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Hair loss is one of those topics people often pretend isn’t happening to them. There’s so much stigma wrapped up in hair and beauty standards that it can feel like one of the hardest things to talk about honestly. As a woman who lost her hair during chemotherapy, I deeply understand the emotions that can surface around hair, identity, and who you are if you lose it.
As a doctor myself, I’ll have patients come in for fatigue, anxiety, irregular periods, or trouble sleeping, and only at the end of the visit will they add, almost apologetically, “And my hair is falling out.” Often followed by a quick reassurance that they know it’s probably just stress, aging, or the wrong shampoo.
It’s not.
“Hair loss is rarely just about hair.”
Hair loss is rarely just about hair. It’s often one of the body’s earliest signals that something deeper is happening hormonally, nutritionally, metabolically, immunologically, or neurologically. And while shedding some hair each day is completely normal, noticeable thinning, widening parts, excessive shedding, or a shrinking ponytail are signs worth paying attention to.
When it is normal, and when it’s not
We all shed hair every day. On average, 50 to 100 strands fall out as part of the normal hair growth cycle. Under healthy conditions, this process goes largely unnoticed until you have to clean that dreaded hairbrush.
The kind of hair loss that raises concern looks different. You may notice:
- Excessive shedding in the shower or on your pillow
- A widening part or more visible scalp
- Thinning at the temples or crown
- Hair that feels finer or less dense overall
What makes hair loss especially confusing is timing. The trigger, whether it’s stress, illness, hormonal shifts, nutrient depletion, autoimmune activity, medications, or under-fueling, often occurs about two to four months before the hair actually starts falling. That delay leaves many people chasing the wrong cause or blaming themselves when nothing they try seems to work.
“What makes hair loss especially confusing is timing.”
A quick note on the hair growth cycle (because this explains the delay): Your hair follicles aren’t all doing the same thing at the same time. They move through phases:
- Anagen (growth phase): This is where most of your hair lives most of the time.
- Catagen (transition phase): A short “wind-down” period where growth slows.
- Telogen (resting phase): The follicle rests before shedding.
- Exogen (shedding): The old hair releases and a new one pushes through.
So when something shifts in the body, the follicle often doesn’t “panic shed” immediately. It may move more hairs into the resting phase first, and the shedding shows up later.
One of the most common patterns I see is telogen effluvium, a form of temporary hair shedding triggered by stress, illness, surgery, postpartum changes, medications, or major life transitions. The key detail is that it doesn’t happen right away. The stressor may be long over by the time the shedding begins, which can make it feel sudden and inexplicable.
“The stressor may be long over by the time the shedding begins, which can make it feel sudden and inexplicable.”
Other patterns, such as alopecia areata (an autoimmune form of hair loss that often shows up in patches) or androgen-related pattern thinning (female pattern hair loss), may follow different timelines and require a different approach.
The good news is that many forms of hair loss are treatable or reversible. The harder truth is that recovery takes time, and the body needs the right conditions to feel safe enough to regrow.
Stress and hair loss
Stress is not just a mental inconvenience. It has a profound impact on your hormones — and your hair follicles feel that.
When the body perceives threat, whether emotional, physical, inflammatory, or metabolic, cortisol rises. Energy is diverted toward survival functions. Hair growth, which requires significant cellular energy, is temporarily deprioritized. To the body, having luscious hair is simply less important than surviving a perceived threat.
“To the body, having luscious hair is simply less important than surviving a perceived threat.”
This is why hair loss related to stress often shows up months after a difficult season rather than during it. The body essentially presses pause, waits for safety, and then sheds hair it can no longer maintain later down the road.
This can happen after:
- A prolonged period of emotional stress
- Illness or infection (even after a fever)
- Surgery or injury
- Postpartum recovery
- Significant life transitions
Stress also increases the body’s demand for nutrients like B vitamins, zinc, and magnesium, all of which play critical roles in hair follicle health. At the same time, stress often disrupts sleep, digestion, and appetite, further compounding the issue.
Hair loss in these cases is not a failure, but more of a message.
Iron deficiency and ferritin, an overlooked cause
One of the first things I assess when someone presents with hair loss is ferritin, a marker of stored iron.
“One of the first things I assess when someone presents with hair loss is ferritin, a marker of stored iron.”
You can have a “normal” hemoglobin level and still have ferritin that is too low to support hair growth. This is especially common in menstruating women, those with heavy periods, postpartum individuals, endurance athletes, and people who under-eat or follow restrictive diets.
Iron is essential for oxygen delivery at the cellular level, including to hair follicles. When iron stores are low, hair growth slows or stops.
In my clinical practice, many women experiencing hair loss feel dismissed because their labs fall within reference ranges. Functional medicine looks deeper, asking not just what is normal, but what is optimal for this person’s physiology.
