Telogen effluvium is the second most common reason for hair loss

By Nancy LeBrun 

Published on October 19, 2023

 Medically reviewed by Susan Bard, MD

Telogen effluvium is when you shed significantly more hair than usual due to a change in the number of hair follicles actively producing hair. It is one of the most common reasons for thinning hair.

This condition is often a reaction to physical stress or trauma, medications, or illness. It can leave you with noticeably less hair, and it can be distressing.

The good news is that telogen effluvium is usually temporary. This article covers what you need to know about telogen effluvium, including symptoms, causes, and treatments.

Reproduced with permission from ©DermNet New Zealand and ©Waikato District Health Board www.dermnetnz.org 2023.

How to Know If You Have Telogen Effluvium Hair Loss

Your hair grows and sheds in a cycle. About 10% to 15% of your hair is in the telogen, or resting, phase at any one time.

During the telogen part of the cycle, your hair follicles (small tubes in the skin that produce hair) become inactive.¹ These tiny organs may be preparing to grow hair during this phase.²

Geyfman M, Plikus MV, Treffeisen E, Andersen B, Paus R. Resting no more: re‐defining telogen, the maintenance stage of the hair growth cycle. Biological Reviews. 2015;90(4):1179-1196. doi:10.1111/brv.12151

 The existing hair can remain until the follicle reactivates and creates a new hair that pushes the old one out.

If you have telogen effluvium, however, there is an increase in the follicles that are in the resting phase and the hairs come out easily. Sometimes it's worse near the front of the scalp.

Typical hair loss for most people is up to about 100 hairs a day, but if you notice you are shedding more than usual, you may have telogen effluvium.³ It can affect people of any sex.

What Are the Symptoms of Telogen Effluvium?

Signs that hair loss is due to telogen effluvium include:⁴

• Noticeable hair loss on your pillow or while washing or styling your hair

• Generally thinner hair, often on the top of the scalp

• Hair that is easy to pluck out

• Hair strands have a white bulb at the root

• Possible hair color change, usually from darker to lighter

• Trichodynia—tenderness, pain, burning, itching, or stinging of the scalp⁵

Telogen effluvium can be acute or, more rarely, chronic. Acute telogen effluvium lasts less than six months and goes away in most people.

The chronic form lasts longer and can affect a larger area of the scalp. It tends to begin suddenly in females between the ages of 30 and 60 who have thick hair. The hair may come out in handfuls when it begins, though it comes and goes and may become less severe over time.⁶

What Causes Telogen Effluvium?

Telogen effluvium has many causes, often connected to a physical change or trauma. Common triggers for telogen effluvium include the following.⁵

Stress and Trauma

Physical stress is a common cause of telogen hair loss. It's often due to an event such as major surgery, chronic illness, or a high fever. It may also be linked to emotional or psychological stress.

Hormonal Changes

Hormonal changes during pregnancy can cause telogen effluvium. Thyroid disease, which affects the hormones that the gland produces, has also been linked to hair thinning.

Medications

Medications that can cause telogen effluvium include:⁵

• Oral contraceptives

• Androgens (sex hormones such as testosterone)

• Retinoids

• Beta-blockers

• Angiotensin converting enzyme (ACE) inhibitors

• Anticonvulsants

• Antidepressants

• Anticoagulants, including heparin and Jantoven (warfarin)

Diet

Crash dieting, which involves severe calorie restriction, is a common cause of telogen effluvium. If the body lacks sufficient nutrients, including protein, iron, zinc, or vitamin D, it can trigger excess hair shedding.⁷

Health Conditions

Chronic health conditions that can lead to telogen effluvium include:⁵

• Amyloidosis (a rare disease that causes a buildup of abnormal proteins in organs)

• Liver failure

• Kidney failure

• Inflammatory bowel disease (IBD)

• Human immunodeficiency virus (HIV)

• Psoriasis (an autoimmune skin disease)

• Seborrheic dermatitis (a chronic inflammatory skin condition)

• Dermatomyositis (a rare disease that inflames muscles and causes skin rash)

Telogen Effluvium Treatment

Telogen effluvium is usually temporary. It tends to start a few weeks to a few months after the event or illness that causes it. Often, no treatment is necessary, as the hair will grow back.

