“SAAB” is a syndrome where the psychological stress of losing ones hair leads to physiologic changes that further accelerate male pattern baldness. Little old me, armed with only an associate degree in nursing from a local community college, am the first person to indentify and name this condition. I wonder if the term will spread? I wonder if it will ever get serious consideration by the medical community? The purpose of this article is to make a credible case that this syndrome does exist and is hindering many people's efforts to treat their balding condition. People afflicted with SAAB are usually younger. The discovery that they are losing their hair is more than they can handle. They "freak out". They become fearful and obscessed about their hair and in a sense become their own worst enemy.

I’ve been an RN now for more than 17 years. In that time I've come to some conclusions based upon my experience trying to help my patients. I now understand that many of us can definitely “make ourselves sick”. Or at the very least we can make ourselves sicker. In fact I think I’m being a bit too kind by saying some of us can make ourselves sick. In reality all of us can make ourselves sick. All of us, at one time or another, will exacerbate a health condition simply because we obscess about it.

Let me use an example of a patient making themselves sicker. This is an absolutely true story. I'm just going to change the patient's name to protect their privacy.

Thomas is an asthmatic patient and complains he is experiencing some trouble breathing but it is not life threatening. As his nurse I have two medications available I can give him. The first is an albuterol inhaler (a medication that is used specifically for asthma that opens up your brochiole tubes). The second is Ativan. This is an anxiety pill…..aka nerve pill. I give him his albuterol inhaler and an hour later he’s still complaining he is short of breath. Since inhaled albuterol is a relatively fast acting medication it is safe to conclude at this point that it was not effective. Now I give him a dose of Ativan…a medication that supposedly has nothing to do with improving lung function. I come back in an hour and the patient is smiling and having no trouble breathing anymore.

So what happened? Well what you just read is something every experienced nurse has had. True Thomas does have asthma however he made the asthmatic attack worse because he was obscessing about it. This led to an increased level of stress causing the body to require even more oxygen. Stress in and of itself can also contribute to further lung constriction. When we effectively treated the stress or anxiety with Ativan, his breathing got better.

I could give you numerous examples of how almost every disease or condition can be made worse by stress and improved by medications eleviating stress. People in chronic pain can be effectively treated with medications like Ativan. People suffering from heart palpitations, sleep disorders, depression, tinnitus, Parkinson’s disease, cancer, allergies, etc etc. also benefit from these type drugs. That’s because when you effectively get people to relax, virtually every condition or disease will improve. Don’t misunderstand me. I’m not recommending that people go to their physician and ask for a prescription for Ativan. This would only be a short term way to treat a long term condition. These type drugs have a tremendous downside when used for extended periods of time. I’m not even recommending that people should necessarily visit their doctor at all. What I’m saying is that if you can reduce the stress level you have about your hair loss, you will slow down the rate at which you are balding and give your treatment regimen a chance to actually work for you.

There are numerous ways to reduce levels of stress that do not require the help of a physician. All you need do is a google search and I’m sure you will find many ideas. Some things that work for me are aerobic exercise and getting a good night’s sleep. Eating right and staying away from caffeinated beverages are another one that tends to help.

Now let’s examine some evidence to support that stress causes physiological changes that exacerbate pattern baldness. Here’s the first study:

“It has been much disputed whether or not stress can cause hair loss (telogen effluvium) in a clinically relevant manner. Despite the paramount psychosocial importance of hair in human society, this central, yet enigmatic and controversial problem of clinically applied stress research has not been systematically studied in appropriate animal models. We now show that psychoemotional stress indeed alters actual hair follicle (HF) cycling in vivo, ie, prematurely terminates the normal duration of active hair growth (anagen) in mice. Further, inflammatory events deleterious to the HF are present in the HF environment of stressed mice (perifollicular macrophage cluster, excessive mast cell activation). This provides the first solid pathophysiological mechanism for how stress may actually cause telogen effluvium, ie, by hair cycle manipulation and neuroimmunological events that combine to terminate anagen. Furthermore, we show that most of these hair growth-inhibitory effects of stress can be reproduced by the proteotypic stress-related neuropeptide substance P in nonstressed mice, and can be counteracted effectively by co-administration of a specific substance P receptor antagonist in stressed mice. This offers the first convincing rationale how stress-induced hair loss in men may be pharmacologically managed effectively.”

