Photo by Towfiqu barbhuiya on Unsplash.

We all admire a nice full head of hair. A good hair day is a boost and a bad hair day is a bummer. At the same time, quite a few men and a not insignificant number of women manage to make baldness cool, sexy, and arguably the most convenient style of all.

The challenge of hair loss

Americans spend about $3.6 billion a year on hair loss treatment.

What we’re not so enamored of is that in-between state of hair loss, whether caused by unpreventable genetics in the case of male or female patterned baldness, the autoimmune disorder known as alopecia areata, or the side effects of chemotherapy or radiation to the head. Whenever the shower drain begins to look a little alarming, we want answers and whenever possible, solutions to the problem.

Psycho-social effects of hair loss are well-documented and as most hair loss is closely associated with the culturally undesirable inevitability of aging, we have learned to shun it along with wrinkles, crepey skin, and inability to use apps on your phone. For women, it can be even more difficult to deal with as it is genetically less common and in many Western cultures, those who identify as female often include good hair in that identification.

Sadly, as cancer becomes more and more prevalent, having a bald head may signal to others that you are undergoing cancer treatment, and whether or not chemotherapy or radiation is the cause of your glowing dome, it may bring unwanted attention.

Americans spend about $3.6 billion a year on hair loss treatment, from chemicals to transplants, with varying degrees of success. Chemical applications may have a success rate of about 50%. Transplants are generally 85-90% effective, but are likely out of reach for many, with costs up to $15K not usually paid for by insurance.

Understanding Alopecia Areata

Stress is likely a factor in the development of alopecia areata.

Besides the inherited causes of baldness and the expected temporary hair loss caused by medical treatments, alopecia areata affects about 6.7 million Americans and 160 million people worldwide. It is a sudden and alarming, usually patchy loss of hair that happens when the immune system attacks the hair follicles. Follicles are the pore-like, tubular structure at the base of each shaft of hair. You are born with all the hair follicles you will ever have, but even though as they weaken and shrink they no longer produce healthy strands of hair, the fact that they stay alive is why some treatments for hair loss work.

As with all immune disorders, stress is likely a factor in the development of alopecia areata, and if you have other auto-immune diseases such as psoriasis, vitiligo (loss of skin color), or thyroid disease your odds of getting the hair loss condition increase.

The three types of alopecia areata lead to patchy hair loss on the scalp, total hair loss all over the scalp, or total body hair loss. Sometimes the nails are also affected. The condition does not discriminate; all ages and genders are susceptible, although women get it slightly more than men, and it usually affects people in their 20s and 30s. It affects healthy people and those with compromised health. There are some genetic links to other auto-immune diseases suggesting family history being a factor, yet many develop it with no family history.

It affects healthy people and those with compromised health.

There is no sure way to predict the progression of the condition. The first patch may regrow hair which at first can be white or gray and later change back to the original color. Even as one patch regrows hair, another bald patch may develop. In less common cases, patches eventually denude the entire scalp and in the rarest of cases, the hair loss affects the whole body.

In most cases, the hair will come back, but those who have had it before are more likely to have alopecia areata again. The older you are and the less hair you lose when you get it the first time increases the chances that your hair will come back and stay put.

Link between stress and hair loss

While there have been no studies directly linking the disorder to stress, several studies have come out since the start of the covid pandemic pointing to a rise in cases accompanying other manifestations of stress during that time. Even before the pandemic, one study showed a rise in the incidence of alopecia presumed to correlate to other increasing stress factors such as anxiety, depression, and insomnia that are on a rampage in the modern world.

One 2021 study isolated a stress hormone in lab mice that prevented the regrowth of hair. This points to hope for treatment but requires further study.

If you are experiencing unexplained hair loss, make an appointment to see your provider to rule out more serious causes that could be detrimental to your health. She may refer you to a dermatologist who can recommend the best remedies for your particular case of alopecia.

Embrace your look

If baldness is your fate, and you have eliminated any more serious causes, you can adjust your appearance so that the emotional toll is lessened. There are some drug therapies that may help, many of them similar to drugs prescribed for other immune system disorders.

And there is always the challenge of embracing baldness, not an easy thing to face if you’re in your 20s. However, there is plenty of emotional support out there to help you bring back a sense of confidence in your appearance that doesn’t involve elaborate comb-overs or the perpetual presence of a trucker hat seemingly super-glued to your head.

Whether your jam is Sinead O’Connor or Michael Jordan you likely can reframe your look to something that works for you. Partners of cancer patients often shave their own heads to show solidarity with their loved ones, so baldness as a statement may be a thing.

Meanwhile, don’t blame your maternal grandfather, that theory is no longer considered universally true, and, as we seem to say an awful lot, please do something to reduce your stress levels.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.