Stress and Trauma have a physiological and psychological effect which can have a significant impact of hair growth and trigger hair loss.

Stress will not result in immediate hair loss and won't present itself until around 6 - 12 weeks or longer after a stressful event.  This is down to the hair growth cycle, 

This is why stress management is so important as stress levels can increase when hair loss occurs creating an ongoing cycle. 

When we are under stress we often neglect ourselves by not eating properly.  and the body is denied of nutrients and calories for energy. 

Hair is a non essential tissue so the body will use the little nutrients & energy it is receiving to survive. As hair is non essential it is often the first thing to be negatively impacted. 

Stress effects the body's immune system making us more prone to illness. Immune system disruption can trigger hair loss.

The types of hair loss most related to stress are:

• Telogen Effluvium (excessive daily hair shedding)
  
• Alopecia Areata (hair Loss in patches)
• Trichotillomania (hair pulling)
• Androgenic Alopecia

CORTISOL 

(Alternative name Hydrocortisone)

Cortisol is a steroid hormone that is vital in the regulation of a wide range of processes in the body such as metabolism, acts as an anti inflammatory & immune response, influences blood pressure and controls blood sugar levels and how the body responds to stress. 

'FIGHT OR FLIGHT'

Cortisol (known as the stress hormone) is made in the cortex of the adrenal glands. When the body perceives stress cortisol is released into the bloodstream.

The hormone triggers a flood of glucose that supplies an immediate energy source to your large muscles, but inhibits  insulin production so the glucose is not stored and available for immediate use. Cortisol narrows the arteries, whilst another hormone, epinephrine, increases the heart rate. Together they force your blood to pump harder and faster as you confront the 'threat'.

This is know as 'fight or flight' as a reaction to stressful situations.

During periods of high, chronic stress your body may constantly produce and pump out cortisol.

Almost every cell contains receptors for cortisol so it has many  different  actions depending on each cell type.  

CORTISOL & METABOLISM LEADING TO HAIRLOSS

These effects include  controlling  blood sugar levels therefore regulating metabolism,. Cortisol stimulates fat and carbohydrate metabolism to create fast, instant energy. This then stimulates insulin release & maintenance of blood sugar levels. As the cells cry out for energy these actions can increase appetite through false hunger signals & cause cravings for sweet, high fat, high calorie foods. These foods often have low nutrient values so will lacking nutrients vital to healthy hair growth and as the body view hair as non essential tissue it begins to suffer.

Unused glucose in the blood is stored as fat, resulting in weight gain.  Weight gain alone can cause additional stress and the cycle continues.

CORTISOL & DIGESTIVE PROBLEMS LEADING TO HAIR LOSS

As the body reacts to a 'threat' it shuts down other critical functions. One being digestion. With constant stress levels the digestive tract cant digest or absorb food well, again the body is not receiving essential nutrients.

CORTISOL & FATIGUE

Fatigue is a very common symptom of high levels of cortisol. (Adrenal Fatigue)

It creates the feeling of overwhelming tiredness & lack of energy or motivation.

This is where lack self care and poor diet can occur.  A poor diet will lead to malnutrition denying the body of vital nutrients essential to healthy hair growth which can lead to hair loss.  Lack of nutrients also lower the immune system leaving the body more susceptible to illnesses such as virus'

Virus' can trigger autoimmune responses , causing autoimmune disorders. Some autoimmune disorders are contributory factors in hair loss. 

CORTISOL & ANXIETY & DEPRESSION

Sustained chronic stress with elevated cortisol can lead to decreases in serotonin and other neurotransmitters in the brain including dopamine which are all linked to depression. Depression causes fatigue which can lead to poor self care and poor diet either by over eating and craving high sugar, high calorie foods low in nutritional value and leading to weight gain or loss of appetite again causing nutrient deficiency which can lead to hair loss.

Depression is a mental health illness and can trigger eating disorders.

Anxiety can trigger the ' fight or flight' response which releases more cortisol into the blood stream. 

It is common for depression and anxiety to be treated with anti depressants. 

A side effect of some anti depressant medications can be hair loss.

CORTISOL & HIGH BLOOD PRESSURE LEADING TO HAIR LOSS

Constricted arteries and high blood pressure can lead to blood vessel damage and plaque build up in the arteries. (Heart Disease) Constricted blood flow can restrict the delivery of vital nutrients to the hair follicles.

CORTISOL INTERRUPTING  HAIR GROWTH

When high levels of cortisol are present the adrenal glands begin to produce fewer hormones that promote hair growth. Without the presence of those vital hormones then normal hair growth is interrupted. Interrupted hair growth is the cause of Telegen Effluvium.

CORTISOL & IMMUNE RESPONSE LEADING TO HAIR LOSS

Cortisol is an anti - inflammatory and contains the immune response. Chronic elevations can lead to the immune system becoming 'resistant'. The accumulation of stress hormones and increased production of inflammatory *cytokines further compromise the immune response. 

*Cytokines are a large group of proteins that are secreted by the specific cells of the immune system. They are signalling molecules that mediate & regulate immunity.

Stress also decreases the body's lymphocytes - the white blood cells that help fight infection..

Lets explore all four main hair loss conditions attributed to stress.

TELOGEN EFFLUVIUM

Telogen effluvium is diffuse hairloss throughout the scalp. Noticeable by the presence of excessive daily shedding.

It occurs when an internal disruption occurs within the body. More hairs in the Anagen phase (actively growing) are halted & growing stops. The hairs enter the catagen phase (resting) before rapidly moving into the telogen phase (shedding) 

ALOPECIA AREATA 

Alopecia Areata is hair loss in areas. it causes bald patches, usually circular in appearance and they can differ in size.  

Alopecia areata is accepted as an autoimmune disorder. The body identifies certain hair cells as a foreign body and begins to attack the cells.

Autoimmune disorders are often triggered by a recent illness such as a viral infection.  

ANDROGENIC ALOPECIA

Androgenic alopecia is commonly referred  to as male / female pattern baldness. It is Is caused by the conversion of testosterone into dihydrotestosterone (DHT)

The hair follicles have receptors and in some people have inherited a sensitivity to DHT. DHT will cause the follicles to shrink (miniaturise) Hair will grow back thinner over time making the scalp visible and eventually follicles will shut down completely creating baldness.

Stress significantly accelerates androgenic alopecia. 

Cortisol increases testosterone levels & production leading to conversion of more DHT.

Please read section on Genetic Factors for further information on Androgenic Alopecia.

TRICHOTILLOMANIA

Trichotillomania (self hair pulling) is a complex psychological disorder in which the sufferer has an irresistible urge to pull out their hair. (This can be from the scalp or any part of the body)

It is a very distressing mental health disorder classified under Obsessive - Compulsive & Related Disorders. 

Hair pulling is triggered or accompanied by several emotional states.

Stress, depression, anxiety, trauma, tension and boredom can trigger the urge which is followed by feelings of relief, gratification or pleasure. These can then be followed by feelings of disgust, self loathing, disappointment which lead to further stress, anxiety, depression and tension, creating a continuous cycle.