As the technician finished combing through my hair, magnifying my scalp with a microscopic camera, I anxiously waited for the results. It’d been months of hair falling out in dense clumps and circling the shower drain. What felt normal at first became quickly troubling—was I experiencing hair loss? All signs, including the yellow bar blinking on my chart, pointed to yes.
Just six months prior to my scheduled scalp analysis, I had been laid off, started planning a wedding (in Italy, no less), and packed up my life with my fiancé to move from New York to Austin for his new job. Stress was my middle name. Up until then, I had been in denial despite the all the hair in my brush. But the answer was plain as day, with science and technology to back it up. My first thought was pure panic about my health—what is wrong?
“Hair loss can have lots of causes, but genes are usually the biggest driver,” explains board-certified dermatologist Marnie Nussbaum, MD, FAAD. “The most common type is pattern hair loss or androgenic alopecia, which is hereditary and happens gradually with hair getting thinner and finer over time, especially as we age.” But there are a few other culprits, too. Hormones can play a huge role. As they fluctuate during pregnancy, postpartum, perimenopause, menopause, and even from certain birth control methods, it can affect the state of your scalp. And even hair being pulled too tightly from extensions, ponytails, and braids (called traction alopecia) can trigger hair loss.
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Hair loss could also be a wake up call that something else is going on, like nutritional deficiencies, an over- or under-active thyroid gland, or illnesses like cancer or autoimmune diseases so it’s crucial to see your dermatologist or doctor to rule out anything more serious. Often a consult and blood test can check levels and rule out some causes. “Blood tests can show anything that might indicate weakening hair follicles like low iron, thyroid imbalances, nutritional deficiencies (in vitamin D and B12), autoimmune or inflammatory conditions, and of course, hormonal shifts, including testosterone or DHT levels, which can cause hair follicles to shrink,” says Dr. Nussbaum.
However, previous bloodwork showed no major red flags and according to this analysis, my hair follicles were healthy and active, just my hairs per follicle were low—meaning my hair loss was likely due to something else. “Hair follicles are sensitive to both physical and emotional stressors,” says New York dermatologist and psychiatrist Amy Wechsler, MD. According to Dr. Wechsler, stressful life events—which can be physical, like illness, infection, pregnancy, and surgery, or psychological, like a breakup, career change, or big move—can also cause a type of hair loss called telogen effluvium. Ah—there it was.
Hair growth happens on a cycle over several months and this type of hair loss causes hair to move from the anagen (growth) phase to the telogen (rest) phase, causing hair shedding. “When your body is under stress, it can push a large number of hair follicles into the resting phase all at once,” says Dr. Nussbaum. “Those hairs stay that way for a few months before shedding, which is why you often notice hair loss three to six months after a stressful event.” But it’s not all doom and gloom—there is a glimmer of hope. “I reassure patients that telogen effluvium is self-limited,” says Dr. Wechsler. “It’s only temporary and once your body recovers, the hair will grow back.”
