with androgenic alopecia can slow hair loss or regrow hair. 

In general, hair loss can be caused by a variety of factors. Finding the reason for your hair loss is important in addressing the issue. Our Happy Head licensed, board-certified dermatologists can help you determine the best approach to your hair loss including a custom topical hair regrowth treatment that’s made for you. Our hair regrowth products are made for both men and women, so there’s a solution for everyone. Contact us to learn what Happy Head can do for you.


(01) https://medlineplus.gov/ency/article/003211.htm

(02) https://www.ncbi.nlm.nih.gov/books/NBK499948/

(03) https://www.nejm.org/doi/full/10.1056/nejm199908123410706

(04) https://www.nih.gov/news-events/nih-research-matters/how-stress-causes-hair-loss

(05) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606321/

(06) https://www.niams.nih.gov/health-topics/alopecia-areata

(07) https://www.sciencedirect.com/topics/medicine-and-dentistry/trichotillomania

Is There a Genetic Test that Can Predict Hair Loss?

Nowadays, there’s a genetic test for just about everything.  Even to determine our dog’s lineage.   Just one quick saliva sample or blood test and, within days, you can find out if you’re destined for cancer, diabetes, or heart disease.  There’s even a DNA test to determine whether you’re likely to experience anxiety.  

Suppose a genetic test can give you accurate information to guide your health care plan and prevent future disease.  Can it also accurately predict whether you’re predisposed to losing your hair?  If a genetic test shows that you are likely to inherit your Great Uncle Bernie or Aunt Bonnie’s hairline, is there a way to ensure that you don’t follow in their footsteps?  Are genetic hair tests reliable?  Do dermatologists use DNA tests to help make diagnoses? Before you click “Buy Now” to order a genetic test kit, keep reading.  We’re here to answer your questions about genetic testing for male and female pattern baldness.

Can Alopecia Really be Inherited?

When people hear the word “alopecia,” they often think of hair loss caused by a medical condition.  Types of alopecia such as alopecia areata and lichen planopilaris are caused by autoimmune conditions.  Androgenetic alopecia, however, is a type of alopecia that is inherited.  It’s the most common type of alopecia.  As many as 80 percent of all men will experience male pattern baldness in their lifetime. (01)  In addition, many women experience female pattern baldness, usually around menopause.  

What’s the Link Between Genetics and Pattern Baldness?

A study conducted on twins confirms what we’ve long suspected.  Male and female pattern baldness have a genetic component. (02)  About 79 percent of men who were balding in the study could attribute their hair loss to their genes.  But, there’s a catch.  Researchers are still working to fully understand which genes are affected.  We’re still learning.  Here’s what we do know.  There are 63 genes that could potentially cause baldness.  Six of those are associated with the X chromosome, where the Androgen Receptors (AR) are found.  It’s also possible that not one isolated gene is the culprit.  Several genes working together may be to blame.

Can You Take a DNA Test to Determine Whether You Will Go Bald?

Ads make genetic testing very tempting, especially if your Mom or Dad starts losing their hair in their 20s.  It would be nice to know whether you will lose your hair too.  But, unfortunately, we’re not quite there yet.  As mentioned previously, there are still too many unanswered questions about which genes are involved and how the genetic process affects your locks. Also, false positives are not unusual with genetic testing.  You don’t want a test to tell you that you’ll experience androgenetic alopecia if that isn’t really the case. (03)

How do you Know if the Type of Alopecia You Have is Genetic?

When men and women experience androgenetic alopecia, they see specific hair loss patterns.  The first sign for men is usually a receding hairline.  The hair loss then progresses to the top, creating a horseshoe pattern above your ears that circles around to the back of your head.  Female pattern hair loss typically presents differently.  Women usually notice thinning on the top and crown.  Often, women will notice a widening of the center part.  Many other conditions cause hair loss besides androgenetic alopecia.  If you think your hair loss is genetic, be sure to have your dermatologist confirm your findings.  Early diagnosis is key to preventing further hair loss and to stimulating new growth.  You also want to make sure you’re addressing the right condition with the right treatment.  

