Understanding the Link Between Cortisol & Hair Loss

Losing more than one hundred hairs per day is a sign of hair loss. You're not alone if you're tired of seeing more hair in your brush than on your head. Approximately 35 million men and 21 million women suffer from hair loss. Stressful triggers can push 70% of hair follicles into the resting phase of the hair growth cycle, supporting the notion that stress (and high cortisol) may be at the root of your hair loss problem.

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The Role of Cortisol in the Body

Cortisol is a glucocorticoid steroid hormone made in the cortex of the adrenal glands. Cortisol helps maintain homeostasis in the body, especially during times of stress, by regulating energy metabolism, blood pressure, blood sugar, immune function, and inflammation. 

Effects of High Cortisol Levels

Chronically high cortisol levels, commonly resulting from stress and hypothalamic-pituitary-adrenal (HPA) axis dysfunction, have negative consequences across multiple body systems, leading to:

• Imbalances in thyroid and reproductive hormones
• Vitamin and mineral deficiencies 
• Mood disorders, such as depression and anxiety
• Insulin resistance and high blood sugar levels
• Chronic, low-grade inflammation, which is associated with the development and progression of chronic disease

Common Causes of Hair Loss

Hair loss can happen due to many variables, including:

• Genetics
• Poor diet and nutrient deficiencies
• Hormonal changes, such as those that occur with pregnancy, childbirth, menopause, and thyroid disorders
• Underlying health conditions
• Stress
• Medications
• Certain hairstyles and treatments (16, 17, 32) 

The Connection Between Cortisol and Hair Loss

Three types of hair loss have been associated with high stress (and cortisol) levels:

• Telogen Effluvium: Sudden and temporary hair loss that occurs a few months after a stressful trigger.
• Trichotillomania: Recurrent, irresistible urges to pull out one's own hair, often as a coping mechanism for difficult emotions.
• Alopecia Areata: An autoimmune condition causing sudden hair loss, typically in small, round patches on the scalp

How Cortisol Affects the Hair Cycle

Cortisol dysregulation and resulting oxidative stress disrupt cell signaling pathways that maintain the health of the hair follicle and the normal transitions of the hair growth cycle.

Studies have indicated that high cortisol levels shift the immune system to favor pro-inflammatory pathways, resulting in the excessive production of pro-inflammatory chemicals (cytokines), including tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFNγ). These cytokines arrest hair growth by preventing the hair growth cycle from transitioning from the telogen rest phase to the anagen growth phase. (25) 

A 2021 study performed on mice further illuminated another potential mechanism behind stress-induced hair loss. Researchers demonstrated that corticosterone, the rat equivalent to cortisol, suppresses the expression of a molecule called growth arrest specific 6 (Gas6), which activates hair follicle stem cells. Hair growth stopped and shedding increased in mice with high corticosterone levels. (4) 

Diagnosing Cortisol-Related Hair Loss

Diagnosing stress-related hair loss starts with recognizing distinctive patterns of hair thinning. Following this observation, clinicians often perform cortisol testing to better understand the body's stress response and its potential role in the onset or exacerbation of hair loss.

Symptoms and Signs

These symptoms are suggestive of stress as the underlying cause of hair loss:

• Accelerated hair shedding and diffuse hair thinning across the scalp, often with abrupt onset
• Changes in hair texture
• Dry or flaky scalp 
• Feelings of anxiety, tension, or overwhelm
• Difficulty sleeping
• Fatigue
• Muscle tension
• Headaches
• Acne
• Centralized weight gain (20, 27) 

Laboratory Testing

Unlike serum cortisol, salivary and urinary cortisol tests reflect the portion of bioavailable, unbound cortisol in circulation. This makes these tests physiologically relevant because they offer a more accurate representation of cortisol activity and its impact on health in vivo. 

The following tests can be used to diagnose stress-related hair loss: 

• DUTCH Plus by Precision Analytical (DUTCH)
• Adrenal Corticoids Profile by Doctor's Data
• Adrenal Stress Profile by ZRT Laboratory
• Adrenocortex Stress Profile by Genova Diagnostics

Managing and Treating Cortisol-Induced Hair Loss

Stress-induced hair loss is self-limiting. Hair will regrow once the stressful trigger has been resolved and cortisol levels have been normalized.

Lifestyle Changes and Stress Management

Treatment should involve managing stress with healthy coping mechanisms and restoring the HPA axis to reduce cortisol levels. Management strategies include: 

• The Mediterranean diet is a nutrient-dense, anti-inflammatory diet that is correlated to lower cortisol levels and is potentially an effective adjunctive therapy for treating hair loss. 
• Stay physically active while allowing sufficient time for recovery
• Spend time in nature
• Practice mind-body therapies, including yoga, meditation, and deep breathing
• Make sleep a priority and aim to get the recommended amount each night based on your age.

Medical Treatments

If stress-induced hair loss persists despite your best efforts at self-care, it's time to have a conversation with your doctor about potential medical treatments:

• Minoxidil is a medication that stimulates hair growth
• Cognitive behavioral therapy (CBT) helps individuals identify and address maladaptive thought patterns and behaviors to manage stress and the psychological burden often accompanied by hair loss.
• A multivitamin or other tailored dietary supplements can correct nutrient deficiencies that are exacerbating hair loss.
• Adaptogenic herbs and stress-relieving supplements help treat stress and anxiety by bolstering resilience to stress.

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Key Takeaways

• Cortisol, the body's stress hormone, can disrupt the hair growth cycle and cause stress-induced hair loss.
• Diagnosing stress-induced hair loss involves recognizing specific hair thinning patterns and cortisol testing to assess the HPA axis.
• While stress-induced hair loss is often self-limiting, therapeutic interventions that manage stress and regulate cortisol levels can promote faster, healthier hair growth.