If it lingers, treatment depends on the cause of the condition. You can take a few steps to try to minimize the shedding or recover more quickly. Talk to your healthcare provider before making any significant changes to your routine or starting a home treatment.

Diet and Nutrition

Crash dieting is a common cause of telogen effluvium. Some experts associate hair loss with a weight loss of 20 pounds or more, and it has also been associated with bariatric (weight loss) surgery.⁸

A healthy, balanced diet with adequate amounts of protein, fruit, and vegetables may stop hair shedding and is vital to overall good health.

Hair Care

Try to treat your hair very gently while you're experiencing hair shedding. Vigorous brushing and styling could remove hairs that may typically remain in the follicles if handled delicately. Use hair care products that are gentle on the scalp and hair.

Pharmaceuticals

Over-the-counter (OTC) hair treatments that contain minoxidil may be effective, but the evidence is inconclusive.⁵ If it helps, you must continue using it for as long as the condition is active. When normal hair growth returns, you can stop using minoxidil.

Steroids, usually given in pill form, may help if you have chronic telogen effluvium, meaning it lasts for more than six months.⁵ Talk to your healthcare provider about prescription steroids for excessive hair shedding.

Stress Management

The types of stress that cause telogen effluvium may be physical or psychological. Relaxation techniques like meditation, yoga, and appropriate exercise may help you recover from physical trauma and reduce stress levels, which could lead to restored hair growth more quickly.

Talk to your healthcare provider before starting any exercise routine.

Platelet-Rich Plasma (PRP) Injections

Platelet-rich plasma is a liquid component of blood. In PRP treatments, a person's blood is drawn and spun in a centrifuge to create a layer rich in platelets, which are blood cells active in clotting that contain growth factors. PRP is injected into the skin to stimulate hair follicles.

This treatment has been used for hormone-related hair loss (often in addition to minoxidil or finasteride) and is under study for telogen effluvium.⁹

Hair Supplements

Oral supplements that support hair growth are available OTC. These include Nutrafol and Untangled. They contain a variety of vitamins, minerals, and other substances.

The Food and Drug Administration (FDA) warns that biotin (found in some of these supplements) can interfere with lab tests, which may result in misdiagnosis of health conditions.¹⁰ Biotin has not been proven to be effective for hair regrowth.¹¹ If you are taking a supplement containing biotin, discuss it with a healthcare provider before any blood work.

Some hair supplements contain saw palmetto, which should not be consumed by people who are pregnant or breastfeeding. It can alter hormone levels in the fetus or baby.¹² It may also interfere with oral contraceptives.

High levels of some vitamins and minerals, such as selenium, vitamin A, and vitamin E, are linked to hair loss, so over-supplementation is counterproductive for telogen effluvium.¹³ Talk to your healthcare provider before taking any OTC supplements.

Red Light Therapy

Therapy based on stimulating hair growth with red light from light-emitting diodes (LEDs) or low level lasers has been studied for some types of hair loss, such as after chemotherapy or with hormone-based hair loss.¹⁴ More studies are needed to show it is effective.

Telogen vs. Anagen Effluvium

Telogen effluvium is excessive hair shedding during the telogen, or resting, phase of the hair cycle. Anagen effluvium occurs during the anagen phase, which is the part of the cycle where hair is typically growing from the follicles.

Anagen effluvium is often a side effect of chemotherapy or can be due to immune system reactions. It can also develop from hairstyles that pull on the hair or from harsh hair care products.³

Is Telogen Effluvium Hair Loss Permanent?

Telogen effluvium is not a permanent condition. Usually, the hair grows back within several months of resolving the trigger. In the case of chronic telogen effluvium, the regrowth may take longer, and the shedding may come and go.

Summary

Telogen effluvium is a temporary condition of excessive hair shedding. Fortunately, it usually reverses itself over time. It can be upsetting to see your hair become thinner, but it will very likely go away.

Talk to your healthcare provider if you notice an increase in how much hair is coming out so they may help identify the cause and treat any underlying conditions. In certain cases that last longer than six months, steroids may help.

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By Nancy LeBrun
In addition to her extensive health and wellness writing, Nancy has written about many general interest topics for publications as diverse as Newsweek, Teen Vogue, abcnews.com, and Craftsmanship Quarterly. She has authored a book about documentary filmmaking, a screenplay about a lost civil rights hero, and ghostwritten several memoirs.