Dear Dr. Garner,

I read your column every week, and I have a question. While I know that this is not as serious as some of the other topics you address, I would like to know if it is possible to lose your hair due to aggravation.

When my kids entered high school, I had a full head of hair. Now I notice it’s falling out, sometimes in clumps. Is it true that hair can fall out from stress, or is it a myth?

Thanks for your columns. I look forward to the return of the TV show.

Balding in Brighton Beach

Dear Balding,

Your question is a difficult one. Hair may be affected by the body’s overall physical condition. Severe stress can affect the body and can cause hair loss. Studies have shown that problems with DNA cause you to go bald. Stress can accelerate this process.

Not all stress is the same, and so it should be divided into two categories: major stress and minor stress. Major stress is the type that can cause hair loss. A well-known example of major stress is that experienced by baseball player Roger Maris. He lost clumps of hair as he faced all kinds of pressure trying to break Babe Ruth’s home-run record.

Everybody loses about 100 hairs a day. This is normal hair loss. Most people do not notice this.

Emotional stress is a major stress that causes the body to malfunction. Just as severe stress can cause stomach and bowel problems, emotional stress can affect the body by causing hair loss. The good news is that once the stress is addressed, the hair can usually grow back. Some lifestyle issues that cause stress to the body can cause hair loss. These include: a strict, low-calorie diet; severe illness; high fever; major surgery; medications; and severe infection.

Stress can sometimes indirectly cause the body to lose hair. An example of this is severe emotional trauma, which interferes with your eating and sleeping and may cause weight loss. This in turn can cause severe hair loss.

Hair loss can affect your scalp or your entire body. Baldness typically refers to excessive hair loss from your scalp. Signs and symptoms of hair loss include gradual thinning on the top, patchy or circular bald spots or sudden loosening of hair where you can actually pull out handfuls of hair.

Severe stress can cause hair loss by putting hair follicles into the sleeping phase (no longer grows). There are three types of hair loss associated with high-stress levels:

1. Stress which pushes the hair follicles into a sleeping phase where it is no longer growing.

2. The immune system spurred by stress can cause destruction of the hair follicles and hair loss as a result.

3. Under stress, certain chemicals are released by the scalp, which can cause hair loss. One such chemical is cortisol, a stress hormone.

It is interesting to note that no major clinical trials have been done on this topic. Some studies in mice show that stress can cause shedding of hair resulting in the mice becoming bald. There is also evidence that in about three to five months after the birth of child, a woman can experience temporary hair loss. Of course, there is a tremendous amount of stress on women during this period.

Some recent studies show that there is a relationship between high blood pressure and hair loss, although no known cause has been identified.

Baldness has also been associated with scalp pain, particularly in patients who have patchy baldness. When pain is eased by medications, such as Botox, the hair grows back. This indicates a relationship between the pain of stress and hair loss.

The relationship between hair loss and stress is a complex topic. It sounds as if you are under severe stress at times, which can lead to hair loss. I believe you would benefit from stress reduction techniques.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.