Do Dermatologists Use Genetic Testing to Diagnose Male and Female Pattern Baldness?

The truth is that dermatologists don’t need high-tech tests to determine whether or not patients have androgenetic alopecia.  Most of the time, they can tell from your hair’s appearance and your hair loss pattern.  If there is any doubt, he or she may use a densitometer to magnify your hair follicles to see if miniaturization is occurring.  Miniaturization is when the hair follicles shrink, causing existing hair to fall out and preventing new growth.  Your dermatologist may order a biopsy and blood test to rule out other causes. Patients often ask about the benefits of running a hair analysis based on what they hear about on social media.   Hair analysis is not used to diagnose male or female pattern baldness.  Instead, it’s used to determine whether there’s lead, arsenic, or another substance causing your hair loss.  

What Can You Do to Treat Hair Loss Caused by Genetics?

Treatment for male or female pattern baldness is designed to meet two goals.  The first is to stop the progression of your hair loss.  The second is to promote new hair growth.   The best way to accomplish those two goals is by using a combination of medications simultaneously.  Here are medications often included in treatment plans for androgenetic alopecia:

  • Minoxidil topical foam – A vasodilator that enlarges the hair follicles
  • Finasteride, Dutasteride, or Spironolactone  – Prevents testosterone from converting to DHT that attacks the hair follicles and causes hair loss
  • Topical or oral cortisone – Treats any redness or irritation (not needed for evey patient)

Some men are concerned about experiencing sexual side effects with oral Finasteride.  If this is the case, topcial Finasteride has been proven to be just as effective without the side effects. (04)  Even better, topical solutions which mix Finasteride with Minoxidil, Cortisone and Retinol offer an even more effective all-in-one solution.  The retinol improves absorption of the other three medications.  

Are There Other Causes of Hair Loss Besides Genetics?

Male and female pattern hair loss are the only types of genetically induced alopecia.  However, other types of alopecia exist and treatment plans are designed to treat the type of alopecia you are experiencing.  Examples of other types of alopecia include:

  • Temporary Alopecia (Telogen Effluvium) – Occurs due to sudden illness, stress, or shock and usually reverses itself without treatment
  • Autoimmune Alopecia (Alopecia Areata and Lichen Planopilaris) – People experience flares and periods of remission
  • Trauma-induced Alopecia (Traction Alopecia and Trichotillomania) – Alopecia results from hairstyles that pull on the hair follicles or when people pull out their hair as a stress response)

Can You Prevent Hereditary Hair Loss?

Let’s play pretend for a minute.  Let’s say that a genetic test does exist that will determine whether or not you will lose your hair.  The tests come back showing that you are genetically predisposed to androgenetic alopecia.   Is there a way to prevent hair loss before it begins?  Sure, eating right, exercising, and managing stress never hurt.  But, even with that, you can’t necessarily fight Mother Nature.  That would be nice, though.  If male or female pattern baldness does rear its head, then it’s time to take action.  

Can You Reverse Hereditary Hair Loss

If you’re experiencing male or female pattern baldness and want to learn more about products available, contact us.  Although there isn’t a way to prevent androgenetic alopecia from occuring in the first place, there are things you can do to reverse the condition.   Minoxidil, Finasteride and other medications have been found to be safe and effective. Our board-certified dermatologists and hair specialists are available to answer your questions and help you develop the ideal treatment plan for your needs and lifestyle. 



(01) https://www.ncbi.nlm.nih.gov/books/NBK538178/

(02) https://academic.oup.com/biomedgerontology/article/60/8/1077/545174

(03) https://www.nature.com/articles/gim201838

(04) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609098/


The Invisible Effects of Alopecia on Your Mental Health

Losing your hair can have serious effects on your mental health. This customer is looking at his hair in the mirror and noticing that his hair isn't as thick as it used to be, but now he's using Happy Head custom hair loss treatments to stop hair loss and gain confidence.

