Telogen Effluvium

What is telogen effluvium?

Telogen effluvium is a type of temporary hair loss caused by a stressor or change to your body. Your hair has three stages of growth and loss (shedding):

• Anagen (growth): This is the most active stage of your hair growth cycle. The cells in the lower part of a hair follicle rapidly divide. Once new hair has formed, it pushes the hair out of your follicle and elongates your hair shafts. A hair follicle can grow hair in the anagen stage for up to four years. Around 80% to 90% of your hair follicles are in the anagen stage at any given time.
• Catagen (resting): This is a transitional stage of your hair growth cycle. The lower portion of your hair follicle regresses and the hair stops growing. Around 5% of all hairs are in the catagen stage at any given time.
• Telogen (shedding): This is the resting stage of your hair growth cycle. The hair follicle is inactive, and there’s a white bulb of keratin at the root (club hair). The bulb of keratin keeps the hair in the follicle until it sheds, which then starts the hair growth cycle over again. Around 5% of all hairs are in the telogen stage at any given time.

Telogen effluvium affects your hair when it’s in the telogen stage. After a stressor or change to your body, up to 70% of your hair in the anagen stage prematurely enters the telogen phase, which causes hair loss.

What’s the difference between acute telogen effluvium and chronic telogen effluvium?

Acute telogen effluvium lasts fewer than six months, and your hair loss tends to happen two to three months after a stressor or change to your body. In 95% of cases, acute telogen effluvium goes away (resolves).

Chronic telogen effluvium lasts longer than six months. It affects your entire scalp and may not have a clear cause. You may lose your hair in handfuls during the early stages of chronic telogen effluvium, but it won’t cause total baldness.

Who does telogen effluvium affect?

Anyone can develop telogen effluvium. However, your chances of developing chronic telogen effluvium without a detectable cause increase if you’re a woman or assigned female at birth (AFAB) and are between 30 and 60 years of age.

How common is telogen effluvium?

Telogen effluvium is one of the most common causes of rapid hair loss. It’s also one of the most common causes of hair loss in women and people AFAB.

How does telogen effluvium affect my body?

Telogen effluvium causes hairs to enter the resting stage from the growing stage prematurely. Most people who are healthy lose up to 100 strands of hair per day. If you have telogen effluvium, you may lose up to 300 strands of hair per day.

Telogen effluvium may affect the hair all over your scalp, but it most commonly appears on the top of your head rather than the back or sides of your head. It usually won’t affect your hairline or cause total baldness, but severe cases of telogen effluvium may affect other areas of your body, including your eyebrows and body hair. Occasionally, the hair-thinning can mimic male- or female-pattern hair loss. Telogen effluvium has heavy shedding and rapid loss. Male- and female-pattern hair loss has slow thinning.

Telogen effluvium won’t affect your physical health, but it can affect you psychosocially (how society and social groups affect your thoughts and emotions) and psychologically (how you think about yourself and your behavior). You may experience emotional stress, anxiety and depression.

What are the symptoms of telogen effluvium?

Symptoms of telogen effluvium include:

• Increased hair loss, which you may notice in your hairbrush, in your shower drain or on your pillow.
• Thinning hair on your scalp.
• Dry hairs that fall out easily.

If you have telogen effluvium, your scalp should look healthy. You shouldn’t have any other symptoms, such as a rash, itching, burning, pain or flaking.

What triggers telogen effluvium?

The following factors may trigger telogen effluvium:

• High fever.
• Childbirth.
• Severe infections.
• Psychological stress.
• Major surgery.
• Hyperthyroidism.
• Hypothyroidism.
• Discontinuing use of birth control pills.
• Fad diets that don’t have enough protein.
• Some medications, including retinoids, beta-blockers, calcium channel blockers, depression medicines and nonsteroidal anti-inflammatory drugs (NSAIDs).

Is telogen effluvium contagious?

No, telogen effluvium isn’t contagious.

How is telogen effluvium diagnosed?

Telogen effluvium is easy to recognize. A healthcare provider can confirm it during a physical examination of your scalp. They may conduct a “pull test,” in which they gently pull a small clump of 40 to 60 hairs between their fingers. Under typical conditions, they may only pull two to three hairs from your scalp. If you have telogen effluvium, they may pull at least four to six hairs from your scalp with white bulbs at the roots.

