Does EMOTIONAL Stress Cause Hair Loss?

Hair loss can be a deeply distressing experience, often leading to significant emotional strain. But can emotional stress itself contribute to hair loss? While many people anecdotally report shedding during periods of high emotional turmoil, the scientific evidence linking emotional stress to hair loss is complex. While experimental research suggests strong biological mechanisms connecting stress and hair loss, epidemiological data remains less definitive, partly because hair loss itself can also be a major source of stress, complicating the direction of causality (Asghar et al., 2020).

The Research Behind Stress-Induced Hair Loss

Experimental studies in mice have provided clear evidence that stress can impact hair follicle health. In a foundational study, Arck et al. (2003) demonstrated that psychoemotional stress in mice disrupted hair growth by prematurely ending the anagen (growth) phase, increasing apoptosis (controlled cell death) in hair follicles, and triggering inflammatory responses. Further, the administration of substance P, a natural neuropeptide associated with stress responses, mimicked these effects, while blocking substance P reversed the damage (Arck et al., 2001). These findings strongly suggest that stress-induced neuroimmune mechanisms contribute to hair follicle disruption.

Brain-Hair Follicle Axis proposed by Ito et al. (2005)

Human studies have also reinforced the idea that stress-related hormones and neuropeptides can directly impact hair follicle function. Ito et al. (2005) explored whether human hair follicles possess an intrinsic stress response system, analogous to the hypothalamic-pituitary-adrenal (HPA) axis. Their results suggest that human hair follicles can synthesize and secrete cortisol when exposed to stress signals such as corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH). This supports the concept of a "Brain-Hair Follicle Axis," wherein emotional stress can trigger a localized stress response within the follicle, accelerating hair cycle regression and promoting hair loss.

So does emotional or psychological stress cause hair loss?

Although there are basic science mechanisms that support a link between psychological stress and hair loss, the clinical connection has been difficult to make. A cross-sectional study in Saudi Arabia found that participants who experienced stress were ~3 times more likely to have hair loss than those without stress; those with severe stress were over 5 1/2 times more likely to experience hair loss than those with no stress. Finally, logistic regression analysis calculated 33% of the variation in hair loss can be explained by stress levels (as opposed to other factors, e.g., genetics, diet, medical conditions, etc.). However, the cross-sectional nature of the study prevents conclusive directional causality, as one could also interpret this as hair loss causes stress, the reverse relationship. (Alanazi et al., 2023)

There are many types of hair loss, threes of which have a questionable stress component. The prototypical "stress" hair loss is called telogen effluvium, a type of hair loss that is associated with a variety of factors including pregnancy, severe infections, high fevers, major surgeries requiring general anesthesia, and many others. But the most established triggers are primarily physical stressors. Many dermatologists do believe significant psychological stress can cause this type of hair loss, but the connection is not as clear as it is for physical triggers. (Asghar et al., 2020; Karakoyun et al., 2025; Ortega & Stefanato, 2023)

Another type of hair loss, trichotillomania (aka trichotillosis) is a behavioral type of stress-induced hair loss. It's a form of compulsive hair pulling to the point of pulling one's own hairs out. Patients may have insight into this, much like nail-biting as a behavior to help cope with stress. Or, sometimes its related to other psychiatric conditions where patients are unaware or unwilling to admit the behavior leading to the loss of hair.

Alopecia areata is an immune-mediated form of hair loss with an uncertain cause, but there have been mechanistic and clinical links to an association with emotional stress. (Ahn et al, 2023)

What about androgenetic alopecia (aka AGA, androgenic or male/female pattern alopecia)? Cheng et al. (2024) conducted a retrospective cohort study on 120 AGA patients, categorizing them based on stress levels as measured by the Depression Anxiety Stress Scale-21 (DASS-21). They found that higher-stress individuals had increased cortisol levels and altered neurotrophic factor levels that could impact hair growth, and observed worse hair growth parameters. These individuals also showed poorer responses to minoxidil treatment, indicating that stress may not only contribute to AGA progression but also interfere with standard therapeutic approaches. This aligns with research that suggests stress creates a self-perpetuating cycle: hair loss causes distress, which in turn exacerbates shedding, particularly in stress-sensitive individuals. (Hadshiew et al., 2004)

Reproduction of diagram created by Hadshiew et al. (2004) illustrating the complex interplay between stress and hair loss.