Thyroid health and hair shedding
Hair follicles are highly sensitive to thyroid hormone. Both hypothyroidism and hyperthyroidism can disrupt the hair growth cycle, leading to diffuse shedding or thinning.
What’s often missed is subclinical thyroid dysfunction. Symptoms like hair loss, fatigue, cold sensitivity, dry skin, and brain fog can appear before labs cross diagnostic thresholds.
“What’s often missed is subclinical thyroid dysfunction.”
Autoimmune thyroid conditions, particularly Hashimoto’s, are also associated with hair changes. In these cases, inflammation and immune activation play a role beyond hormone levels alone, and hair loss may be part of a broader autoimmune picture that can include alopecia.
Hair loss related to thyroid imbalance often improves when the thyroid is properly supported, but regrowth takes time and typically lags behind symptom improvement.
Hormonal shifts in postpartum, perimenopause, and beyond
Hormones have a profound effect on hair follicles.
During pregnancy, high estrogen levels keep hair in the growth phase longer, which is why many people experience thicker hair while pregnant. After delivery, estrogen drops rapidly, and hair follicles move into the shedding phase. This is classic postpartum telogen effluvium and typically peaks around four months postpartum.
Perimenopause can bring similar challenges. As estrogen becomes more erratic and progesterone declines, hair follicles may become more sensitive to androgens, a group of hormones that includes testosterone.
“Androgens are often thought of as ‘male hormones,’ but everyone has them. The real issue is often signaling and sensitivity.”
Androgens are often thought of as “male hormones,” but everyone has them. The real issue is often signaling and sensitivity: In some people, hair follicles are genetically or hormonally more reactive to androgens. That sensitivity can shorten the hair growth cycle and gradually miniaturize the follicle — meaning each cycle produces hair that’s a bit finer and less dense.
This pattern is often referred to as female pattern hair loss, and it can have a genetic component. Just as male pattern baldness can run in families, female pattern thinning can as well.
Hair loss during these transitions is common, but that doesn’t mean it should be ignored. Supporting hormone balance, stress resilience, and nutrient status can make a meaningful difference.
Insulin resistance, PCOS, and pattern thinning
Insulin resistance is another under-recognized contributor to hair loss. Elevated insulin levels can increase androgen signaling in the body, which in turn can affect hair follicles.
This is particularly relevant in people with polycystic ovary syndrome (PCOS), where hair thinning on the scalp may occur alongside acne or unwanted hair growth elsewhere.
“Blood sugar may appear normal while insulin remains elevated behind the scenes.”
What’s important to understand is that insulin resistance doesn’t always show up clearly in standard labs. Blood sugar may appear normal while insulin remains elevated behind the scenes.
Addressing insulin resistance through balanced nutrition, strength training, sleep optimization, and stress management can improve hair health over time. Hair is often one of the last symptoms to resolve, but it does respond.
Scalp inflammation, infections, and the “local environment”
Sometimes the root cause isn’t only internal — it’s also local.
The scalp has its own immune activity and microbiome, and chronic inflammation can interfere with the conditions follicles need to stay in a healthy growth cycle. This can look like:
“The scalp has its own immune activity and microbiome.”
- Flaking, itching, tenderness, or burning
- Persistent dandruff or seborrheic dermatitis
- Folliculitis (inflamed follicles)
- Fungal infections like tinea capitis (more common in kids and in certain adult contexts)
Not every scalp issue causes hair loss, and not every hair loss case includes symptoms, but it’s an important layer to consider — especially if the scalp itself feels “off.”
Undereating, over-exercising, and “clean” diets
Hair loss is a common consequence of chronic under-fueling.
The body interprets insufficient calories, carbohydrates, or protein as stress. This includes extreme dieting, prolonged fasting, intense exercise without adequate recovery, or overly restrictive eating patterns.
“The body interprets insufficient calories, carbohydrates, or protein as stress.”
Hair follicles are sensitive to energy availability, especially in women, whose hormonal systems are closely tied to energy balance. When fuel is scarce, growth slows. This is not a failure of willpower, but a protective response.
The nutrient layer: Why food preparation matters
Hair health depends on more than hitting macros or taking supplements. Nutrient absorption and bioavailability matter just as much as intake, because your body has to be able to use what you’re giving it.
“Nutrient absorption and bioavailability matter just as much as intake, because your body has to be able to use what you’re giving it.”
Protein provides the building blocks for keratin. Iron, zinc, selenium, iodine, and B vitamins support follicle function and cellular turnover. Omega-3 fatty acids help regulate inflammation at the scalp and systemically.
Absorption is also influenced by mindful eating and digestive health. Low stomach acid, chronic stress, gut inflammation, and eating on the go can all impair your ability to break down and assimilate nutrients, even if your diet looks “perfect” on paper.
