Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia, a chronic disorder impacting the autonomic nervous system, which regulates involuntary body functions like heart rate, blood pressure, and digestion. Individuals with POTS often experience excessive heart rate increase upon standing, leading to symptoms such as dizziness, fatigue, and brain fog. While hair loss is not a primary diagnostic criterion for POTS, patients frequently report significant hair shedding. This suggests a complex, indirect connection between the chronic condition and hair health, stemming from the systemic burden the disorder places on the body that disrupts the hair growth cycle.
Systemic Stress and the Hair Growth Cycle
POTS does not directly target hair follicles, but the chronic physiological disturbance acts as a constant stressor on the entire body. Autonomic nervous system dysregulation leads to sustained activation of the “fight-or-flight” response, resulting in elevated stress hormones like cortisol. This persistent internal turmoil prompts the premature reallocation of resources away from non-essential processes like hair production.
The hair growth cycle is sensitive to these systemic changes, consisting of the Anagen (growth), Catagen (transition), and Telogen (resting/shedding) phases. Chronic inflammation and the burden of illness can force hair follicles to shift prematurely from the active Anagen phase into the resting Telogen phase. Impaired blood flow and circulation, often associated with autonomic dysfunction, may also reduce the delivery of oxygen and nutrients to the scalp, weakening the hair shaft and increasing shedding.
Indirect Triggers: Medications and Nutrient Deficiencies
Hair loss in POTS is often secondary to external factors tied to managing the condition. Treatment frequently involves prescription medications that, while effective for symptom management, carry potential side effects including increased hair shedding. For example, certain beta-blockers, used to control excessive heart rate, have been linked to temporary hair loss.
Other medications, such as Fludrocortisone, a mineralocorticoid used for volume expansion, may also cause hair thinning. It is important to remember that patients should never discontinue a prescribed medication without first consulting their physician to discuss alternatives or dosage adjustments. These medication-related effects are distinct from the illness itself but contribute significantly to the total hair loss burden.
Nutrient Deficiencies
A major indirect trigger is the prevalence of nutrient deficiencies, which are common in the POTS population due to related gastrointestinal issues. Symptoms like nausea, poor appetite, and gut dysmotility can lead to malabsorption, preventing the body from utilizing necessary vitamins and minerals. Iron and its storage form, ferritin, are crucial for hair production, and deficiencies are often observed in POTS patients.
Deficiencies in Vitamin D, Zinc, and Vitamin B12 are also frequently noted, as they play important roles in regulating the hair growth cycle. Vitamin D influences the initiation of the Anagen phase, while Zinc is required for hair tissue growth and repair. Addressing these nutritional deficits is a fundamental step in managing hair loss, as the body cannot sustain healthy hair growth without the necessary building blocks.
Recognizing Telogen Effluvium
The most common pattern of hair loss associated with systemic stress and chronic conditions like POTS is Telogen Effluvium (TE). This condition is characterized by widespread thinning rather than distinct bald patches or a receding hairline. In TE, a significant number of hair follicles are shocked into the Telogen, or resting, phase simultaneously.
A defining feature of TE is the delay between the triggering event and the onset of shedding, which typically occurs two to four months after a major physical or emotional stressor. This lag means that the hair loss observed is often the result of an event, such as a severe POTS flare or an acute nutrient crash, that occurred weeks or months prior. During the Telogen phase, the hair remains dormant for about three months before the old hair is pushed out by a new growing hair, leading to noticeable shedding.
Shedding from TE is diffuse, affecting the entire scalp, and is often reported as losing handfuls of hair while showering or brushing. This pattern helps distinguish TE from other forms of hair loss, such as Alopecia Areata or male/female pattern hair loss. Understanding the nature and timing of TE can provide reassurance, as this type of hair loss is temporary and reversible once the underlying systemic stressor is managed.
Diagnostic Steps and Management Strategies
Addressing hair loss in the context of POTS requires a focused approach involving both the dysautonomia specialist and a dermatologist. The first step is to obtain comprehensive laboratory blood tests to identify nutritional or hormonal imbalances. These tests should include a complete iron panel, ferritin level, Vitamin D level, and a thyroid panel, as thyroid dysfunction often co-occurs with POTS and causes hair shedding.
Once deficiencies are identified, management focuses on supplementation and dietary adjustments to restore optimal nutrient levels. Correcting iron deficiency, for example, may require high-dose supplementation guided by a healthcare provider. Managing the chronic stress of POTS through techniques like biofeedback, gentle exercise, and improved sleep hygiene can also help reduce the systemic burden that triggers shedding.
Patients should also review their current medication list with their prescribing physician to explore whether a drug side effect is contributing to the problem. A medication change or dosage adjustment may alleviate the shedding in some cases. By systematically addressing systemic stress, medication side effects, and nutrient deficits, individuals with POTS can take proactive steps toward minimizing hair loss and promoting healthy regrowth.