Is Stress Causing Your Hair Loss?

Dr. Angela Phipps [00:00:02]:
The trichotillomania does cause chronic hair loss and chronic inflammation, but it doesn't cause a scarring form of hair loss. Once you get them under control and they're no longer pulling, then the inflammation will go away from that chronic pulling and everything will settle down and the environment of the scalp will return to normal and healthy. And you can transplant into those patients as long as they're under psychological behavioral treatment to make sure, because you don't want them to start pulling out the transplanted hairs as well.

Kevin Rolston [00:00:44]:
Welcome to HairPod, the podcast where you get to hear real people talk about their hair journeys. I'm your host, Kevin Rolston, and each week I get to interview people from different walks of life whose lives have been touched by hair loss in some form or fashion. Many of our guests have experienced hair loss themselves and found a way to get their confidence and their hair back. In this episode of HairPod, I'm going to be talking with one of our favorite guests of all time, Dr. Angie Phipps. Dr. Phipps is a hair transplant surgeon who is an expert in all things hair loss. Last time we had her on the show, we had an in depth conversation about male and female pattern thinning and how our hormones and genetics interact to determine whether that's something you'll experience.

Kevin Rolston [00:01:29]:
It was an enlightening conversation, and if you want to check it out, we linked to episode 34 in our show notes. So we all know we can't change our genetics as far as hair loss is concerned. But I wanted to go into more depth with Dr. Phipps about what kinds of things we can control when it comes to hair loss and what those external factors are.

Dr. Angela Phipps [00:01:53]:
The biggest one is stress. It's funny though, because stress comes back to producing a hormone. So when you're under stress, you produce a hormone called cortisol. So cortisol is another hormone and it rises. And your hair follicle cells are so sensitive to changes in hormones, they detect that changing cortisol level systemically through your body when you're under stress. And it scares them that these cortisol levels are high. So they think they need to protect themselves from this bad hormone, cortisol, and it will cause the cells to shut down and go and prematurely go in or jump into the dormant or resting phase of the hair follicle life cycle. And when that happens, then the hair that's growing will then stop growing and fall out.

Dr. Angela Phipps [00:02:39]:
So stress can cause hair loss. Now, what I tell patients, though, is that stress does not cause permanent hair loss, meaning that the Cortisol hormone does not kill the hair follicle like the testosterone DHT hormone does. So it just causes it to shock and shut down and the hair loss falls out. But the stress has to get back to a normal level where the cortisol levels are normal so that the hair follicle cells don't recognize them anymore so that they can recover from their resting phase and go back into their growth phase and produce the hair again. So you got to get the stress under control. But if you're under constant stress, you're going to have constant hair loss and shedding. But it's not necessarily permanent unless that stress is a activator or kind of like a kick in the pants. For the male pattern hair loss, it accelerates it, it's an accelerant.

Dr. Angela Phipps [00:03:34]:
So the stress can be an accelerant for male pattern hair loss. And so then it can accelerate the male pattern hair loss and you can eventually see permanent hair loss from stress because it was the accelerant or the inducer for the male pattern hair loss to kind of take off and pick up or female hair loss at a faster rate than it would if the stress wasn't there. Because I tell patients, look, if stress caused permanent hair loss, I would be bald. Every mother in America would be bald. Right? And we're not. And so it can cause hair loss. It's not permanent hair loss, but it takes six to nine months for your hair follicle cells to recover from stress hair loss because it's got to go through the dormant phase of the resting phase before it can go back into the active phase. But it can be a trigger or an accelerant for male pattern hair loss.

Kevin Rolston [00:04:20]:
Now do you have any idea? Because we all have stress. If you have a job, if you have kids, if you have in laws, you know, you have stress. If you're married in a relationship, there are going to be stressors. But then there are things that are more extreme stress. I've heard about, for instance, going through a divorce and that is a high stress level and the effects that that has on the body. Have you noticed through studies that different forms of stress like divorce or things like that rank higher than somebody who just has a challenging job or challenging children?