Although talking about mental health is more acceptable today than ever before, it’s still not the most comfortable topic of conversation. Add hair loss to the mix, and you have a double whammy. Bald spots and thinning hair may be noticeable, but the grief that many people feel when losing their hair isn’t. You’re probably not going to go up to your co-worker and say, “Hey, see my bald spot? I’m upset about losing my hair, and it’s ruining my life.” So who can you talk to, and how can you get help if you’re feeling depressed or anxious about your alopecia? Read on to learn about the of invisible effects of alopecia on your mental health and what resources are available if you’re struggling.

Understanding How Hair Loss & Mental Health are Connected

Alopecia isn’t physically harmful, but it has been proven to have immense psychological effects. A qualitative research study conducted in 2020 confirms that anxiety and depression related to alopecia are not only real, they can be debilitating for some. (01) One study participant said, “It was devastating when it first started. And when I first lost it all four years ago, I cried a lot. And it took me about two years. I really had to mourn the loss of my hair.” It’s not uncommon for people with alopecia to experience an ongoing bereavement process. (02)

The study also categorized emotions and the triggers that people with alopecia often experience:

  • Sadness and depression due to diagnosis
  • Insecurity, inadequacy, and self-consciousness when hair thins or bald spots appear
  • Helplessness, anxiety, fear and stress are often due to disease progression, recurrences, and failed treatment options

Given that hair is such a big part of our identity, it’s understandable that such strong emotions are evoked. People are often described and defined by the color or style of their hair. Before you were the perky brunette with the curly hair or the blonde dude with the buzz cut, and now you’re “the bald one.”

Why Depression and Anxiety Related to Alopecia Should be Addressed

Some people are so concerned about hiding their hair loss that they don’t want to participate in everyday activities. Work, birthday parties, happy hour, and even going to the gym can be tough.

When asked about how alopecia affects her social life, one respondent said, “Does it affect me physically? No. The ability to move around? No. To be around people? Yeah, it does. It does play a big role.” (03) Another mentioned that he missed his friend’s wedding because he was too embarrassed about the way he looked. “Once the alopecia was at its worst point that I had, I was just like, a homebody, you could say. I wouldn’t want to go out. [ …] I would avoid it. I wouldn’t go to, like, parties where you have to suit up. Yeah, I missed, like, my friend’s wedding.” Nobody chooses alopecia, and certainly nobody chooses to be debilitated by it. What’s the solution? Awareness and support.

How to Identify Whether Your Emotions are Manageable

The first step in getting help for anxiety and depression stemming from hair loss is being aware of your feelings. Everyone gets stressed out from time to time, and it’s only normal to be upset about losing your hair. After all, that’s a pretty significant change. How do you know if the amount of anxiety you’re feeling about your alopecia is appropriate?
According to the National Institute of Mental Health, “Anxiety disorders involve more than a temporary worry or fear. For people with an anxiety disorder, the anxiety does not go away and can worsen over time.” (04)

Symptoms of Anxiety and Depression Caused by Hair Loss

Androgenic alopecia, alopecia areata, or even telogen effluvium can trigger depression, general anxiety, and other mental health disorders in predisposed individuals. Although each of the mental health conditions is different, you can have multiple conditions simultaneously. Here are some general symptoms to look for (05):


Depression causes constant sadness and loss of interest in activities that you used to enjoy. People who are depressed may feel:

  • Tearful, empty, or hopeless
  • Angry, irritable, or frustrated
  • Less interested in activities that they used to enjoy
  • Tired
  • Restless
  • Less able to concentrate or make decisions
  • Worthless

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) occurs when people with alopecia worry non-stop about their hair loss. The anxiety doesn’t cease and begins to interfere with everyday life. People with GAD are often:

