Article by Diana Tsui, The Zoe Report, January 4, 2022

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.

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 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.