Hair has purpose, it helps keep us warm or cool as needed, it helps protect our scalp and skin from environmental damage, and it also helps emit pheromones. Hair also plays a psychological and social role.
Healthy hair with a great hairstyle helps us feel confident; it often defines our signature look and style. It is easy to see why one would stress over the color, the curls, the density, and preserving that signature look.
One of the most distressing hair issues many people face is unexplained hair loss. Most people will experience excessive hair loss at some point in their lives. Because there are so many contributing factors to hair loss it can even happen several times throughout your life.
Hair loss can be caused by many issues including hormonal changes, genetics, medications, fevers and illness, cancer treatment, stress, the aging process, and scalp conditions.
In this post, I am going to discuss the hair growth and loss cycle and the more common reasons and times we experience excessive hair loss. I think it is important to understand the stages of hair growth, so you better understand when you may need help from your doctor.
(Keynote and disclaimer: I am a research writer; I am not a medical doctor, dermatologist, or hair stylist. Please seek professional assistance should you feel I have found information you personally want to look into. This post is for informational purposes and all resources are hyperlinked throughout.)
Table of Contents:
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Hair Growth Phases
The hair growth and rest cycle is a constant ongoing process that overlaps. It is dependent on many coordinated factors involving:
- hormones (endocrine system),
- nutrition (digestive system),
- stress (nervous system),
- and your blood (vascular system).
When all these systems are functioning happily together, a normal hair growth cycle occurs.
You are born with all the hair follicles you will ever have, at the peak of maximal hair growth you have around 80,000-150,000 individual hair strands on your head.
Each hair follicle has its very own sebaceous gland, a tiny little muscle called the arrector pili muscle, and its own blood supply.
Growing Phase
The Anagen Phase, is when the follicle grows, this phase lasts anywhere from 2-7 years, 85-95% of your hair is in this phase at one time. Your hair will grow up to half an inch a month during this phase and can grow as much as 30 inches during those seven years until an unknown signal triggers the next phase.
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Transition Phase
The next phase is the Catagen Phase, which is where the follicle transitions from growing into disconnecting from the blood supply. The hair then converts to what is known as a club hair. This phase lasts up to three weeks, and 1-5% of your hair is in this phase at one time.
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Resting and Shedding (Hair Loss) Phase
Then the hair enters the Telogen Phase, which is two parts, the resting phase and the shedding (exogen) phase. The telogen phase lasts approximately three months, and 10-15% of your hair is in the telogen phase at one time.
2.6% of your telogen hair is in the shedding phase. The normal amount of daily shedding is around 50-100 hairs.
Should you experience a stressor like childbirth, serious illness or injury, or surgery that prematurely caused the telogen phase; you can lose up to 70% more.
If this condition happens, it is called telogen effluvium. This usually occurs 3-6 months after the event.
Telogen effluvium can occur with any number of imbalances or disruptions (usually something severe) in the body systems that help create hair (digestive, vascular, nervous, and endocrine). Telogen effluvium can be triggered anywhere from 2-3 months before the exogen phase where the hair is actually shed and usually tapers off after 6-9 months.
Telogen effluvium is normal and temporary. Usually your hair will return to normal growth and shed cycle once the stressful event has been resolved or the imbalance corrected.
Our hair normally grows and sheds seasonally.
We tend to grow more hair during the cooler seasons and taper growth off during the hotter months.
Just like most mammals, humans also shed seasonally. The lowest rate of shedding is in the winter, which makes sense, since our hair helps regulate temperature. The highest rate of shedding is in the summer.
So how do you know if you have breakage, normal shedding, or hair loss?
Shedding:
The key when evaluating natural hair shedding is the hair fall will be the entire length of the hair with the bulb at the root tip end of the hair strand present.
These strands will total around 50-100 per day.
This is the normal shedding process and is not considered hair loss, unless as mentioned before, you have a stressor event.
Breakage:
Broken hair will be pieces of hair with no bulb end. They can be any size and they will usually have a frayed end where it broke off.
The small hairs on the top of your head that generally frizz are not always broken hair so this is not a determining factor. This can be new hair growth, especially if you have recently discontinued chemical processing.
Causes of broken hair are usually external and include:
- An imbalance in hydration in your products
- Being too rough on the hair with combing, brushing and even towel drying
- Sleeping with wet hair
- Constant and repeated damage from heat tools weaken the cuticle and the hair eventually breaks
- Tight ponytails and hair styles can cause breakage, you will notice small hairs around where you wear a bun or ponytail
- Chemical processing: dye, bleaching, straightening, or perming all cause cuticle damage
Most of the internal causes of hair loss (medications, illness, etc.) cause imbalances in the build of the hair during the growth phase which can make the hair brittle.