Dr. Angela Phipps [00:04:50]:
Yes. It's not just everyday stress that causes that type of hair loss. It's major traumatic events like a divorce, a death in the family, undergoing, you know, a major surgical procedure, undergoing bariatric surgery. That's a huge stress on the body where hormones and all kinds of things are being manipulated. You lose a lot of weight, all kinds of things are shifting. So it's the major metabolic stressors to the body and major psychological stressors to the body that cause that hair loss, just not your day in and day out stress. So when patients come in and they're, they're talking about their hair loss and you know, usually when patients say, you know, I've lost this hair gradually over the last five to 10 years, that's pretty typical for the story of male or female pattern thinning. When they say the past, you know, I've lost all this hair over the last six months.

Dr. Angela Phipps [00:05:44]:
A year ago my hair was fine. And I say, okay, let's backtrack six months. What's going on? Or like, nothing. I'm like, six months ago, what happened? And they're like, oh, I had, you know, my favorite aunt died, or I broke up with my boyfriend, or, you know, if you trace the story back six months to nine months or so, you can almost always identify some sort of major stressor potentially that then happened and then the hair loss ensued over the, over the, quickly over the next several months. That's an indicator of the stress. Hair loss. It's called stress telogen, effluvium. So the, the medical term for that hair loss is called telogen because that's the resting phase of the hair follicle.

Dr. Angela Phipps [00:06:23]:
Effluvium means shedding out.

Kevin Rolston [00:06:26]:
Okay, now, when you have stressful situations too, sometimes you may not be eating or doing things like that. So how much do periods in your life where you're just so stressed you can't eat, or you're so sad you can't eat and you're not getting the nutrients in your body that you need. How much of an effect would that also have to play with the stress in you shedding the hair?

Dr. Angela Phipps [00:06:49]:
Yeah, your diet is a huge component to healthy hair, just like your diet's a huge component to having healthy skin and, you know, just healthy organs and healthy everything. Your hair, you know, recognizes whenever it's in a vitamin or mineral or protein deficiency and will react accordingly by being scared and shut down and fall out. You see lots of pictures with, you know, young girls who have eating disorders and their hair is usually always very thin, brittle, easily damaged. And it's because they're not getting the nutrients to maintain strong hair follicle cells to produce strong hair shafts. So in crash dieting, women are just prone to wanting to be thinner sometimes and will do drastic measures to try and lose weight quickly for a reunion or for a Holiday. And that is not good for the body and it's definitely not good for the hair.

Kevin Rolston [00:07:41]:
Have you noticed any kind of correlation or connection with women or men either way, who are on any of these newer diet drugs that are out there? The Ozempics, semaglutides and hair loss, are those connected in any way?

Dr. Angela Phipps [00:07:53]:
I have seen Ozempic. We're calling it Ozempic hair loss and they call it Ozempic face or Ozempic tush. You know, seeing Ozempic hair because they're losing weight so quickly that there's a shift in your metabolics. And the GLP1 medications are changing the metabolism, which is good for fat know, loss. But when you do it that quickly and not over a steady state, the hair follicle cells respond to that drama, the drastic change, and they start to shut down and have shedding.

Kevin Rolston [00:08:26]:
Wow. Okay. Yeah, that's. Well, what, what an experience where you're losing the weight, but you're also losing the hair.

Dr. Angela Phipps [00:08:32]:
Yeah. And we have, you know, when Covid was so rampant, I mean, I saw hundreds of patients with COVID hair loss because they were having that major viral load in their body that was wreaking havoc and it was, you know, causing internal inflammation. And your hair follicle cells recognize internal metabolic changes and inflammation and they respond accordingly by going into protective mode. And that means shutting down, going dormant, and that causes the shedding of the hair shaft.

Kevin Rolston [00:09:06]:
Stress comes in a variety of forms, and they're not always immediately recognizable as something that could cause hair loss. Whether it's a major event like the loss of a loved one or rapid weight loss, these things can cause strain on the body, and it's important to be aware of that. Hair health can be almost like an indicator for what your body might be going through. So it's important to pay attention to those thinning patches, especially if you've gone through any major life changes. This got me thinking about how illness can affect the body and whether something like the flu or Covid could cause hair loss.

