(Hair)

If You Have Hair Loss From COVID, You’re Not Alone

What the professionals say *actually* works.

Around the holidays it seemed like everyone was trying to dodge COVID and celebrate safely with loved ones. If you were unlucky like me, you came down with it anyway, despite being vaccinated and boosted. Months later, I noticed an unfortunate lingering effect: hair loss. It’s not a ton, but there’s enough thinning at the temples that it made me frantically Google COVID-induced hair loss one night. Reassuringly, it turns out I’m not the only one who’s experiencing this unexpected side effect.

“There’s a form of hair loss called telogen effluvium, which is often referred to as ‘stress-induced’ and can be triggered from many things including childbirth, illness, medication, or major life stressor,” says Dr. Robert Finney, a board-certified cosmetic dermatologist at Entière Dermatology. The hair on our head is constantly cycling through three phases: anagen, or the growing phase; catagen, which is the transition; and telogen, when it rests. Telogen effluvium refers to when strands go into the resting phase and then fall out. While on average you’ll lose about 100 strands per day, in this case you’ll lose larger clumps of hair (in some cases between 30% to 50% of your hair). That said, chances are, most of what sheds grows back within three to six months, but for some people, that’s not the case.

While scientists are still studying Covid and its lingering effects on the body, according to Bridgette Hill, a certified trichologist and founder of Root Cause Scalp Analysis, your recent bald spots are likely due to a combination of factors. Stress hormones play a part as well as your body’s immune response to illness, which can negatively affect the follicle. “The impact of psychological stressors trigger an abundance of epinephrine and cortisol and these hormones can contribute to COVID-related hair loss,” she says, adding, “The body responds to COVID by creating a pro-inflammatory state, which leads to tissue damage that may trigger telogen effluvium.”

Besides stress on the body, there’s also the natural aging process to factor in, as for many women, we tend to lose hair as we get older. With the pandemic stretching onwards for two plus years, your COVID may also reveal your body’s genetic propensity for hair loss, a phenomenon that can happen at any age. “What we see is that it can unmask your underlying predisposition which is called androgen alopecia,” says Hilary Coles, the co-founder of hers, a women’s wellness service. She adds that you can tell this is the case when you’re finding it takes time for your hairline to regrow.

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Thinning hair isn’t just due to normal shedding — the strands themselves can start to shrink in diameter as we get older, so they look more like what we call baby hairs. “You can think that our hair ages like we do, as an interaction between our hormones and our genetics. When testosterone starts converting into dihydrotestosterone, or DHT for short, it attacks the follicle and causes it to shrink slowly,” says Sarah Mardis, clinic director at Harklinikken. She goes on to explain that not only are your strands getting tinier, they’re also losing some of their color and their life cycle is shortening as our bodies produce more DHT over time.

In my case, my thinning turned out to be a mixture of both COVID and the stress from it, mixed in with the natural aging process. The wispy bits at my temples were stress induced, likely due to being sick in addition to other pandemic-related worries, which may also include my body’s mild reactions to the vaccine and booster, as those counted as stressors. I did see some separation at my hair’s part (although I’m lucky that my parent both have very healthy heads of hair). Mardis showed me a chart that ranked scalp parts on a scale of one to seven, with one being thick and healthy while seven indicated significant thinning. I ranked in between a two to three.

Compared to others who are experiencing more significant thinning, my situation is on the mild end and, chances are, that no one noticed a difference besides me. But I still wanted to get ahead of it, so I looked into possible treatments. With that in mind, here are the best ways to tackle hair loss, whether due to COVID, aging, or some combination thereof.

Spironolactone For Hair Loss

It turns out the 100 mg of spironolactone that I take daily for my hormonal acne doesn’t only just give me great skin. Since the pill reduces testosterone production in the adrenal glands, it disrupts the conversion of testosterone to DHT, minimizing any negative effects on my follicles. “We've heard anecdotally from our dermatology advisors that women who are on spironolactone for acne often see a benefit of reduced hair loss or increased growth,” says Coles. Your dermatologist or hers can prescribe you the medication but the optimal dosage can be slightly higher than what most patients take for their acne, ranging from 100 mg to 20 mg. You can expect to see results as soon as six months up to a year, so it’ll take a bit. One caveat: If you’re pregnant or breastfeeding, this isn’t recommended.

Minoxidil & Finasteride For Hair Loss

“The best over-the-counter treatment is topical minoxidil,” says Dr. Finley. More commonly referred to as Rogaine, which is the brand name, minoxidil is a topical spray or foam that you apply to your scalp to promote hair growth. While the exact reason why it works is not fully known, it’s thought to reverse follicle shrinkage. Hers’ version also includes finasteride, which you might know by its brand name Propecia. Finasteride reduces DHT in the scalp, thereby minimizing the hormone’s attack on follicles. It can take a few weeks to months in order to see its effects and unfortunately, if you stop using the topicals, you will see hair loss again.

Also worth noting: If you dye your hair blonde, minoxidil should be avoided completely. “It interacts with lifting agents to turn your hair neon yellow and will stay so until it grows out,” says Colleen Flaherty, master colorist and color educator at Spoke & Weal. “You can’t guarantee how blonde you will get. Plus, the more often you use it the more yellow your hair will be.”

