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Hair Falling Out? This Might Be Why

My husband was the first to comment, “What’s with all the hair in the sink?” 

My medical assistant was second, when she stopped me before I stepped into an exam room to point out the handful of loose strands scattered over my shoulders and back. My stylist was third, when I went in for a haircut and she remarked how my hair ... just ... kept ... falling -- and that was before she started trimming.

What I’m going through now is called telogen effluvium, a common form of hair loss that I often call “shock shedding.” (Dermatologists know all about it, but we are not immune to it!) It can happen a few weeks after a significant surgery or illness (including COVID-19), childbirth, a change of medication, a poor diet, iron deficiency, certain medical conditions, or high stress. I’ve seen more telogen effluvium in my patients over the last few months than I ever have before -- clearly because of pandemic-related stress. 

Men can have telogen effluvium, but they often won’t notice it if they have short hair. Women with medium or long hair definitely do notice those large clumps of hair in their brush, handfuls of strands that come loose during a shampoo, or a shrinking ponytail diameter. That’s when a terrible, panicky thought may cross your mind: “Oh no! I’m going bald!”  

Here’s the good news: This form of hair loss, though distressing, is temporary and reversible (and, no, you won't go bald from it). Your hair follicles are not scarred or damaged. They are just resting. The hairs on our head are continually cycling between growing, shedding, and resting (telogen) phases, and shedding becomes more obvious when an increased number of our hairs synchronize in the resting phase. Three to 6 months later, or possibly 12 months after shedding starts, you should start to notice fine, baby growth as the hairs start growing in again. 

But some of us aren’t patient. Our hair can be part of our identity, our appearance, and our confidence, and we want to get it back faster. What can help?

Clarify the diagnosis. A board-certified dermatologist can assess your scalp and determine whether you have telogen effluvium or another form of hair loss (there are several types, and I find that many women actually have more than one at the same time). They may check lab work, might consider a biopsy if the diagnosis is unclear, and can help to tailor an effective treatment plan to give your hair a boost.

Make lifestyle changes. It makes good sense to take everyday steps to reduce stress, exercise, and eat a healthy diet, with protein. Gentle hair care is a must. That means not-too-tight styles, gentle shampooing, and minimizing harsh heat and chemicals. 

Consider treatments and supplements. Dermatologists often recommend over-the-counter minoxidil (Rogaine) 5% solution or foam to the scalp once or twice daily. Some may suggest vitamins, such as Nutrafol or Viviscal, which have been shown in human studies to optimize the nutritional environment to support hair growth. (Discuss with your doctor whether a supplement may be right for you.) 

A cosmetic procedure called platelet rich plasma (PRP) may stimulate hair growth. That's where a dermatologist draws your blood from a vein, separates out the growth factors that circulate in your bloodstream, and injects them back into your scalp. The injections take under 5 minutes but can be uncomfortable, it can take weeks to see results (since hair growth takes time), and insurance doesn’t cover the treatment. But many women who try it do notice improvement, especially over three or more sessions. 

So what am I doing while my hair is “resting”? I’m trying to rest my body and my mind, too. I’m making an effort to eat a balanced diet and to relieve stress through exercise -- even if some days, that only means taking the dog out for a brisk walk. I’m taking a hair supplement I believe in (Nutrafol). And I’m going to ask one of my dermatologist friends to perform PRP on my scalp, if we can find time. But even if I do nothing at all, I know my hair will naturally return to a healthier, fuller state in a few more months. If you’re suffering from telogen effluvium, I am confident yours will, too. 


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