Does stress really cause hair loss?

“Director, everyone experiences stress. But why am I the only one losing hair? Is stress really the cause of hair loss?”

This is one of the most frequently asked questions in the doctor's office. This question is filled with skepticism about the relationship between stress and hair loss and a desire to clearly know the cause of hair loss. To conclude, stress may not be the only or absolute cause of hair loss. However, it is true that stress has various effects on our bodies and acts as a very important 'trigger' that increases the likelihood of male pattern baldness, female pattern baldness, and alopecia areata occurring.

1. Stress is just a ‘trigger’, the ‘bullet’ may already be loaded

Here's the answer to the question, "Everyone's stressed, why me?" Even if the same 'trigger' called stress is pulled, it is as if the trigger only occurs in people who have already loaded the 'bullet'. Here, ‘bullet’ refers to the ‘Pre-existing Vulnerabilities’ of an individual vulnerable to hair loss. Stress makes people with these underlying conditions much more prone to telogen effluvium and can dramatically worsen existing hair loss.

• Family history of hair loss (genetic predisposition):If you have a hair loss gene but it has not yet been expressed, extreme stress can act as a switch on for the dormant gene.
• Pre-existing scalp dermatitis:People who have had seborrheic dermatitis or folliculitis may experience accelerated hair loss as the inflammation worsens due to stress.
• Underlying Conditions:Anemia, polycystic ovary syndrome (PCOS), thyroid disease, diabetes, and various autoimmune diseases are factors that make hair weak. When stress is added in the presence of these diseases, the hair follicles undergo a double or triple attack and become rapidly weakened, easily leading to hair loss.

In other words, stress can cause hair loss even in healthy people, but it has a more fatal effect on people with the above vulnerabilities.

2. 3 scientific links between stress and hair loss

That stress causes hair loss is not just a guess, but a scientific fact proven through a clear biological mechanism.

Link 1: Stress hormone ‘cortisol’ turns off the hair growth switch

This is the best known mechanism. When the level of cortisol, a stress hormone, increases due to chronic stress, the growth phase (Anagen), when hair follicles actively grow, is forcibly shortened and the hair follicles enter the telogen phase (telogen), the stage just before shedding, prematurely. As a result, Telogen Effluvium, in which a large amount of hair falls out at once, occurs 2 to 3 months after a stressful event.

Link 2: Neurotransmitter ‘Substance P’ causes inflammation around hair follicles

Stress causes microscopic inflammation around the hair follicles through the nervous system. When you are stressed, a neurotransmitter called 'Substance P' is secreted from the nerve endings, and this substance stimulates immune cells around the hair follicles, causing an inflammatory response. This ‘Neurogenic Inflammation’ suppresses the activity of hair follicle cells and promotes hair degeneration, worsening hair loss.

Link 3: Disrupts the immune system and causes it to attack hair follicles

In particular, alopecia areata (Alopecia Areata) is closely related to stress. Alopecia areata is an autoimmune disease in which immune cells mistake hair follicles for enemies and attack them. Extreme stress can disrupt the immune system and act as a trigger that causes immune cells such as T cells to attack hair follicles.

3. Indirect effects of stress: lack of sleep and nutritional deficiencies

In addition to directly affecting our hormones, nervous system, and immune system, stress also indirectly causes hair loss by disrupting our lifestyle habits. When we are stressed, we often have trouble sleeping or eating poorly due to loss of appetite. Hair divides and grows with the help of growth hormones while we sleep, but lack of sleep inevitably disrupts this process. Additionally, as food intake decreases, the supply of protein, the main component of hair, and vitamins and minerals essential for growth decreases. This lack of sleep and nutritional deficiencies in themselves cause telogen effluvium hair loss.

4. “The stress is over, but why won’t the hair loss stop?”

This is also a question many patients ask. Let's compare the situation to a 'wildfire'. Lightning (stress) struck and caused a big fire in the forest (scalp). The rain has put out the lights, and now there's no more lightning (the stress is gone). But can the forest, which has become ashes, automatically return to its former lush appearance just because the fire is extinguished? That's not true. The land (tissue around the hair follicles) was devastated, and the trees (hair follicles) were burned or weakened and lost the power to sprout on their own.

The same goes for hair loss. After the acute period of stress passes, the aftereffects of ‘damaged hair follicles’ and ‘weakened hair growth function’ remain on our scalp. Therefore, to manage hair loss after stress has subsided, it is better to receive 'active recovery treatment', like rebuilding a devastated forest, rather than just 'waiting'.

5. The first thing I recommend when you're under a lot of stress is sleep.

“I can’t sleep because of the stress.” Many people complain like this, but paradoxically, the most powerful weapon to overcome stress is sleep.

• Sleep is a ‘natural stress reliever’:Scientifically, deep sleep is the most effective way to stabilize our body's stress response system and lower levels of the stress hormone cortisol.
• Keys to breaking the vicious cycle of hair loss:If you can't sleep due to stress, your cortisol levels will remain high, which will reduce your sleep quality and further accelerate hair loss, creating a vicious cycle. Therefore, when you are stressed, it is very important to consciously try to sleep more rather than forcing yourself to endure it.

Stress can be a major signal that signals the beginning of hair loss. But you shouldn't ignore the signs or think that if you just manage your stress, you'll be fine. Only when we combine stress management with more fundamental treatment that restores the strength of already weakened hair follicles can we finally regain the healthy hair we have lost.