I started pulling my hair out when I was twelve. By the time I was twenty-eight, I had a bald spot the size of a golf ball on the right side of my head, thinning at my crown, and barely any eyebrows left. Trichotillomania — compulsive hair pulling — had controlled my life for sixteen years, and I had never told anyone about it.
Understanding From Pulling to Peace: Overcoming Trichotillomania and Regrowing My…
The shame was the worst part. I hid the bald spots with creative styling, headbands, and eventually extensions. I lied about why my hair looked thin. I avoided swimming, windy days, and any situation where my hair might be exposed. The pulling itself was a cycle: I would feel tension building, pull to relieve it, feel shame about the damage, and then pull more to soothe the shame. It was an addiction with visible consequences.
Getting help was the hardest and most important step. I told my primary care doctor, who referred me to a therapist specializing in body-focused repetitive behaviors (BFRBs). The diagnosis was trichotillomania, and the treatment was Habit Reversal Training (HRT) — a specific form of cognitive behavioral therapy that helps identify triggers and replace the pulling behavior with competing responses.
The HRT protocol involved three components. First, awareness training: keeping a daily log of every pulling episode, noting the time, situation, emotion, and body position. This was excruciatingly embarrassing at first but revealed clear patterns — I pulled most while watching TV, while reading, and while lying in bed before sleep. Second, competing response training: whenever I felt the urge to pull, I would clench my fists for one minute, or hold a fidget toy, or sit on my hands. Third, stimulus control: making pulling more difficult — wearing gloves while watching TV, putting Vaseline on my fingertips at bedtime, and keeping my hair tied back in a silk scarf.
I also started taking N-acetylcysteine (NAC) 1200 mg twice daily, based on a 2009 study that showed it significantly reduced hair-pulling urges in people with trichotillomania. The mechanism is not fully understood but may involve NAC’s effects on glutamate regulation in the brain. My psychiatrist was supportive of this approach and monitored my progress.
For the physical recovery of my hair, I started 5% minoxidil foam applied twice daily to the bald spots and thinned areas. My dermatologist explained that the follicles in trichotillomania-affected areas may remain viable for years as long as the pulling has not caused permanent scarring. In my case, sixteen years of pulling had caused some follicular damage but no complete scarring, which meant regrowth was possible if I could stop pulling.
The timeline had two parallel tracks: the behavioral recovery and the hair regrowth. Month one through three of therapy: I reduced pulling from approximately 50-100 hairs daily to about 20-30. The NAC seemed to help — the urges felt less compulsive, more manageable. Month four: I had my first pulling-free week. The bald spot on the right side of my head showed tiny baby hairs emerging. Month six: I was pulling only 2-3 times per week, usually during high-stress periods. The baby hairs at the bald spot were about half an inch long. Month eight: two pulling-free weeks in a row, baby hairs approximately one inch and starting to pigment. Month ten: the bald spot was approximately 40% filled in with new growth. Month twelve: pulling episodes reduced to once or twice monthly, approximately 55% regrowth in the affected areas.
The setbacks were frequent and humbling. At month three, a stressful work project triggered a pulling binge that undid several weeks of progress. At month seven, a romantic rejection caused a severe relapse that lasted two weeks. Each time, my therapist helped me reframe the relapse not as failure but as part of the recovery process. The goal was not perfection but progress — a principle that applied equally to the behavioral work and the hair regrowth.
Key Takeaways and Recommendations
I also had to address the underlying anxiety and perfectionism that fueled the pulling. I started taking sertraline 50 mg daily (later increased to 100 mg), which helped reduce the baseline anxiety. The combination of HRT, NAC, and sertraline was more effective than any single approach alone.
At month fifteen, my trichotillomania is largely under control. I have occasional urges — usually during stress — but I have the tools to manage them without pulling. The bald spots have filled in to approximately 70% density, and with careful styling, the remaining thinness is barely noticeable. My eyebrows have fully regrown.
The practical takeaways: Trichotillomania is a real, treatable condition — you are not alone and it is not your fault. Habit Reversal Training is the gold standard behavioral treatment. NAC (1200 mg twice daily) has clinical evidence for reducing pulling urges. Minoxidil can help regrow hair in pulling-affected areas if the follicles are not permanently damaged. SSRI medication may help address the underlying anxiety. And relapse is part of recovery — what matters is that you keep coming back.
The most important thing I learned: the hair regrowth was proof of healing, but the real recovery was learning to sit with discomfort without pulling. The hair was the visible reward. The invisible reward was learning that I could face difficult emotions without destroying myself to escape them.
One aspect of this journey that I have not seen discussed enough is the financial cost. Between dermatologist visits, bloodwork, prescription medications, over-the-counter supplements, and hair care products, I spent approximately $200-300 monthly on hair recovery. Insurance covered some of the prescriptions but none of the supplements or topical treatments. I mention this not to discourage anyone but to set realistic expectations — effective hair loss treatment is an investment, and budgeting for it is part of the process.
I also want to talk about the role of patience in a way that goes beyond the obvious “be patient” advice. True patience in hair recovery means accepting that you will have weeks where it seems like nothing is happening, weeks where things seem to be getting worse, and occasional weeks where you notice genuine improvement. The overall trajectory matters more than any single data point. I found it helpful to review my monthly photos rather than daily mirror checks — the progress was much more visible when viewed over longer intervals.
The social dimension of hair loss is something I underestimated. Comments from well-meaning friends and family — “Have you tried biotin?” or “My cousin used rosemary oil and it worked!” — while intended to be helpful, often felt dismissive of the medical complexity I was navigating. I learned to have a prepared response: “I am working with a dermatologist on a comprehensive treatment plan, and I appreciate your concern.” This was polite but also set a boundary that stopped the unsolicited advice.
I also found it helpful to be selective about who I shared my journey with. Not everyone deserves access to your vulnerability. I shared openly with my closest friends and family, selectively with colleagues, and not at all with acquaintances. This protected my emotional energy for the things that mattered — my treatment, my recovery, and my mental health.
One more practical point: I kept a detailed journal throughout my recovery, noting my treatment adherence, stress levels, sleep quality, and subjective hair assessments. Looking back, this journal was invaluable for identifying patterns — I could see that poor sleep consistently preceded increased shedding, and that the shedding always decreased about 4-6 weeks after a particularly good stretch of adherence to my protocol.
I want to address something that rarely comes up in hair loss discussions: the role of expectations. When I started treatment, I expected a linear improvement — steady, consistent progress toward full recovery. The reality was anything but linear. There were plateaus, regressions, and unexpected leaps forward. The path was more like a stock market chart than a straight line, and accepting this non-linearity was essential for my mental health.
I also learned to redefine success. My initial goal was full restoration to my pre-loss hair density. As the journey progressed, I adjusted this to meaningful improvement — hair that looked good, felt healthy, and allowed me to live without constant anxiety about my appearance. This adjusted expectation was not giving up; it was being realistic about what treatment could achieve while still appreciating the genuine gains I was making.
The comparison trap is another danger. Other people’s before-and-after photos on social media can be inspiring, but they can also be misleading. Lighting, angles, styling, and photo editing all affect how hair looks in images. Your real-life mirror under normal lighting is a more accurate gauge than anyone’s Instagram post.
Internal linking suggestions: [Trichotillomania: Understanding and Treating Hair Pulling], [NAC for Trichotillomania: What Research Shows], [Hair Regrowth After Compulsive Pulling]