PRP Injections For Hair Loss

PRP stands for platelet-rich plasma injections, which is a process where a doctor will draw your blood which is then centrifuged to isolate plasma and platelets. The resulting solution is then injected back to the area being treated, whether it’s a sports-related injury or for hair loss. In the case of your scalp, in order for effective treatment you’ll need to target the follicles so expect to get pricked every centimeter or so. “PRP is definitely a great treatment option. The growth factors contained in our platelets are effective at preventing hair from transitioning to a resting phase and at telling those that did so to wake back up,” says Dr. Finney. In other words, researchers have found that platelets, which aid in tissue repair, may also help reverse or prevent damage to your follicles.

If you’re experiencing COVID-related shedding, Dr. Finney says one round of shots may be enough and patients can see a difference in as little as a week. “I haven’t had to do a second treatment in any COVID-related cases so far. For genetic hair loss, we typically do an initial series of three before scheduling regular maintenance treatments,” he explains. That means if the shedding isn’t slowing down or stopping, expect to go back in once a month until it does. And if your hair is back to normal, then you won’t need any further injections. That said, it’s expensive (injections in New York City can cost $1,500 and upwards per session) and is not covered by insurance, should you want to go this route.

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Plant-Based Treatments For Hair Loss

If you’re hesitant to spend a ton of money on PRP injections and you don’t want to commit to long-term over-the-counter topical treatments, there are also an array of plant-based treatments on the market. In my case, since I’m experiencing mild hair loss, it seemed like a good option to fill in the gaps and Hill agrees. “I see effective reduction in hair shedding and loss with the use of drug-less, plant-based topicals,” she says. Three of the more common ones are Harklinikken, Nutrafol, and The Nue Co.

The Nue. Co

The Nue Co. features both an oral supplement meant to be taken every morning and a serum that you apply to the scalp two to three times a week. “Our ingestible targets nutrient deficiency and includes adaptogens for cortisol maintenance as well as compounds for thyroid function,” explains Jules Miller, founder of The Nue Co. But the real hero ingredient in the pills is BiovaBIO. Derived from egg shells, it’s a clinically studied complex that contains growth factor proteins and peptides, collagen, and vital polysaccharides that have been shown to increase hair thickness, growth, and decrease breakage. In conjunction with their Supa_Thick topical, which has redensyl — a compound that’s been proven to stimulate the growth phase of hair — the treatment can possibly help you see results anywhere from 30 to 90 days. And unlike over-the-counter topicals, you may not have to continue them indefinitely.

Nutrafol

Another option is Nutrafol, which offers options depending on your age. “Women go through different life stages which can lead to times where their hair thins and sheds more, like childbirth and menopause,” says Sophia Kogan, MD, co-founder and chief medical advisor of Nutrafol, adding, “Our product is the only supplement that’s been tested on women going through menopause.” To that end, they offer a women’s supplement, which includes Sensoril Ashwagandha, an adaptogen that helps with stress relief, saw palmetto, which aids in reducing DHT, as well as vitamin E and peptides. For those over 45, the women's balance supplement has additional hormone-supportive ingredients like maca, astaxanthin, and extra saw palmetto. And for those experiencing postpartum shedding, the brand has a supplement that features peptides, vitamin E, and nettle, a plant that can help lower DHT levels. Nutrafol also offers a topical serum that has ashwagandha. Like The Nue Co., it’ll also take around the same time to see regrowth: 30 to 90 days.

Harklinikken

Should you want more extensive hair consultations, Harklinikken may be your best bet. The Scandinavian hair clinic has locations in New York, Miami, and Los Angeles in addition to offering digital consultations. After undergoing a review of your scalp, they’ll send you off with their serum as well as their shampoo, conditioner, and any other extra moisturizing or styling treatments. You’re to apply the topical treatment daily by massaging in one dropper full of liquid, waiting 30 minutes to administer the second dose. Made with proprietary ingredients derived from burdock root, marigold, apple, sandalwood and cow’s milk, it’s meant to stimulate the follicles. “Our minimum results are to get you anywhere between 30% to 35% more hair but we’ve seen clients get anywhere between 50%, 60%, and even 70% more hair,” says founder Lars Skjøth. Expect to see changes within a month, and the clinic recommends a follow-up within eight weeks, so they can adjust dosage of the serum as needed.

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Lifestyle Changes To Manage Hair Loss

Whatever route you decide to go with treatment, be it with a dermatologist or with a plant-based treatment, there are other changes that’ll help with hair growth as well. The first is maintaining good scalp health, which includes washing your hair more often than you think. “Healthy hair starts at the healthy scalp. We want to make sure that we're neutralizing the pH levels and removing sebum as well as any other pollutants,” says Mardis. In my case, given my oily skin, twice-a-week washes were probably doing my hair more harm than good. Also, my dependency on dry shampoo was less than ideal. “Dry shampoo binds to oil and dead skin cells, creating an environment for microorganisms that can lead to follicle infections,” says Skjøth.

Intuitively all of the things that lead to a healthy body are also good for your scalp like getting more sleep, eating better, and reducing stress. “I promote green juices or smoothies. Foods like kale, collards, avocado and cucumbers are great for hair,” says Hill. As for dyeing or treating your hair, it really depends on who you ask, Dr. Finney recommends avoiding it while you’re in treatment for telogen effluvium. Other experts say that it’s fine, provided you make it a point to hydrate your scalp and hair after, and you’re not using minoxidil in conjunction with lightening agents.

As for me, I’ve started Harklinikken and made it a point to eat better, sleep earlier, and exercise more. It’s still early in the process and the only thing I’ve noticed is that my scalp does feel better now that I’m washing it more often. The treatment does take some getting used to, especially since it does drip if I’m not applying it slowly and carefully. But my goal is to keep my hair and scalp healthy in the long term, since I like to dye it. Hopefully in 30 days, I’ll see some positive change.