To combat breakage:
- Get regular trims to help prevent split ends.
- A bond builder can be helpful if you have used chemical processes like bleaching or straightening.
- Clarify routinely to prevent buildup that causes breakage.
- Deep condition after any chemical process to help rehydrate the hair.
- Use a quality shampoo and conditioner to help hydrate without buildup and keep a normal hair elasticity.
- Using a leave-in helps create slip so you don’t break the hair during combing and brushing.
- Use The Perfect Haircare microfiber towel (get the pink one, the black transfers dye).
- Go easy on heat tools and use heat protectant when you do.
- Sleep with dry hair on a 100% pure silk pillowcase.
Hair Loss:
The medical term for hair loss is alopecia; it means the loss or thinning of hair on the scalp (and anywhere else on the body). It is common and there are several reasons that it occurs beyond normal hair shedding.
The Main Types of Hair Loss & Their Causes:
1. Aging and Genetic Hair Loss:
Which includes male-pattern and female-pattern baldness.
Unfortunately, some people have it embedded in their DNA to have excessive hair loss, and there really is nothing to stop it.
Aging also plays a role for most everyone along with losing pigment and graying, by a certain age we will all experience a certain percentage of hair loss, a reduction in hair growth, and usually finer hair.
2. Autoimmune Diseases:
Most of the time the hair loss from an autoimmune disease is related to the immune system attacking the hair follicle or the subsequent inflammation of the skin from an inflammatory disease. This is referred to as Alopecia areata.
Autoimmune diseases that can cause hair loss include but are not limited to:
- Celiac disease
- Chrohn’s disease
- Hashimoto’s Thyroiditis
- Grave’s disease
- Rheumatoid arthritis
- Psoriasis
Your hair loss should subside once you and your doctor find a treatment plan that works for you.
3. Telogen Effluvium:
There are multiple and often compounding reasons for telogen effluvium (TE), so this section is broken into the primary causes of telogen effluvium, but remember they often overlap.
Disease/Illness/Surgery:
- Major physical injury and recovery
- Surgery and Anesthesia
- Fevers
- Viral, bacterial, or fungal infections (flus, Covid-19*, yeast, etc.)
With an illness, fever, physical injury, or recovery the hair shedding can occur up to three months later. Usually, TE will resolve with time and distance after healing. If you have extended hair shedding for more than three months see your dermatologist they may be able to help slow it down with medical care.
Nutrition and Hair Loss:
Our immune system needs nutrients, not only to maintain normal daily health but also to fight off any threats. Nutrition is imperative to maintaining healthy hair at every stage; and deficiencies at any of the growth phases could result in premature losses. Vitamins help build healthy cells and balanced cellular function, any change in diet, weight, or health can deplete the system, which can lead to hair loss.
- Restrictive dieting
- Weight loss of 20 pounds or more
- Nutritional deficiencies:
- B Vitamins
- Vitamin C
- Vitamin D
- Iron
- Vitamin B-12
- Folic Acid
- Zinc
- Protein (building blocks of hair)
- Essential Fatty Acids (omegas)
- Water (dehydration, a major culprit because the follicle needs water to build the hair)
Nutritional imbalances are usually the easiest to resolve. Have your blood work done especially if you suspect iron or vitamin D deficiencies.
While fighting any infection especially if you had a fever, like the flu or Covid-19, your system rapidly becomes deficient in vitamin D, vitamin B-12, protein, and water. Nutritionally replacing these four nutrients can help bring back your stamina, energy levels can rise, and it should slow down any increased hair shedding.
It is estimated that around 42% of North Americans are already vitamin D deficient without illness, and 20% of people over the age of 60 are already deficient in B-12.
Some hair nutrient deficiencies will cause brittle hair, so following hair nutrient basics will help with that as well as hair loss. You can read more here: Great Nutrition for Great Hair
Stress (physical or psychological):
Stress is conjunctive and compounding to all other issues. Stress can stand alone, but eventually unchecked and untreated it can affect all other bodily systems leading to other causes of hair loss mentioned here.
- anxiety
- depression
- high stress job or home-life
- pregnancy/delivery/postpartum
- grief and loss
- divorce
- moving
- being a primary caregiver
- hair loss, ironically the more we stress over it the worse we make it
- Covid Stress* (I personally experienced this in 2020)
- a psychological disorder called Trichotillomania where a person pulls their own hair out
Usually once the stressor has been resolved or removed, the hair begins to grow back on its own with little to no intervention.