Dr. Angela Phipps [00:09:46]:
Usually the flu is so short lived that it doesn't necessarily cause that, but, you know, because what we found with the COVID is that is, even though the symptoms may have only lasted a particular length of time, the inflammation that was caused from that virus was staying in the system a lot longer and causing persistent internal effects on the lungs and other organs that you wasn't necessarily manifesting outside physical symptoms anymore. Like, you know, but internally it was still having a chronic effect. But yeah, chronic medical conditions can cause hair Loss and people who are had chronic, especially chronic inflammatory illnesses like lupus and autoimmune disorders because the autoimmune disorders produce inflammation and your hair follicle cells don't like your body having inflammation, it scares them and so they shut down and have shedding. So a lot of times people, patients who have chronic medical conditions, even if it's not an inflammatory medical condition, though they're taking medications. And chronic use of certain medications has even been shown in studies to potentially have a deleterious effect to the hair follicles because of the chronic medication use by the mechanism of action that the medications are having on the body.

Kevin Rolston [00:11:04]:
Well, talking about how important nutrients are to your body, what foods have you noticed that either add to hair loss or can help prevent hair loss? Are there certain foods? How should your diet look if this is the goal that you have to slow down your hair loss?

Dr. Angela Phipps [00:11:18]:
Yeah. So you don't need. No specific food's going to make your hair grow or I'd be eating it every day. But you need a well balanced diet. You need, you know, the recommended daily allowances of all your vitamins and your minerals and your, you know, your nutrients. You need to be eating your fruits, you need to be eating your vegetables. And so just eating a well balanced diet, you don't want to be too high in protein or too low in protein or no carbs and no sugar. You know, it's all about balance and making sure that you're.

Dr. Angela Phipps [00:11:49]:
Because your hair follicles need the nutrition just like your body does. And in order for your body to stay in homeostasis or balance, you need a well balanced meal.

Kevin Rolston [00:11:59]:
Have you noticed any correlation with over processed, overly processed foods or maybe some of the sodas that we consume? Has there ever been any kind of correlation to that with hair thinning or hair loss?

Dr. Angela Phipps [00:12:10]:
Nothing documented study wise that I can recall. Again, it's just a, you know, a balance of limiting your, you know, processed foods. Absolutely. Because it has a high salt and that's just not good for, you know, you know, good for your heart, good for your body, good for anything.

Kevin Rolston [00:12:24]:
Right.

Dr. Angela Phipps [00:12:24]:
Okay. And just watching the, you know, the diet sodas because of the aspartame and the end of, you know, the different sweeteners that they use is just not good. But as far as being having a direct correlation to any hair loss. No.

Kevin Rolston [00:12:35]:
Now there might be other things that are not necessarily due to what you're doing with your body and the food you're consuming. Maybe something that would be a hormonal Imbalance, like a hypothyroidism or something like that. How do you know if maybe that's what is causing it? How do you get something like that diagnosed?

Dr. Angela Phipps [00:12:52]:
Yeah, so when patients come in, I go through a full medical history, you know, asking them about all the body systems and the endocrine system is, you know, one of the major ones that can be off kilter that can have a contributory effect to hair loss. Thyroid is one of the hormones that, when it's off your hair follicle cells, you know, respond to. And so I'll ask my female patients and my male patients, you know, have you been to the doctor in the last year and had a metabolic workup to see if your thyroid is functioning normally or to make sure you're not anemic? So. And there can be medical causes of hair loss other than the genetics of the male or female pattern. And the two most common medical conditions that cause hair loss are thyroid abnormalities and anemia. So those are usually the two blood tests that I recommend patients to go have checked at their family practice doctor if they haven't had anything done to do a workup for their hair loss, because they may have male or female pattern hair loss, but they may also have thyroid or anemia that's compounding the male or female pattern hair loss. So you want to get rid of any medical cause of hair loss that you can and get that treated, and then we can, you know, work on the, you know, the genetic component.

Kevin Rolston [00:14:03]:
So are there different types of these autoimmune diseases? I assume, you know, you could look into something like Hashimoto's disease or something along those lines, and an expert would be able to identify that pretty quickly what you have.

