Struggling with Hair Loss and Self-Esteem

Same!! I had to wear hats for years as a teen because of the bald spots. I also pull my eyelashes so I was self conscious about that too. And I recently went back to hats after an IUD made the pulling worse and the bald spots became too obvious. But ever since it started as a teen (same week as I first started my period) no matter how hard I tried, I couldn't avoid pulling my hair, and I was pulling like 100 hairs a day. I finally found a medication that significantly reduces the hair pulling, I've had several days in a row where I haven't pulled a single hair! I still kind of want to pull but it's pretty easy to not, where before it was just hopeless. I think it works by protecting microglia (a type of immune cell in the brain) based on a few studies I've seen (there was a very interesting one that tied together trichotillomania, microglia, anxiety, and female hormones). The medication is mirtazapine 30 mg. At the lower doses I had increased appetite and sleepiness but it went away once I got up to 30 mg, and that's when it really helped with the hair pulling. You might give it a try, ask your doctor.

I have noticed that with me having most of my hair pretty short and putting clips and stuff in my hair helps because then it is harder to pull and pick at, but I know that might not help everyone