Simple stress relief goes a long way to help you holistically:
- Yoga
- Tai chi
- Meditation
- Therapy
- Breathing exercises
- Play
- Laughter
- Massage
- Acupuncture
- Exercise
- Gardening
Covid-19 Related Hair Loss:
There is no documented “side-effect” of hair loss during covid-19 illness, but as with any severe illness that includes a fever or is an extended recovery time, telogen effluvium can occur within a few months after illness.
Update October 2022: When I wrote this article in 2020, I was not able to fully discuss Covid-19 caused hair shedding, without being flagged for inaccurate Covid-19 information. It is now well documented with some individuals they may experience telogen effluvium within three months after illness with Covid-19 and it may be rather extreme and extended. My best advice is to boost your nutritional levels of vitamins C, B-12, and D to help your immune system recuperate. Should you experience more than six months of hair shedding, see your dermatologist for medical support.
Beyond actually getting ill, Covid-19 related stressors have affected us all on many levels:
- Our finances
- Jobs and businesses
- Stay-at-home orders and social isolation
- Home schooling
- Working from home
- Concern over family members and their wellness or illnesses
- Anxiety over you or your loved ones contracting covid-19
- Even the political environment surrounding the issue
Those are all stresses that would lead to telogen effluvium one at the time, but we all have been experiencing some combination if not all of these.
I myself, experienced this in 2020, with a personal injury and trying to keep up with the demands of a small business evolving through the pandemic, I lost a lot of hair (I’ll admit it was scary) for about six months. It has resolved now and my hair is back to its normal amount of shedding.
4. Chemotherapy and Medications:
Cancer Treatment can cause Anagen Effluvium
- Hair follicles grow and divide quickly. Chemotherapy is designed to attack rapid growth cells; so, while it’s killing cancer cells it also attacks hair follicles.
- It is recommended that you avoid any chemical treatments to your hair before chemotherapy.
Other Medications (with hair related side effects)
- The list of medications is too long for me to include here. If you are taking any medications read your medical inserts and talk to your doctor or pharmacist.
Your hair should begin growing back as soon as treatment is over, or the medication is altered or changed. (Do not discontinue any medical treatment without consulting your doctor.)
5. Hormones:
One thing we all have in common is hormones. Hormones dictate more about your hair than you may have ever realized; including changes in your curl pattern, hair color, hair or no hair, hair loss, hair length, hair texture, and frizz on your temples.
At some point in your life, well multiple points, your hair will change due simply to hormonal changes.
- Puberty
- Pregnancy, delivery and post-partum
- Polycystic ovary syndrome
- Peri Menopause: Hair loss during this time is thought to be the effect of androgen overproduction by the adrenal glands.
- Menopause: It is estimated that 20-60% of women will suffer from menopausal related hair loss before they reach the age of 60.
- Hormone treatment cessation (stopping HRT or the birth control pill)
- Hypothyroidism
- Andropause (male equivalent to menopause)
- Androgenic alopecia (hair loss related to the male hormone androgen which is also present in small amounts in women)
Read my post on What You Can Do About Hair Loss and Menopause to learn more.
6. Chemical reactions:
Hair processes including hair dye, hair relaxers, and perms. Reactions to products and ingredients can cause temporary increased hair loss usually around the use of the process or products.
We have all witnessed the latest rounds of class action lawsuits against major hair brands for hair loss in recent years.
The top ingredients with reactions are formaldehyde and formaldehyde releasers, parabens, imidazolidinyl urea, and DMDM hydantoin. These ingredients are found in many salon processes and home hair care products.
Usual hair growth and loss stages will resume once the process or product has been removed from your hair routine.
7. Traction Hair loss:
This is mechanical hair loss, where you are pulling the hair out from tight hairstyles or trichotillomania.
Hair style related loss can be stopped by loosening it up or discontinuing the style. Should you be pulling your hair out due to trichotillomania please see your doctor and/or therapist.
Treatment Options:
As there are multiple and potentially compounding reasons for hair loss, the various types of treatments and solutions are usually specific to the type of hair loss. As you noticed above, I included the basics where advisable on treatment and resolution time.
First step, write down when you first noticed the excessive loss begin, and then try to keep track and see if it spontaneously resolves or if it continues. Remember a normal seasonal increase in shedding occurs in the warmer months.
Second step, measure your hair density, you can do this by measuring the circumference of your ponytail. Alternatively, do a scalp check, take a pic, and keep doing so about once a month to see if it is changing. What will change is the visibility of the scalp, if you are losing a lot of hair your scalp will become more visible, this is a difficult one to get an eye on if you have white hair. Also, check for and document any bald patches.
