Does stress cause hair loss? How to know if it’s telogen effluvium or something else

Does stress cause hair loss?

Yes, stress can disrupt the hair’s normal growth cycle and cause a temporary type of hair loss called telogen effluvium.

“Telogen effluvium is a temporary but often overwhelmingly distressing condition of extreme hair shedding,” says Craig Ziering, D.O., a board-certified dermatologist and hair restoration surgeon. It typically peaks about two to three months after the stressful event, but it could really be anywhere from one to six months. That stressful trigger could be psychological stress (like going through a breakup, loss of a loved one, or a traumatic event) or physical stress (like weight loss, surgery, a high fever, certain medications, or prolonged illness), Dr. Ziering explains.

In normal circumstances, your hair goes through cycles of growing, resting, and shedding, says Ava Shamban, M.D., a board-certified dermatologist and founder of AVA MD Beverly Hills, Santa Monica. With telogen effluvium, stress-related hormonal changes “lengthen the shedding phase and shorten the growth phase, resulting in a higher percentage of hair loss than usual,” Dr. Shamban says.

This is similar to postpartum hair loss, which is also driven by hormonal shifts, but in this case we’re talking about cortisol (the stress hormone) rather than changes in estrogen or progesterone, Dr. Shamban says.

How long does telogen effluvium last?

In most cases, telogen effluvium is temporary, lasting up to six months (but usually less). Once you address the stressful trigger, your hormones can begin to regulate, allowing your hair growth cycle to return to baseline.

However, Dr. Obayomi notes, “the hair does not just snap back overnight.” Recovery happens gradually. “Most patients start noticing less shedding within three to four months after the trigger resolves. Visible regrowth, meaning you can actually see the hair looking fuller, usually takes about six to twelve months. Full recovery can take up to eighteen months in some cases.” Having realistic expectations can also help manage any anxiety you have about the timeline itself.

“In most cases, telogen effluvium is self-limiting, meaning the hair does regrow once the underlying trigger is resolved,” Dr. Obayomi adds. “However, there are cases where it can become chronic, lasting longer than six months, particularly if the stressor is ongoing or if there are multiple contributing factors that have not been addressed.”

How to know if stress is causing your hair loss

While stress can be a real driver of excessive hair shedding, it’s far from the only reason you may notice clumps of hair in the drain. The only way to know for sure what’s causing your hair loss is to call in the professionals. Yes, you might need multiple appointments for this one.

A dermatologist is a good place to start. There are a few things they’ll be looking for to determine if it’s telogen effluvium. “First, a diffuse pattern of shedding, all over the scalp rather than in patches. Second, an identifiable trigger event that occurred roughly two to three months before the shedding started,” Dr. Obayomi says. “Third, when I do a pull test in the office, where I gently tug on a small group of hairs, I typically get more hairs than normal, and most of them will be in the telogen phase, meaning they have that little white bulb at the root.”

A dermatologist may also ask questions like: “When did the shedding start? What was going on in your life two to three months prior? Are there any other symptoms, any medication changes, any significant dietary shifts, any recent pregnancies or hormonal changes?” Dr. Obayomi says. “All of that context is critical.”

Symptoms like patchy hair loss, scarring on the scalp, and the absence of a clear triggering event would suggest that something else might be going on, Dr. Obayomi says. “I would also investigate further if the shedding does not improve after several months, if there is significant thinning along the part line or frontal hairline in a specific pattern, or if the patient has other symptoms like fatigue, weight changes, or irregular periods that might point to an underlying medical condition.”

Even though this all sounds pretty straightforward, it’s also a good idea to get bloodwork done to make sure there aren’t any specific deficiencies causing the hair loss. Because yes, you may be stressed, but you may also have a thyroid issue or vitamin D or iron deficiency, Dr. Obayomi explains.

Other things that can look like stress-related hair loss

Stress-related hair loss is real, but it’s important to rule out other factors that could be contributing. There are a handful of health conditions and physically stressful events that can cause hair loss, such as:

• Thyroid dysfunction, including overactive and underactive thyroid
• Nutritional deficiencies, including low iron and protein levels
• Autoimmune conditions, such as lupus and Sjögren’s syndrome, and the medications used to treat them
• Androgenetic alopecia, a form of genetic hair loss that’s also known as male pattern hair loss or female pattern hair loss
• Traction alopecia, which happens when tight hairstyles, braids, weaves, and extensions cause gradual hair loss, particularly along the hairline at at the temples

Dr. Obayomi says she most commonly sees androgenetic alopecia attributed to stress. “Because [it] can progress slowly and sometimes becomes noticeable during a stressful period, patients often assume stress is the sole cause when there is actually a genetic component driving it,” she explains.

