Hi ladies, I've been a long, long time lurker of this site-- having suffered from alopecia, on and off, for years. I've been through it all-- quarter sized patches, alopecia totalis, diffused hair loss, worn toppers, wigs, concealers, scarves, cried endlessly, you name it. Without rambling, ad nauseum, about the obvious things you can related to, I thought I'd share the most poignant lessons learned. Take it with a grain of salt. After all these years, this is what has finally worked for me, but as they say, your mileage will vary. Despite the suspicious, brand spanking new username, I didn't come here to gloat and then "peace out". If my post resonates with one person, then I'll have considered my words worth sharing. 1. Stress. I remember a former derm saying that stress has not been clinically proven to cause alopecia. I wasn't about to research fanatically to find out the merit of her statement, but my intuition called bull sh*t. Stress wreaks havoc on the entire body and is a major contributing factor to many diseases. Looking back at all the significant episodes I had, I could pinpoint major stressful situations a few weeks/months prior to the start of hair loss. I *had* to prioritize the management of stress, not eliminate, but dedicate a lot of effort to reducing stress. Zazen medication, vipassana multi-day meditation retreats, yoga, connecting and maintaining personal close relationships, breathing exercises, EFT techniques, heart rate variability exercises, something. No where is it promised that once you have your hair back, that you will automatically be happy or stress free. You will always have to work on your stress levels and emotional issues. Always. 2. Nutrition. I've been to 4 derms, 2 psychologists and 1 psychiatrist. None inquired about my eating and sleeping habits. It wasn't until I visited an ayurvedic practitioner where I proverbially got bitch-slapped up side the head with a rude awakening. Everything you put into your mouth is either fighting or fueling disease. You can have the sexiest car on the market, but without gasoline, you're going no where. The cliffnotes version? I cut out sugar, caffeine, alcohol, soy, grains and wheat. I follow mostly a paleo diet, getting most of my calories from fat and animal products: non-industrial grass fed meat and specific non-industrial oils (ghee, grass fed butter, MCT oil, coconut oil). Vegetables, tubers, bone broths, fermented products, limited sprouted nuts are a staple, but I've dumped the rest. Now does that mean I'm militant about my diet? No. This goes back to rule #1: stress. To strive for some perfectly clean diet typically produces this weird obsession and militancy that isn't going to help with the stress factor. 90/10. And that 10%, you bet I'm going to enjoy whatever it is I'm eating or drinking. Again, your mileage may vary, but I would take a long, hard look at what exactly you are putting in your mouth, why you believe in the diet you are ascribed to and the research that supports it. I was a long time vegetarian on a low fat, high carb, high grain diet. I won't get on some preachy carnivorous soap box, but I will say that by adopting my latest dietary eating habit, I have leaned down to 15% body fat without abusive exercise, without calorie restriction, gained lots more energy, blood work has never been better and have an almost full head of hair. I'd be happy to talk to anyone about my insights, point you to blogs, podcasts, peer reviewed/reputable studies and great books to read that support my beliefs. PM me. 3. Acceptance of your disease, but conscious of the idea that you have (might have) some control over managing your alopecia. Again, I'm not trying to speak for everyone. I can't tell you the number of times I would coil up and freeze under the idea that I have no control-- that at any moment I would lose my hair and have to put my life "on hold". Again. It's a crippling feeling and it was dis-empowering to the point that it only fueled the alopecia. I remember reading the posts under this very topic, "A positive Outlook" when someone would mention the power of acceptance, or "finally coming to terms" and I would either get upset, sad and or refuse to believe that I could ever come to accept this part of me. I will always have alopecia, somewhere "lurking", waiting to be triggered. I'm certain I will always have thin and short hair. While I still struggle with this, I am slowly learning to love all the various parts of me and to quit compartmentalizing them. I tend to stay on the clinical, scientific side of things, but I've come to learn there is immense power in positive thinking, in acceptance of who you are and loving yourself in a gentle and humble way. Self hate, self pity/victimization and anger festering inside is toxic. Baby steps. I'm not saying it's easy to love yourself, but you've got to work on acceptance. It's part of the healing process. 4. As for drugs and treatments? I've done the Spironolactone, rogain, horse hair shampoo, countless supplements and shots. I will still get kennalog shots if there are small patches that come up and it works at stopping the size of the patch. As for vitamins, I try to get most of my nutrients from nutrient dense foods, but will supplement with Vitamin D, magnesium and fermented cod liver oil for non-alopecia related reasons. I still use Indian herbs suggested by my ayurvedic doctor, switching between Amla oil, a Nirgundi/Mahakshirbala mix and another herbal complex mixed with yogurt once a week. I incorporated his recommendations the same time I made a huge dietary ovehaul, seriously began to incorporate meditation into my life and adopted way better sleep hygiene. In my self-experimentation and body/mind hacking, I held no variables constant, so who knows why my hair grew back with such fervor. But again, it's a holistic approach: nutrition, stress management, incorporate some western injections with some eastern herbs and acupuncture and wa-la, the turnaround this past time shocked not only me, but my family and hairdresser. Sorry for the horrific grammar. I just really wanted to spend the afternoon getting this out there to share. There is hope. You have to believe that there is and believe in yourself. Pre-alopecia, I lived somewhat of a superficial, less appreciative life. After repetitive hair loss, I was forced to look inward toward reflection, and after everything I've learned after this last bout of pretty bad shedding (1/2 head), I now truly believe that our deepest pains are a gift, but only once I was smart enough to appreciate that this pain could actually be my greatest teacher. I wasn't willing to learn this lesson in prior episodes, but I'm glad that although it took many years to finally get it in my head, I've learned these lessons. I hope you, too, can learn and save yourself some heartache, if possible. The framework in which I'll handle myself if I lose hair down the road will be different, but I am choosing to believe that because of the lessons I've learned I will have taken it upon myself to drastically reduce the chances of severe hair loss down the road. Again, I hope this helps someone, somewhere in that off chance that you're neglecting the fundamentals to what it means to be healthy: sleep, mental health and food based nutrition. And although it feels like it more often than not, you are NOT alone. Feel free to contact, criticize, ask questions and reach out via PM for support.