A quick word on supplements: more isn’t always better. Some nutrients (like selenium, zinc, and vitamins A and E) can backfire when taken in excess. Targeted support is powerful. Random stacking is not.
Collagen also comes up in conversations about hair loss. Collagen can be such a helpful source of amino acids, particularly glycine and proline, but it works best as a complement to a protein-sufficient diet rather than a standalone solution.
Nutrient density isn’t just about what you eat, but how consistently you eat, how well you digest, and whether your body feels safe enough to use those nutrients for growth.
What I look at clinically
When someone comes to see me with hair loss, I’m not just looking at their scalp. I’m also looking at a timeline of their health journey.
We review what was happening in the months before the shedding began. Stress levels, sleep patterns, illnesses, dietary changes, hormonal shifts, medications, and life transitions all matter.
“Stress levels, sleep patterns, illnesses, dietary changes, hormonal shifts, medications, and life transitions all matter.”
From a lab perspective, I often assess the following:
- Ferritin + iron studies (not just hemoglobin)
- Thyroid function, including antibodies
- Vitamin D, Vitamin B12, Folate, Zinc, Magnesium, and others
- Blood sugar + insulin markers (because fasting glucose alone can miss early insulin resistance)
- Stress patterns, inflammation, & autoimmune markers when clinically relevant
- Sex hormones, when indicated (and sometimes androgens, depending on the pattern)
Dermatology can also be an important part of care. A dermatologist can help assess the scalp, identify scarring versus non-scarring hair loss, diagnose alopecia subtypes, and rule out conditions that require medical treatment. In some cases, tools like dermoscopy (trichoscopy) or a biopsy can clarify what’s happening beneath the surface.
There are medications that can support certain types of hair loss, and for some people, they are appropriate tools. However, they are rarely the starting point in a functional approach. Addressing root causes first helps improve long-term outcomes and avoids relying solely on symptom suppression.
Just as important is the emotional experience. Hair loss can be deeply distressing. It can affect identity, confidence, and mental health. Supporting someone through hair loss means addressing both physiology and nervous system safety.
“Supporting someone through hair loss means addressing both physiology and nervous system safety.”
What I often tell patients is this: hair loss is not your body betraying you. It’s your body responding to a period of increased demand, stress, inflammation, or change.
Hair regrowth takes time. Even when the root cause is addressed, progress can feel slow. This doesn’t mean the plan isn’t working. It means the body is rebuilding deliberately.
Hair care strategies that support regrowth
When someone is addressing the root causes of hair loss, there’s often a period where the body is healing but the hair hasn’t caught up yet. During that time, how you care for your scalp can support the regrowth process.
“How you care for your scalp can support the regrowth process.”
Many of the strategies below come from practical, in-clinic recommendations shared by Love.Life Health Coach, Katie Lombardi, who works closely alongside my patients while navigating hair loss during recovery:
Scalp massage is one of the simplest tools you can add to your routine. Using firm pressure with your fingertips or a silicone scalp brush helps increase blood flow, delivering oxygen and nutrients to hair follicles. Press down and move in small circular motions so the scalp itself moves. A few minutes a day is enough to be helpful.
Scalp hygiene matters as well. Dryness, irritation, and product buildup can all suppress growth signals, especially in telogen effluvium. Keeping follicles clear and the scalp balanced can make regrowth easier.
For oilier scalps, gentle chemical exfoliation once weekly before shampooing can help reduce buildup. For drier or more sensitive scalps, pre-wash oiling with a lightweight oil like jojoba, followed by a gentle shampoo and a barrier-supporting scalp serum, can improve comfort and hydration.
Some people benefit from low-stimulation modalities such as red light therapy or gentle microneedling, which may support follicle signaling and circulation when used appropriately.
For androgen-related pattern thinning, topical minoxidil shampoo systems can be a helpful tool for some individuals. Minoxidil improves blood flow to hair follicles and can extend the growth phase of the hair cycle. That said, it does not address root causes and works best as part of a broader, supportive plan.
If your hair is changing, your body is speaking
We live in a culture that treats hair loss as either vanity or inevitability. Neither tells the full story.
“Hair loss deserves curiosity, not dismissal. Compassion, not shame.”
Hair loss deserves curiosity, not dismissal. Compassion, not shame. And care that looks beneath the surface rather than offering quick fixes or telling you that you’re just out of luck.
If your hair is changing, your body is speaking. Listening is the first step.
Dr. Jaclyn Tolentino is a Board-Certified Family Physician and the Lead Functional Medicine Physician at Love.Life. Specializing in women’s health and hormone optimization, she has been featured in Vogue, The Wall Street Journal, and Women’s Health. As a functional practitioner and a breast cancer survivor, Dr. Tolentino is dedicated to uncovering the root causes of health challenges, employing a holistic, whole-person approach to empower lasting wellbeing. Follow her on Instagram here for more insights.