Dr. Angela Phipps [00:14:15]:
So when you go to the doctor, they'll test your, you know, your thyroid, and based upon what those hormone levels are, it'll. It'll direct them into a way of whether you have low thyroid or high thyroid and, you know, can get you on the proper medications. The other autoimmune, you know, disorders that produce chronic inflammation are more along the lines of like lupus, sarcoid and some of those inflammatory conditions like that. But those are, you know, two things that can cause hair loss. Those are common, but not real common. The real common medical causes are, you know, usually thyroid anemia and poor diet.

Kevin Rolston [00:14:53]:
What would you say is the hardest thing to treat when it comes to it? You got anything from just your standard genetic hair loss. You've got your stresses, you've got your autoimmune diseases. What do you find to be the most threatening to a good head of hair.

Dr. Angela Phipps [00:15:07]:
Yeah. So the autoimmune, or what we call scarring, forms of hair loss are the most hard because what's happening is underneath the surface of the scalp skin, your body is producing inflammation chronically. But it's what we call subclinical inflammation, meaning that you don't feel it and you don't see it, even so you don't know that it's there. So it's there for years, just ruminating underneath the surface of the skin. And that inflammation is causing pressure on the roots of the hair follicles over time and just pressing and pressing and pressing, and eventually it'll kill the hair follicle cell from just being there for so long. So it's super important for both men and women to get an appropriate specialty evaluation by a hair loss physician in the early times of hair loss, so that if it looks suspicious or the history of it just doesn't seem like male or female pattern hair loss, that we can get you to potentially a dermatologist and get a biopsy of that scalp skin to find out what's going on at the cellular level underneath the surface of the skin, so that we can treat the pathological condition that's causing the hair loss, so that it we can either hopefully restore those hair follicle cells back to functioning capability and regrow hair, or at least get rid of the inflammation or tame or control the inflammation so that the hair loss doesn't get worse. Because once it's gone. In scarring forms of hair loss, you can't even transplant into those areas, because if you take a transplanted hair and put it into that area, the cause of the reason of why the hair fell out the first time will cause the transplanted hair to fall out.

Dr. Angela Phipps [00:16:46]:
So you need to detect early detection for those scarring forms of hair loss so that it doesn't get to the point of there actually being a bald spot. Because sometimes then we can't even do anything from a surgical standpoint. However, the saving grace of that is we have hair club who can use their expertise to be able to give hair to those patients.

Kevin Rolston [00:17:09]:
This is an absolute masterclass and just how our bodies respond to stress in so many different forms. Dr. Phipps gave so many good reminders of medical conditions and viruses that can cause hair loss. Hopefully, if you're sitting at home and wondering why your hair is falling out, maybe this is a sign to check in with your doctor to see whether or not your hormone levels a nutrient Deficiency or even a chronic illness could be the reason. The human body is incredibly complex and it's critical to have professional help. In a lot of these cases, not only could it reverse or reduce your hair loss, that could just be the tip of the iceberg as far as your healing is concerned. But physical health issues aren't the only cause of hair loss. Mental health disorders like trichotillomania can cause a person to compulsively pull their own hair out.

Kevin Rolston [00:18:00]:
I was curious as to whether or not this could cause scarring like some of the inflammatory illnesses we were talking about.

Dr. Angela Phipps [00:18:13]:
The trichotillomania does cause, you know, chronic hair loss and chronic inflammation, but it doesn't cause a scarring form of hair loss. And on the TV show Bad Hair Day, I actually did two transplants on two patients that had trichotillomania. Once you get them under control and they're no longer pulling, then the scalp will, the inflammation will go away from that chronic pulling and everything will settle down and the environment of the scalp will return to normal and healthy. And you can transplant into those patients as long as they're under psychological, behavioral treatment to make sure, because you don't want them to start pulling out the transplanted hairs as well. So they have to be under medical care for the trichotillomania. I did a scalp transplant on a female who had trichotillomania, and we did two surgeries on her, very successful. And I did an eyebrow transplant on a patient who pulled out all her eyebrows. And we just did one, you know, one treatment to her and it was successful.

Kevin Rolston [00:19:08]:
Now, you working with Bosley, understanding what hair club does, how do you determine when somebody is best with a surgical procedure or whether best going to a hair club and getting a hair system or something along those lines. Can you look and how do you determine who you send where for something like that?

