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Hair loss affects hundreds of millions of people worldwide. For many people it is more than an aesthetic concern, much more. For some people it can, and does, have a profound impact their self-worth, mental and emotional well-being. It can create anxiety, depression, and be a contributory factor in social isolation.

Hormonal and genetic factors in hair loss

Hair loss, medically known as alopecia, can result from various factors. Here are some of the most common causes.

• Genetic causes. Androgenetic alopecia, commonly known as male-pattern baldness or female-pattern hair loss, is the most frequent form of hair loss. It is influenced by both genetics and hormones. If close relatives – particularly fathers or grandfathers in men and mothers or grandmothers in women – experience hair loss, their offspring are more likely to inherit the condition.
• Hormones. The hormonal component of androgenetic alopecia is linked to dihydrotestosterone (DHT). In genetically susceptible individuals, DHT interacts with hair follicles, causing them to shrink over time. This leads to gradual thinning, often starting at the temples and crown in men and resulting in diffuse thinning in women.
• Pregnancy and childbirth. Hormonal shifts during and after pregnancy can cause temporary hair loss. Increased oestrogen levels during pregnancy promote thicker, fuller hair, but after childbirth, hormone levels drop, pushing large numbers of follicles into the resting phase. This leads to shedding, but in most cases, hair regrows within a few months.
• Menopause. Oestrogen levels decline during menopause, which can contribute to hair thinning and loss. Many women notice a gradual reduction in hair volume as hormonal changes affect the hair growth cycle.
• Thyroid disorders. Both an underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid can disrupt normal hair growth. When thyroid hormone levels are imbalanced, hair follicles may struggle to maintain a healthy growth cycle, leading to excessive shedding.

Medical and lifestyle causes of hair loss

Medical conditions can contribute to hair loss in various ways. Below are some of the most common causes.

• Autoimmune diseases. In conditions like alopecia areata, the immune system mistakenly attacks hair follicles, leading to patchy hair loss. The severity can vary from small, coin-sized patches to total hair loss on the scalp, eyebrows, and other areas. People with autoimmune disorders such as thyroid disease, hormonal imbalances, and skin conditions are at higher risk of experiencing hair loss.
• Infections. Certain infections can weaken hair follicles and cause hair loss. Fungal infections like tinea capitis and bacterial infections of the scalp can damage follicles, leading to hair thinning or bald patches. Skin conditions such as lichen planopilaris and discoid lupus erythematosus can also trigger inflammation around hair follicles, contributing to hair loss.
• Medications and treatments. Some medical treatments and drugs can interfere with hair growth. Chemotherapy drugs, designed to target rapidly dividing cells, also affect hair follicle cells, leading to temporary hair loss. Blood thinners can disrupt the normal hair growth cycle, resulting in shedding. Some antibiotics may also have hair loss as an unintended side effect.
• Stress. Severe physical or emotional stress can cause excessive hair shedding. Events such as surgery, childbirth, major illness, or trauma can trigger telogen effluvium, a condition where many hair follicles prematurely enter the resting phase. This leads to noticeable hair loss a few months after the stressful event.
• Traction alopecia. Certain hairstyles can put excessive strain on hair follicles. Tight braids, ponytails, cornrows, weaves, and extensions can weaken the roots over time, leading to hair loss known as traction alopecia. Constant tension on the scalp increases the risk of permanent follicle damage.

What is the psychological impact of hair loss?

Hair loss can have a substantial impact on a person’s mental health. The common, but not universal effects, many of which are linked, include: 

• Reduced self-esteem. Hair loss can significantly damage self-image and body image. For many individuals, hair is an important aspect of their physical appearance and identity. Hair loss can lead to feelings of inadequacy, unattractiveness, and a diminished sense of self-worth. This can be most challenging for people who draw their sense of femininity or masculinity from their hair.
• Anxiety and depression. The emotional distress associated with hair loss can lead to anxiety and/or depression. Anxiety could come from worrying about further hair loss, or being subjected to social judgement, and the self-perceived impact on appearance. Depression can follow from feeling sad, or having no control over the hair loss and no hope of recovering hair, and from reduced self-confidence.
• Social isolation. When people fear judgment and embarrassment that can lead to social isolation. They might avoid social situations, parties, gatherings, and even eschew intimate relationships, based on their perceived concerns about their appearance.
• Relationship challenges. Hair loss can strain personal and professional relationships. Changes in appearance can affect self-perception and interpersonal interactions, which can, in turn, cause difficulties in intimate relationships and harm career progression.
• Impaired confidence. Hair loss can erode confidence in several life contexts. Reduced confidence, can, in turn, impact a person’s ability to: perform at work, function in social settings, and make their relationships thrive. Hair loss can leave some people feeling less attractive, less powerful, and less capable of succeeding in several areas of life.