Your healthcare provider will also ask you about your diet and recent medical history. They may identify a dietary cause or a stress or illness that occurred about three months before you noticed hair loss. In many cases, someone with telogen effluvium has fully recovered from a stressor or illness and doesn’t see a connection between it and their hair loss.

What tests will be done to diagnose telogen effluvium?

In most cases, your healthcare provider can diagnose telogen effluvium without any testing. They may recommend further testing, including blood tests or a scalp biopsy, if they suspect a condition or illness has caused telogen effluvium.

How is telogen effluvium treated?

Because one of the main causes of telogen effluvium is a stressor on your body, it’s important to identify the cause. Once you address the cause, most cases of telogen effluvium will resolve without treatment within six to eight months.

What medications/treatments are used to treat telogen effluvium?

Telogen effluvium should resolve on its own, so you may not need treatment. However, common telogen effluvium treatments may include:

• Medications: Over-the-counter (OTC) medications you apply to your scalp, such as minoxidil (Rogaine®), promote hair growth. Some side effects of minoxidil may include headache, scalp irritation and unusual hair growth. You shouldn’t use minoxidil if you’re pregnant or chestfeeding (breastfeeding).
• Multivitamins or supplements: Multivitamins that contain iron or an iron supplement help promote hair growth. Biotin supplements also help promote strong, healthy hair.
• Styling techniques: You may be able to obscure or hide your hair loss with certain hairstyles, wigs or hair weaves.

How long does telogen effluvium last?

Telogen effluvium usually lasts between three and six months.

Will my hair grow back after telogen effluvium?

Yes, your hair will grow back after telogen effluvium. After the three- to six-month shedding period, you’ll notice new hair growth in your affected areas.

How can I reduce my risk of developing telogen effluvium?

There are ways to help keep your hair healthy and promote hair growth, including:

• Eat extra protein, especially if you’re vegetarian or vegan. You need 40 to 60 grams of protein a day. The Mediterranean diet includes fruits, vegetables and protein that may help minimize hair loss.
• Take vitamins. Certain vitamins and minerals, including vitamins A, B, C, D, E, zinc, biotin and iron, help maintain healthy hair, skin and muscle tissue. Ask your healthcare provider before adding any new supplements to your diet.
• Find ways to cope with stress. Stress is one of the leading causes of telogen effluvium.
• Get enough sleep. Most adults need between seven and nine hours of sleep per night. The benefits of a good night’s sleep include decreased stress.
• Avoid extreme or restrictive diets. Rapid weight loss can trigger telogen effluvium. Restrictive diets can lead to nutritional deficiencies that can cause telogen effluvium. If you must lose weight, it’s a good idea to get regular exercise and follow a Mediterranean-style diet that focuses on fresh fruits and vegetables, whole grains, lean protein and healthy fats.

What can I expect if I have telogen effluvium?

Telogen effluvium can be stressful, and you may fear that you’ll lose all of your hair. However, if you have telogen effluvium, the outlook is good. It usually goes away three to six months after you start noticing your hair loss. Your healthcare provider can also help you take steps to promote new hair growth.

What’s the difference between telogen effluvium and androgenic alopecia?

Telogen effluvium is a type of hair loss that involves rapid shedding of hair over a short period. It typically happens a few months after your body goes through something physically or emotionally stressful. It can also result from sudden hormonal changes. Hair loss due to telogen effluvium is usually temporary, and your hair often grows back without treatment once you no longer have that stress.

Androgenic alopecia (male pattern baldness and female pattern baldness) is a type of hair loss that’s more gradual than telogen effluvium. It’s not known exactly what causes androgenic alopecia. Without medications or treatment, hair loss due to androgenic alopecia is permanent.

A note from Cleveland Clinic

Telogen effluvium is a common condition that causes temporary hair loss anywhere on your body, but it usually affects your scalp. Its causes usually include a stressor or change to your body. It can be emotionally and mentally challenging, and you may fear that you’re going bald, but it’s important to remember that your hair will grow back in time.

Reach out to your healthcare provider as soon as you notice hair loss, especially if it causes additional stress.