Dr. Angela Phipps [00:19:27]:
Yeah, so you have to, number one, you got to talk to the patient and find out what are your goals, what are you looking to achieve, you know, and then you have to look at supply and demand. If a patient comes in and they're totally bald on top, and they've only got that 2 or 3 inch rim of hair around the back of the head, and they want a full head of hair, that's never going to be accomplished with a transplant. And so that's going to be a patient who, if they want a full head of hair or even want, you know, a little bit of hair, sometimes a transplant isn't an option. And that's the you know, that's definitely a patient that I'm referring to Hair Club. And so you have to have the donor hair to be able to move into the area of hair loss, to be able to accomplish the result of having, you know, less scalp visibility. And there is a limit to how thick a transplant can look because there has to be a little bit of spacing in between the hair grafts because they're living little organs that require a blood supply. And so the density that can be achieved safely, surgically in one procedure is usually not the result of being able to take somebody and give them a full head of hair with no scalp visibility in one procedure. And if that's the patient's goal and that's the budget that they have, and they can't potentially do what's necessary to get that result from a hair transplant, we'll send those patients to Hair Club.

Dr. Angela Phipps [00:20:42]:
And women are very difficult from a transplant standpoint because sometimes the donor hair, which is the hair in the back of the head that is typically not affected by the hormones and doesn't thin, can sometimes be affected in women the way it is is not in men. And they are not even a transplant candidate. And so for them, I send them to Hair Club to look at the product called X strands, which can give a really voluminous look of hair, or the X strands plus, which can give them, you know, a complete hair. You know, system just depends upon what their goals are. And a lot of times I see patients that come in and they don't have female pattern hair loss. They've just got really fine, thin hair. And they think, if I get a transplant, it's going to give me a full head of hair again. And that's not what a transplant can accomplish.

Dr. Angela Phipps [00:21:32]:
And so patients who come in with fine, thin hair, I absolutely refer them to Hair Club for the X strands because they're going to be able to provide them with the hair strands attached to their existing hair that's just going to give them a huge voluminous amount of hair that's going to give them the result that they're looking for that they thought a transplant would give, but it can't. So again, it's about seeing, you know, a specialist who can tell you what treatments will work, what treatments won't work, and whether you're a good candidate. Just because you can do something doesn't mean you should do it unless you're a good candidate for something. And so I really pride myself on patient, you know, on my ethics and morals of when a Patient comes in. There's lots of patients I could do transplants on that. I don't because I know what their overall goal is going to be. I know what the result from a surgical transplant that I'm going to be able to give them. And when I know that's not going to match, I don't let them go through with the procedure.

Dr. Angela Phipps [00:22:22]:
I say, look, hair club is the option for you that's going to give you what you want. I know you thought you wanted a transplant, but this isn't something that I can accomplish through these means. I'm going to send you to Hair Club. I'm taking money out of my own, my own pocket. But I'm going to, you know, I'm doing it because I'm your advocate. I tell patients I want your money, but I don't need your money. I need you to be happy. I need you to get what you are paying for.

Dr. Angela Phipps [00:22:44]:
And if I'm not the answer to that, I gladly send them to somebody who is. And that's always haircut.

Kevin Rolston [00:22:54]:
As we wrap up today's insightful discussion with Dr. Phipps, it's clear that stress and illness can profoundly affect not just our minds, but our bodies as well, even leading to hair loss. But remember, understanding these connections is a powerful first step towards healing. There is hope and help available, and you're not alone in this journey. By acknowledging the impact of stress and seeking support, we can all take meaningful steps towards better health and well being. Thanks for listening to another episode of hairpod. Check us out at Hair Club on Instagram or search HairPod on Facebook to continue the conversation. If you know someone who could benefit from hearing this episode, we would love it if you share it with them.

Kevin Rolston [00:23:37]:
If you're enjoying the show, consider leaving us a rating and review on Apple Podcasts or your favorite podcast app. We also have a website. Check it out by going to podcast.hairclub.com we're here to build people up and share real stories so people experiencing hair loss feel a little bit less alone. And when you share, review and subscribe, it helps us do just that. So thank you until next time. This.