You can read the abstract here:

Now this study does not speak spefically to male pattern baldness but it certainly hints to stress causing inflammatory effects which we know are bad for anyone fighting androgenic type hair loss. Here’s a snipet of another study offering further evidence that stress can indeed make your hair loss condition speed up:

“The current pilot study reports the first experimental evidence available in the literature that stress can indeed negatively affect hair growth in vivo, and our key results strongly support the concept that stress inhibits hair growth.”

You can read the abstract here:

Again though this study doen't specifically discuss male pattern baldness it does state that stress inhibits hair growth. Here’s a link the forum member “chore boy” dug up for me.

Here is a summary of the study:

“Increasing scientific evidence suggests that prolonged psychological stress takes its toll on the body, but the exact mechanisms by which stress influences disease processes have remained elusive. Now, scientists report that psychological stress may exact its toll, at least in part, by affecting molecules believed to play a key role in cellular aging and, possibly, disease development.”

This study looks at the damage of stress on our hair from a different perspective. This study is saying that stress accelerates aging. It is not hard to make the theoretical jump that anything that speeds up the aging process will also speed up the balding process. The general consensus or belief in the medical community is that stress also increases the secretion of androgens. But there is yet to be a study that I am aware of that actually demonstrates this. It's easy to see however the vicious cycle being set up. Androgenetic hair loss can be made worse by stress in general, but also by the stress caused by the hair loss itself. The escalation is then endless. Stress increases the hair loss, which increases stress, which in turn increases the hair loss.

Prolonged stress is also known to lead to an overactive adrenal gland. This can lead to increased production of DHEA and DHEA-S, which can then be converted to testosterone. When we increase testosterone levels there is more testosterone that can be converted to DHT. This ultimately results in more DHT in the system and more pronounced male pattern baldness or a faster process of follicular miniaturization.

Here’s another study where hair growth was found in mice that were injected with a compound that reduced stress. Here's the link to the study:

Here’s a snippet of the main finding:

"A team led by researchers from UCLA and the Veterans Administration that was investigating how stress affects gastrointestinal function may have found a chemical compound that induces hair growth by blocking a stress-related hormone associated with hair loss - entirely by accident."

Again this is more evidence that stress can speed up male pattern baldness.

Aside from the physiological reasons the psychological ramifications of those experiencing SAAB can be even more detrimental. Their whole day revolves around how their hair looks. A “bad hair day” is all it takes sometimes to cause them to abandon their current treatment regimen and embark on a whole new idea. People with SAAB tend to jump from one treatment to the next, never giving any treatment enough time to actually work. They generally are very emotional and sometimes even irrational.

A person with SAAB also tends to inflame their scalp by constantly touching and feeling it. Some inflame their scalp still further by rubbing topicals into their scalp more often than they should or by using numerous topicals. The panic they are feeling impaires their judgement and causes them to make irrational decisions about their treatment regimen. I once knew of a guy that hadn't shampooed his hair for over a year because he claimed it caused him to lose more hair! Of course this was irrational and actually the reverse of what he should have been doing.

In my opinion here’s some other things SAAB can cause.

1. It increases the production of DHT.

2. It leads to jumping from one treatment to the next without giving the treatment enough time to work.

3. It leads to cortisol excess which is bad for hair.

4. It speeds up the aging process therefore it speeds up the balding process.

5. It eventually leads to depression which causes them to give up treatment.

6. It causes them to sometimes “invent” side effects that are really not happening.

7. It often causes them to abandon good treatments during periods of shedding even though shedding is a sign that treatment is helping.

In summary the stress related to losing ones hair can speed up the balding process. So taking appropriate steps to eleviate the worry and fear about losing your hair may help you effectively treat the condition. Stress causes actual physiological changes in our body. These changes throw off our entire equilibrium, and affect every system of our body. Hair, being one of the fastest growing tissues is very sensitive to disturbances, and is often the first to feel the effects. The hair growth cycle is easily disrupted, resulting in excess hair shedding and inhibited growth.

Supporting Journal Abstracts

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