  • Restless, wound-up, or on-edge
  • Easily fatigued
  • Having difficulty concentrating
  • Irritable
  • Having headaches, muscle aches, stomachaches, or unexplained pains
  • Difficulty controlling feelings of worry
  • Having difficulty falling or staying asleep

Social Anxiety Disorder

Social anxiety disorder (SAD) makes people worry that they will be judged negatively by others because they have little or no hair. The embarrassment and shame are so extreme that they avoid socializing. SAD can often cause:

  • Feeling self-conscious or fearing that people will judge you negatively
  • Sweating, trembling, blushing
  • Pounding or racing heart
  • Stomachaches
  • Difficulty making eye contact or being around people you don’t know
  • Having things symmetrical or in a perfect order

How to Deal with the Psychological Effects of Hair Loss

There isn’t a one-size-fits-all approach to psychological treatment for alopecia. The key is to seek treatment if you feel depressed or anxious about your hair loss. Treatment options typically include (06):

  • Psychotherapy (Talk therapy)
  • Cognitive Behavioral Therapy (Teaches people to think differently)
  • Acceptance and Commitment Therapy (Uses mindfulness and goal setting to eliminate negative thoughts)
  • Medication (Antidepressants, anti-anxiety medications, beta-blockers)
  • Support groups
  • Stress management techniques

Your healthcare provider may recommend one or more of these approaches to help you cope with your condition.

Can Stress Cause Alopecia?

We’ve established that having alopecia can inflict emotional problems, but can being stressed or depressed cause alopecia? After all, chronic stress can cause heart disease, high blood pressure and a variety of other medical issues. Is hair loss one of them?

The answer is yes. In a study on mice partially sponsored by the National Institute of Health, researchers discovered a particular stress hormone that inhibits stem cells required to grow hair. (07) During the study, mice were subjected to mild stress for many weeks. The corticosterone levels in the mice increased, and hair follicles stayed in the resting phase longer than normal, reducing growth.

Two hair loss conditions in people that are known to be triggered by stress are telogen effluvium and trichotillomania.

Telogen effluvium

As in the research study with the mice, stress could push your hair follicles into a resting period causing hair loss. The good news is that telogen effluvium due to stress is not permanent and can reverse itself.


Among people predisposed to obsessive-compulsive disorders, stress can trigger a hair-pulling disorder called trichotillomania. Despite trying to stop, people with this mental disorder have an irresistible urge to pull out their hair.

Fortunately, as we mentioned above, you can alleviate stress. The faster you seek treatment, the sooner your hair can return to a healthy growth cycle. To get started on your hair loss journey with a Happy Head dermatologist, click here.

What You Can Do to Prevent and Negotiate a Hair Loss Crisis

The key to dealing with hair loss is getting to a healthy level of acceptance. Sometimes it takes hard work, and sometimes it takes a little inspiration. It doesn’t matter how you get there. There isn’t a clear-cut map because the journey is unique for each person.

In a Tedx talk, Jannica Olin, a Swedish actress living in LA, asks the thought-provoking questions, “If I’m not my body, who am I?” and “When that which defines you is gone, do you know who you are?” Jannica lost the hair on her head, her eyebrows, and her eyelashes to alopecia areata. When you watch the video, you can’t help but notice that Jannica gets a little choked up when she removes her wig. Even as a successful TedX speaker who has redefined herself, Jannica is emotional about her experience. The difference is that Jannica can focus on what she has gained through her alopecia rather than lost.

We hope that you find your new normal and take back your power. We’re proud to be your partner and to support you along the way, take the Happy Head questionnaire to get started on a custom hair loss treatment plan all online.


(01) https://jpro.springeropen.com/articles/10.1186/s41687-020-00240-7

(02) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1261195/

(03) https://jpro.springeropen.com/articles/10.1186/s41687-020-00240-7

(04, 05, 06) https://www.nimh.nih.gov/health/topics/anxiety-disorders

(07) https://www.nih.gov/news-events/nih-research-matters/how-stress-causes-hair-loss