“Iron deficiency is another big one,” she adds. “Patients may not realize their iron stores are low, and they attribute the shedding to stress when the real culprit, or at least a major contributor, is nutritional.”

What actually helps telogen effluvium

There’s no shortage of tips and tinctures on social media promising to help you grow long, luscious hair. But when you’re dealing with telogen effluvium, the experts say it’s all about the basics.

Eliminate the stressful trigger

The most important thing you can do to resolve telogen effluvium is to address whatever triggered the shedding in the first place, Dr. Obayomi says. If you don’t, it’s possible that you’ll continue to experience hair loss. Of course, it’s not always possible to pinpoint—or fix—what’s stressing you out. If you’re struggling to manage stress on your own, seeing a mental health provider can help you learn new tools and coping skills.

Give it at least three months

Typically, stress-related hair loss resolves within a few months. “Patients often see the excessive shedding about three months after a stressful incident, and the balance of regrowth to shedding will start to resolve about four to six months after that,” Dr. Shamban says. There’s not a whole lot you can do to control the exact time it takes: “The process requires the shedding and growth cycles to resynchronize, which takes time,” she adds.

Show your scalp some TLC

“The scalp is skin, and treating it gently while creating a healthy environment for hair growth is essential,” Dr. Shamban says. While you’re recovering, avoid harsh scalp and hair products and chemicals, and opt for nourishing, hydrating shampoos and conditioners, she suggests. Massaging your scalp with your fingertips can help to improve circulation and oxygenation to the area, too.

Eat a hair-healthy diet

Loading up on fruits and veggies isn’t going to magically make your hair grow back faster (if you don’t have any legit nutrient deficiencies), but it can help set you up for the healthiest possible regrowth. Dr. Shamban recommends eating a diet full of “colorful foods and leafy green vegetables rich in vitamins and minerals like A,B, C, and E, as well as zinc and other trace minerals, antioxidants, and polyphenols [aka antioxidants].” Getting adequate protein is also essential “because hair is made of protein,” Dr. Obayomi adds.

Try a topical treatment

Minoxidil, an over-the-counter topical treatment used to boost hair growth, “does have evidence supporting its use for telogen effluvium,” says Dr. Obayomi, though the research is limited. While it can’t stop the hair from shedding, it may help stimulate the follicles and bolster new growth. (Though it’s considered an off-label use.) Dr. Obayomi notes that “there can be an initial shedding phase when starting it, which can feel alarming but is actually a sign it is working.”

While people with genetic hair loss have to use minoxidil indefinitely to maintain hair growth, most people with telogen effluvium can stop using it once their hair starts to come back, Dr. Obayomi says, as long as you’ve resolved the underlying trigger, too.

How to manage the stressful, emotional toll of hair loss

If your hair loss is truly stress-related, the best thing you can do is find ways to resolve—or at least manage—the stressful trigger. But that can be hard when you’re constantly faced with a brand new stressor: significant hair loss. “A lot of people, especially women, find personality in their hair,” says Kathryn Cross, a licensed professional counselor with Thriveworks. “Hair loss can cause people to have negative thoughts about themselves. They can feel ugly, or they may choose to not socialize with others. Hair loss can cause depression and make someone feel like they don’t have purpose.”

Here are a handful of ways to manage these complex emotions:

Fact-check your thoughts

Get into the habit of identifying and challenging negative thoughts to separate what’s rational from what’s not based in facts, suggests Marilisa Morea, Psy.D., owner and director of Monarch Therapy and Wellness Center in Thornhill, Ontario. “We want to create a new narrative that’s based on logic rather than feelings,” she says. “For instance, a feeling will tell you lies like, ‘My hair will never grow back,’ or ‘It’s getting worse not better,’ or ‘Everyone is looking at me and judging me.’ But facts are based on actionable or concrete evidence that is tangible and can be recorded and tracked.”

To help differentiate, Dr. Morea suggests journaling, logging, or otherwise documenting what’s true: This is temporary, and your hair will grow back.

Set aside time to worry

Speaking of facts: The truth is, you’re losing hair right now and it’s making you anxious, stressed, embarrassed, all the things. What you’re feeling is valid. Dr. Morea says it can actually help to allow yourself designated time to feel anxious or upset about your life circumstances. “We don’t want to pretend that the reality doesn’t exist, we want to honor it and own that it causes discomfort, but with boundaries so that it doesn’t fully consume us.”