If you think you are experiencing excessive or abnormal hair loss (especially if lasting beyond 6 months, or you see bald patches), see your doctor, a dermatologist who specializes in hair diagnosis, or a trichologist to evaluate what type of hair loss you are experiencing.
Medications are not always necessary or needed, and many aren’t proven for most types of hair loss. This is where it is important to have your issue properly diagnosed (e.g., request blood work to evaluate your nutritional levels, reproductive system, and thyroid system).
The Good News: If your hair loss is not caused by genetics or aging, once successful treatment is established most people will see their hair growing back.
Daily Support:
- Always treat your hair gently, brush or comb your hair gently without yanking or pulling. If you have very long hair, work your brush or comb from the tips upward to the roots first, then work your way back down to prevent tangles, pulling, and breaking.
§ - Scalp Massage helps promote circulation which increases blood flow to the follicle, a simple daily scalp massage with a scalp oil can help. QuickSilverHair Squalane Oil is great for scalp massage.
§ - Check your diet, make sure you are eating healthy and drinking plenty of water. Nutrition is an easy self-support and usually does more good than harm for your entire body. You can read up on my best suggestions for hair nutrition in this post: Great Nutrition for Great Hair
§ - Use gentle shampoos and conditioners, free of fragrances, sulfates, and comedogenic ingredients. My favorite product right now is from SEEN. I swear it helped stop my own Covid-19 Stress related hair shedding. You can read more on that here and there is a coupon code at the end if you want to try it: SEEN: Fragrance-Free Hair Products for Sensitive Skin and Noses
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I hope you found this post educational and helpful.
Thank you for reading. Please feel free to share.
As always it is about so much more than the hair.
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Works Cited:
- “Hair Follicle.” Wikipedia, Wikimedia Foundation, 28 Dec. 2021, https://en.wikipedia.org/wiki/Hair_follicle.
- Bilgen Erdoğan (May 3rd 2017). Anatomy and Physiology of Hair, Hair and Scalp Disorders, Zekayi Kutlubay and Server Serdaroglu, IntechOpen, DOI: 10.5772/67269. Available from: https://www.intechopen.com/chapters/53880
- Guarrera M, Rebora A. Exogen Hairs in Women with and without Hair Loss. Skin Appendage Disord. 2017 Oct;3(4):193-196. doi: 10.1159/000460300. Epub 2017 May 12. PMID: 29177147; PMCID: PMC5697516.
- “Telogen Effluvium.” Wikipedia, Wikimedia Foundation, 18 Sept. 2021, https://en.wikipedia.org/wiki/Telogen_effluvium.
- Spencer LV, Callen JP. Hair loss in systemic disease. Dermatol Clin. 1987 Jul;5(3):565-70. PMID: 3301113.
- Dr Fen-Lan Cherry Chang. “Telogen Effluvium.” Telogen Effluvium (Hair Shedding) | DermNet NZ, Nov. 2019, https://dermnetnz.org/topics/telogen-effluvium.
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- “Alopecia Areata.” Wikipedia, Wikimedia Foundation, 5 Dec. 2021, https://en.wikipedia.org/wiki/Alopecia_areata.
- “Covid-19 Related Hair Loss.” Consult QD, Consult QD, 30 July 2020, https://consultqd.clevelandclinic.org/covid-19-related-hair-loss/.
- Tamer F, Yuksel ME, Karabag Y. Serum ferritin and vitamin D levels should be evaluated in patients with diffuse hair loss prior to treatment. Postepy Dermatol Alergol. 2020 Jun;37(3):407-411. doi: 10.5114/ada.2020.96251. Epub 2020 Jul 16. PMID: 32792884; PMCID: PMC7394174.
- Sweeney, Mary. “Trichotillomania: Causes, Symptoms, Treatment & More.” Healthline, Healthline Media, 28 Feb. 2020, https://www.healthline.com/health/anxiety/trichotillomania.
- Saleh D, Nassereddin A, Cook C. Anagen Effluvium. [Updated 2021 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482293/
- Goluch-Koniuszy, Zuzanna Sabina. “Nutrition of women with hair loss problem during the period of menopause.” Przeglad menopauzalny = Menopause review vol. 15,1 (2016): 56-61. doi:10.5114/pm.2016.58776
- “Female Hair Loss Types: Androgenetic Alopecia, Effluviums, and More.” WebMD, WebMD, 1 Mar. 2010, https://www.webmd.com/skin-problems-and-treatments/hair-loss/hair-loss-types#1-2.
- Gavazzoni Dias, Maria Fernanda Reis. “Hair cosmetics: an overview.” International journal of trichology vol. 7,1 (2015): 2-15. doi:10.4103/0974-7753.153450
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