Measuring Chronic Stress Through Hair Cortisol

One challenge in studying the link between emotional stress and hair loss is quantifying stress levels objectively. Traditional methods rely on self-reported measures, which are inherently subjective. However, researches have explored the use of hair cortisol levels as a biomarker for chronic stress. By analyzing hair samples from various populations, including those with chronic pain and high-stress pregnancies, they found that elevated cortisol levels in hair correlated with prolonged stress exposure. While more research is needed to refine this method, hair cortisol testing could provide a reliable way to assess the physiological impact of stress on hair health. (Gow et al., 2010)

The Overlap Between Physical and Emotional Stress

One of the key complexities in this discussion is the overlap between physical and emotional stress responses. Many of the same hormones and inflammatory mediators are released in both scenarios, making it difficult to isolate emotional stress as a sole causative factor in hair loss. The body's stress response—whether triggered by psychological distress or physical illness—often involves increased cortisol production, changes in neurotrophic factor levels, and immune system activation, all of which can influence hair follicle cycling and health. Furthermore, prolonged physical stress is often accompanied by emotional stress!

A Holistic Approach is Probably Best

While basic science has provided compelling evidence that stress can negatively impact hair growth, large-scale epidemiological studies remain sparse. However, the existing data suggests that stress management should be integrated into hair loss treatment plans. Whether through mindfulness, cognitive behavioral therapy, or lifestyle modifications, reducing emotional stress could help mitigate its effects on hair health -- and probably more importantly, overall health.

Practically speaking, most patients I see are looking for a different recommendation than "reduce stress" as a cure for their hair problems. Although hearing from a caring medical professional that emotional stress could be contributing to one's physical ailments can be a helpful nudge, alone it probably won't fix the issue. Combining proper nutrition, psychological stress management, and available medical therapies will give us the best chance of cultivating a healthy head of hair.

References

1. Ahn D, Kim H, Lee B, Hahm DH. Psychological Stress-Induced Pathogenesis of Alopecia Areata: Autoimmune and Apoptotic Pathways. Int J Mol Sci. 2023;24(14):11711. Published 2023 Jul 20. doi:10.3390/ijms241411711

2. Alanazi AS, Alsalhi WA, Alghuyaythat WK, Almutairi AN, Almazrou MA, Alabdulminaim JA, Mohamed EY. Stress-Related Hair Loss Among the General Population in Al Majma'ah, Saudi Arabia: A Cross-Sectional Study. Cureus. 2023;15(10):e46517. doi:10.7759/cureus.46517.

3. Arck PC, Handjiski B, Hagen E, Joachim R, Klapp BF, Paus R. Indications for a 'brain-hair follicle axis (BHA)': inhibition of keratinocyte proliferation and up-regulation of keratinocyte apoptosis in telogen hair follicles by stress and substance P. FASEB J. 2001;15(13):2536-2538. doi:10.1096/fj.00-0699fje

4. Arck PC, Handjiski B, Peters EM, et al. Stress inhibits hair growth in mice by induction of premature catagen development and deleterious perifollicular inflammatory events via neuropeptide substance P-dependent pathways. Am J Pathol. 2003;162(3):803-814. doi:10.1016/S0002-9440(10)63877-1

5. Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R. Telogen Effluvium: A Review of the Literature. Cureus. 2020;12(5):e8326. doi:10.7759/cureus.8326

6. Cheng Y, Lv LJ, Cui Y, Han XM, Zhang Y, Hu CX. Psychological stress impacts neurotrophic factor levels in patients with androgenetic alopecia and correlates with disease progression. World J Psychiatry. 2024;14(10):1437-1447. Published 2024 Oct 19. doi:10.5498/wjp.v14.i10.1437

7. Gow R, Thomson S, Rieder M, Van Uum S, Koren G. An assessment of cortisol analysis in hair and its clinical applications. Forensic Sci Int. 2010;196(1-3):32-37. doi:10.1016/j.forsciint.2009.12.040

8. Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of Hair Loss: Stress and the Underestimated Psychosocial Impact of Telogen Effluvium and Androgenetic Alopecia. J Invest Dermatol. 2004;123(3):455-457. doi:10.1111/j.0022-202X.2004.23237.x

9. Ito N, Ito T, Kromminga A, et al. Human hair follicles display a functional equivalent of the hypothalamic-pituitary-adrenal axis and synthesize cortisol. FASEB J. 2005;19(10):1332-1334. doi:10.1096/fj.04-1968fje

10. Karakoyun Ö, Ayhan E, Yıldız İ. Retrospective Review of 2851 Female Patients With Telogen Effluvium: A Single‐Center Experience. J Cosmet Dermatol. 2025;24:e70037. doi:10.1111/jocd.70037

11. Ortega IJ, Stefanato CM. Telogen Effluvium: A 360-Degree Review. Ital J Dermatol Venereol. 2023;158(6):457-466. doi:10.23736/S2784-8671.23.07579-5