Why Am I Losing More Hair When I’m Under Stress?
Hair shedding can be especially concerning when it seems to worsen during stressful periods. At Reena Jogi, MD in Katy, Texas and Houston, Texas, we frequently evaluate patients who notice increased hair loss related to both genetic hair thinning and stress-related shedding.
A recent patient asked during her visit:
“Why am I losing more hair when I’m under stress?”
This case highlights how androgenetic alopecia (female pattern hair loss) can occur alongside telogen effluvium, a temporary shedding condition often triggered by stress.
Case Report: 29-Year-Old Female with Hair Shedding
A 29-year-old female returned for evaluation of progressive hair shedding that had been occurring for approximately one year.
Patient History
The patient reported:
Generalized scalp hair thinning
Gradual onset over the past year
Moderate severity of hair loss
Family history of hair thinning in her mother
She was not currently undergoing treatment at the time of her visit.
The patient also reported increased stress, which raised concern for a possible stress-related hair shedding component.
Dermatologic Examination in Katy & Houston, TX
A detailed scalp examination was performed using dermatoscopy, which allows dermatologists to closely evaluate hair follicles and scalp health.
Clinical Findings
Diffuse thinning of the scalp
Positive hair pull test
Pattern consistent with androgenetic alopecia
However, the presence of active shedding suggested an additional diagnosis of telogen effluvium.
Diagnosis 1: Androgenetic Alopecia (Female Pattern Hair Loss)
Androgenetic alopecia is the most common cause of hair thinning in women.
Typical characteristics include:
Diffuse thinning across the scalp
Widening of the midline part
Preservation of the frontal hairline
Progressive miniaturization of hair follicles
This condition is genetically influenced, which explains the patient’s family history of hair loss.
Diagnosis 2: Telogen Effluvium (Stress-Related Hair Shedding)
The patient’s increased stress likely contributed to telogen effluvium, a temporary condition where hair follicles prematurely shift into the resting phase of the hair cycle.
Common triggers include:
Emotional or physical stress
Illness or surgery
Iron deficiency
Thyroid disorders
Certain medications
Telogen effluvium typically causes diffuse shedding across the scalp and often improves once the triggering factor resolves.
Why Both Conditions Can Occur Together
It is common for patients to experience both androgenetic alopecia and telogen effluvium simultaneously.
In these situations:
Genetic hair thinning creates a baseline vulnerability
Stress triggers additional shedding
Hair density may appear to decline more rapidly
Treating the underlying androgenetic alopecia helps stabilize hair growth over time.
Treatment Plan
After reviewing treatment options, the patient elected to begin spironolactone therapy.
Spironolactone
Dose: 50 mg twice daily
Spironolactone works by blocking hormonal signals that contribute to follicle miniaturization in female pattern hair loss.
Potential side effects discussed included:
Breast tenderness
Menstrual irregularities
Fatigue
Dizziness
Elevated potassium levels
Patients were counseled that spironolactone should not be used during pregnancy.
Additional Treatment Recommendations
To further support hair growth, the following options were discussed:
Topical minoxidil 5%
Hair supplements such as Nutrafol or Viviscal
Hair restoration procedures such as AlmaTED
These treatments can help improve follicle stimulation and hair density over time.
What to Expect with Hair Loss Treatment
Hair growth treatments require time to evaluate effectiveness.
Typical timeline:
2–3 months: shedding stabilization
4–6 months: early regrowth
9–12 months: maximal improvement
Telogen effluvium often resolves within several months once stress or other triggers improve.
Hair Loss Treatment in Katy, Texas & Houston, Texas
At Reena Jogi, MD, we specialize in diagnosing and treating many forms of hair loss, including:
Female pattern hair loss (androgenetic alopecia)
Telogen effluvium
Hormonal hair thinning
Stress-related hair shedding
Diffuse scalp thinning
If you are experiencing persistent hair shedding or thinning, a personalized evaluation can help determine the cause and guide effective treatment.
Schedule a consultation at our Katy or Houston dermatology clinic to learn about advanced hair restoration options.