A good way to avoid letting these feelings derail your entire day is to plan specific (and limited) time to sit with those feelings. You can even put it in your calendar: 15 minutes when you’ll let yourself go there. When the time is up, move on with your day. Outside of this time, don’t count how many hairs are in the shower, and try to limit how much you’re fussing with your hair or glancing in the mirror, Dr. Morea says.

Think about what you notice in other people

Think back to the last time you were with a close friend or someone else you love. Try to remember what your friend was wearing or how their hair looked the last time you saw them. “Odds are, you won’t recall,” Dr. Morea says. This serves as a good reminder that “your anxieties focus on your insecurities,” she says. Keep this in mind when you start to assume that that’s all people are focusing on when they look at you.

Visualize your thoughts floating by

If you’ve ever tried not to think about something, you know how hard it is. A more mindful way to navigate anxiety-inducing thoughts is with a visualization exercise known as “leaves on a stream,” which helps you acknowledge and release these thoughts, Dr. Morea says.

Imagine placing your anxious thoughts on leaves and watching those leaves slowly float down a stream away from you. You can do the same thing with clouds floating by, Dr. Morea says. This practice allows you to acknowledge your thoughts and feelings without judgment, and then zoom out and separate yourself from the thoughts, taking away some of their power.

Treat yourself like a good friend

Cross says this is a go-to tactic for her as a therapist. “When challenging negative self-talk and low self-esteem, I always ask clients to think about if their best friend came to them with these same concerns, what would you say to them? Most times they say kind and encouraging things,” she says.

We’re all our own worst critics, so try to talk to yourself like you would a close friend instead. You can even practice complimenting yourself in the mirror the way you would someone else, Cross suggests.

Find ways to distract your brain when you’re having a self-image spiral

Grounding techniques are great for getting out of your head and back into the present moment when you’re spiraling. Here are a few you can try:

• Pick a color. Try to count everything you see in that color, then choose another, until you feel more at ease, Dr. Morea says.
• Pop a sour candy in your mouth. “This will instantly take your thoughts to the candy instead of the negative thought,” Dr. Morea says.
• Narrate what you see out loud. Describe everything in vivid detail. This works because “your mind can’t do two competing things at once,” Dr. Morea says.
• Try the 5-4-3-2-1 technique. Cross suggests using your five senses to stay present and ground yourself when stress hits. One way to do this is looking for five things you can see, four things you can touch, two things you can smell, and one thing you can taste.

What to do if you think you’re dealing with stress-related hair loss

“If you’re noticing significantly more shedding than normal and it’s been going on for more than a couple of weeks, it is worth getting evaluated,” Dr. Obayomi says. You can start with your dermatologist or a primary care provider to go over your symptoms. Even if you think it’s just from stress, the only way to know for sure is to see a professional so you can rule out other factors.

And if it turns out you are dealing with telogen effluvium due to stress and you’re having trouble managing those stressors, checking in with a mental health provider is a great next step. They can help you identify your stressors, develop coping strategies, and manage the emotional toll that comes with hair loss.

Frequently asked questions (FAQ)

How much hair loss is normal?

“Shedding 100 to 150 hairs daily is normal for both men and women,” Dr. Shamban says. Keep in mind that if you don’t wash or brush your hair daily, it may look like you’re losing a lot when you do finally focus on it. So it’s possible the shedding you see is actually a few days’ worth coming out at once, and still completely normal.

How does stress cause hair loss?

Stress causes hormonal and metabolic changes in the body that can disrupt the natural hair growth cycle, causing increased shedding. This typically happens two to three months after the stressor occurs.

How do I know if my hair loss is from stress?

Stress-related hair loss typically occurs suddenly, is distributed evenly throughout the scalp, doesn’t cause obvious bald spots, and is not associated with other symptoms like scalp scarring, weight loss or gain, or fatigue, which can indicate an underlying health issue is contributing to your shedding.

Can stress cause permanent hair loss?

Not usually. If a stressor is ongoing, it could cause telogen effluvium to persist or recur, but typically, stress-related hair loss stops once the stressful trigger is removed.

How long does telogen effluvium last?

Telogen effluvium usually lasts less than six months, but it can take up to a year for hair to fully regrow and return to its old fullness, depending on your hair’s specific growth rate.