Prevention and minimisation

While hair loss cannot always be prevented, certain steps may help minimise it. Maintaining a nutrient-rich diet is one of the most effective ways to support hair health. Below are key dietary components that promote strong and healthy hair.

• Vitamins and minerals. Biotin, vitamin C, vitamin D, iron, and zinc play essential roles in hair growth. These nutrients support follicle health and help maintain a strong hair structure.
• Protein. Adequate protein intake is crucial for hair strength. Hair follicles are primarily made of keratin, a protein that requires a sufficient dietary supply to support growth and reduce breakage.
• Omega-3 fatty acids. These healthy fats contribute to scalp health and help reduce inflammation. Good sources include fatty fish, flaxseeds, and walnuts, all of which provide essential nutrients for hair growth.

Minimise stress 

By adopting and regularly practicing stress management techniques, it is possible to reduce or eliminate stress as a contributor to hair loss. Here are some of the techniques that are known to help reduce stress. 

Yoga combines physical postures, breathing exercises, and meditation, which can help reduce stress levels and promote relaxation, while improving overall health (which also enhances hair growth).

Regular meditation, too, can help calm the mind, reduce anxiety, and improve overall well-being.

Simple deep breathing exercises can help to calm the nervous system and reduce stress hormones.

Protecting hair from damage

One of the best ways to maintain healthy hair is to avoid factors that can weaken or damage it. Below are some key preventive steps.

• Limit harsh chemicals. Shampoos and conditioners containing sulfates and alcohol can strip moisture from the hair, making it dry and brittle. Opt for gentle, nourishing formulas instead.
• Reduce heat styling. Frequent use of blow dryers, curling irons, and flat irons can weaken the hair shaft and cause breakage. Using heat protectant products and lowering heat settings can help minimise damage.
• Handle hair gently. Wash hair with lukewarm water and avoid vigorous scrubbing. Instead of rubbing hair dry, pat it gently with a soft towel to prevent breakage and frizz.

What medical treatments could help reduce hair loss

Are there any medications that can prevent or even reverse hair loss? Yes, in some cases, the available treatments seem to help.

Minoxidil is an over-the-counter topical medication (a treatment that is applied directly to the skin), that can stimulate hair growth in some people with androgenetic alopecia.

Finasteride is an oral medication that can help reduce DHT levels in men, slowing down hair loss and potentially promoting regrowth.

Hair transplantation involves surgically moving hair follicles from areas of the scalp with dense hair growth, (in men, usually the back and sides), to areas that show hair loss.

Low-level laser therapy (LLLT) may stimulate hair growth in some individuals with androgenetic alopecia.

Coping strategies

When hair loss is found to be currently untreatable, or where several chosen treatments have proven ineffective, the only remaining option is to adopt coping strategies. Here are some.

Acknowledgement. As with many life challenges, when there is nothing that can be done to change an unwelcome situation, acknowledging it and finding a way to deal with it emotionally is wise. 

Prioritise self-care activities that boost mood and well-being, such as exercise, hobbies, and spending time in nature. Engaging in activities that bring joy and fulfilment can help improve your overall well-being and move your focus towards more empowering thoughts and emotions.

Given the social norms we are all subjected to, men seem to be able to accept hair loss better than women. Some men make their hair loss an appealing feature of their appearance, and shave off all remaining hair. Several film actors only became famous, and widely acclaimed, after they shaved their remaining hair. 

Women seem to benefit from the social norm that is more acceptable for females to wear wigs than males. Others explore alternative cosmetic options such as weft hair extensions, which can be sewn or clipped in to add volume and coverage in thinning areas. While they don’t reverse hair loss, weft hair extensions can offer a sense of normalcy and control, helping women feel more confident in their appearance

Identify and challenge the negative thoughts and beliefs you have about hair loss, such as: “I’m unattractive because I’m losing my hair,” and replacing them with more realistic and positive thoughts, such as “Hair loss is a common condition, and it doesn’t define my worth.”

Embracing hair loss with confidence

Adjusting to hair loss can be challenging, but finding ways to embrace the change can improve self-image and confidence. Experimenting with different hairstyles – such as shorter cuts, bangs, or hairpieces – can help you feel more comfortable and enhance your appearance. Choosing styles that suit your current hair situation can make a significant difference in how you see yourself.

Support groups can provide valuable emotional encouragement and a sense of community. Sharing experiences with people who understand your journey can reduce feelings of isolation and foster greater self-acceptance.

Whatever the cause of hair loss, those who cope best focus on what they have gained rather than what they have lost. Fewer hair products mean lower costs, and less time spent on styling allows for more enjoyable or productive activities. Finding the silver lining can make all the difference.

Professor Nigel MacLennan runs the performance coaching practice PsyPerform.