Telogen effluvium may not be a term you’ve heard before, but it’s a very common form of hair shedding that dermatologists see and treat quite often. And while it's never fun to lose hair, the good news is that if you’re experiencing telogen hair shedding, it’s neither permanent nor untreatable. Find out what causes this type of hair loss and what you can do to get your hair back to normal.

So What Is Telogen Effluvium, Exactly?

Our hair goes through various phases of growth — some more active, some more passive. The telogen phase is a resting phase in the hair cycle; the hair stops growing, and the follicle becomes completely inactive before pushing out the existing hair and beginning again.

Typically, only 8%-10% of your head's hair follicles are in the telogen phase at any given time. With telogen effluvium, though, the natural balance is disrupted, and a disproportionate number of hair follicles go into the telogen phase. People experiencing TE will have about 30% — or more — of their follicles in this phase.

Telogen effluvium (which tends to be more common in women) is characterized by a general thinning of the hair through a noticeable increase in shedding. It’s often concentrated at the top of the head but can localize on any part of the scalp or can spread evenly over the entire head. 

Read: How Cortisol Affects Hair Loss and Growth

What Telogen Effluvium Is NOT

Hair loss is a symptom of telogen effluvium, but TE is not the only cause of hair thinning or loss. In fact, there is another condition in the effluvium family: anagen effluvium.

With TE, there is a natural period of about three months between the follicle entering the telogen phase and the hair eventually falling out. With AE, on the other hand, hair will unnaturally fall out during the active growth stage (called the anagen phase).

Anagen effluvium (AE) is markedly different from telogen effluvium for two main reasons. Hair loss associated with AE tends to come on much more quickly, and hair shedding tends to be much more intense. 

The most common cause of anagen effluvium is chemotherapy drugs, but AE might also be caused by autoimmune disorders like alopecia areata and pemphigus vulgaris.

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What Causes Telogen Effluvium?

TE can be caused by a large number of things. The highest level root cause in almost all cases, however, is some form of major shock to the body.

According to board-certified dermatologist and founder of AmberMoon, Dr. Erum Ilyas, “The reason telogen effluvium is so common is simply because any stress on the body can trigger this type of hair loss.” So think of things like: 

  • Major life changes: Losing a job, relationship issues, grief or even the pandemic
  • Major health changes: Giving birth or having the flu
  • Body changes: Rapid weight loss or excessive exercise
  • Major diet changes: Extreme diet changes like the keto diet or vegan diet
  • Other changes: Long-distance travel

TE might also be caused by nutritional deficiencies (in particular a deficiency in iron, zinc or vitamins B-6 and B-12), anemia or thyroid issues. If you start or stop a hormone-based contraceptive like the pill or an intrauterine device, the sudden hormonal shift could trigger TE. 

But even with the plethora of potential causes, according to board-certified dermatologist Dr. Rina Allawh of Montgomery Dermatology, “In reality, there is no underlying known cause found in around a third of people.”

Related: How to Minimize Hair Loss From Stress

What Are The Symptoms of Telogen Effluvium?

The main symptom associated with TE is increased hair shedding. While it’s totally natural and normal to lose upwards of 100 hairs per day, if you start to notice more hair falling out than normal, you might have TE.

“Most people become aware of hair coming out in increased amounts, especially when cleaning the shower/bathtub! This is most noticeable after washing with more hair found in the plughole, or after brushing with more on the hairbrush or comb. Some people will notice increased hair on the pillow in the morning or around the house,” explains Dr. Allawh.

While there aren't typically any noticeable scalp symptoms, occasionally telogen effluvium can be accompanied by tenderness and altered sensations in the scalp known as trichodynia.

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How Is Telogen Effluvium Diagnosed?

Your doctor or dermatologist will likely do some routine blood work to rule out underlying medical causes like thyroid disease, anemia or vitamin deficiencies. 

They will also have a look at your hair and scalp. If there is irritation on your scalp, it may be helpful to perform a skin biopsy. “Your doctor may perform a hair pull test to evaluate the number of hairs and if this is consistent with a telogen effluvium type picture,” adds Dr. Allawh. A pull test is done by gently pulling on a small segment of hair to see how many hairs are shed.

They will also discuss the history of your hair shedding with you. Since the telogen stage typically lasts for about three months before the hair actually falls out, it can be hard to connect the dots between the stressful event and the actual onset of hair loss.

“This is usually the point when people come in to be seen. They feel like their hair is falling out so quickly that they cannot imagine they will have any hair left over. Ironically, this is the point when new hair is actually growing in and is technically closer to the recovery phase,” explained Dr. Ilyas. 

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How Is Telogen Effluvium Treated?

Unless there is an underlying medical condition that needs to be treated, hair loss caused by telogen effluvium typically resolves on its own. So there isn't a specific telogen effluvium treatment you should seek out.

“This type of hair loss is temporary. The special exception can be if a major stressful event triggers telogen effluvium and before a full recovery is made, another major stressful event interrupts the recovery process,” advised Dr. Ilyas. This could lead to chronic telogen effluvium.

In other words, if there is a high level of ongoing stress in your life, it could prolong recovery. This makes stress management and addressing ongoing stressors in your life especially important if this is the cause of your TE.

Dr. Ilyas also advises talking to your doctor to really understand the physiological processes happening with your hair follicles and what you can expect during recovery. 

“The best treatment, in my opinion, is knowledge. Understanding hair loss is so important because the stress of hair loss often leads to more hair loss! Talk to your dermatologist about this process and really understand it,” she added.

People might want to also consider biotin supplements to “help strengthen and thicken the hair that you currently have,” recommends Dr. Allawh. Additionally, a hair serum could help boost hair health.

Also: What Is a Trichologist and When Should You See One?

The Key To TE Recovery Is Time and Patience

As Dr. Ilyas mentioned, by the time you notice the hair shedding, you’re already on your way to the recovery period. This is because when your hair is being shed, it signals that your follicles are getting ready to get back to an active growth phase.

“It can take upwards of a year to really appreciate the hair regrowth. This is simply because the new hair growing in is like ‘peach fuzz’ or ‘baby hair’ - it is fine, wispy and unmanageable. As it grows longer, it will get thicker and coarser and start to look and feel the way it used to. This takes time,” explained Dr. Ilyas.

Telogen Effluvium Takeaways

Telogen effluvium is a very common type of hair loss that is caused by a specific stressful incident, which might include:

  • A big life change, like a new job or home.
  • A traumatic event, like the loss of a loved one.
  • A severe, temporary illness, like the flu or COVID-19.
  • An underlying medical condition, like thyroid disease or iron deficiency.
  • A hormonal change associated with birth control.

Telogen effluvium is temporary and reversible. Because of the nature of our hair's growth cycles, by the time you notice the hair loss, your scalp is likely gearing up to begin growing new anagen hair. Keep in mind that telogen effluvium regrowth takes time.

To help your body recover and support your newly growing hair, be sure to proactively manage stress levels while taking care of your general health with a balanced diet, proper rest and, perhaps most importantly, patience!

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Photo credit: Sandra Seitamaa/Unsplash

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