Telogen effluvium is a type of temporary hair loss caused by stress, shock, or trauma. Research suggests it’s the most common cause of diffuse non-scarring alopecia (pattern baldness remains the number one cause of general hair loss for both genders) . And the Covid-19 pandemic appears to have exacerbated the problem, with doctors seeing a rise in the number of patients recovering from Covid-19 who have been diagnosed with telogen effluvium .
So how can you tell if you have telogen effluvium (TE), either as a result of emotional stress, Covid, or another underlying condition? Learn more about telogen effluvium, including the symptoms, causes, and treatments.
What are the symptoms of telogen effluvium?
Unlike male pattern baldness, which is characterised by hair loss in specific areas (namely the crown and temples), TE usually manifests as hair loss across the scalp.
The main symptoms are:
- Thinning hair
- Bald patches that don’t follow typical patterns for androgenetic alopecia (male or female)
- Seeing unusually large clumps of hair in the shower drain, or on your hairbrush or pillow.
Examples of patients experiencing diffuse hair loss from telogen effluvium. Image credit: Wiley Online Library
Some hair loss is normal, especially when washing your hair. Find out how much hair loss in the shower is normal.
What causes telogen effluvium?
Telogen effluvium happens when a higher than normal number of hairs enter the telogen (shedding) phase of the hair growth cycle.
On a healthy scalp, approximately 85% of hairs are in the anagen (growth) or catagen (resting) phase, with the remaining 15% in the telogen phase . Most people shed 50-100 hairs a day — this is a normal amount of hair loss.
Someone with telogen effluvium will see a much higher rate of hair loss. Stress can cause up to 70% of anagen hairs to prematurely enter the telogen phase . When a significant proportion of your hair enters the shedding phase, you’ll see noticeable hair loss. This is known as telogen effluvium, and it can be triggered by many different events or conditions.
Emotional shock and stress
Severe stress or emotional shock is one of the biggest contributors to TE. Grief, depression, or psychological trauma can all cause TE. The onset of TE is usually delayed, with hair loss usually occurring around 3 months after the trigger event . As a result, the cause of your hair loss may not be immediately obvious, causing additional worries.
Events that cause physical trauma to your body can also trigger TE. This includes surgery, childbirth, and significant or sudden weight loss (typically as a result of anorexia nervosa).
Certain medicines can cause sudden hair loss. The contraceptive pill, anticoagulants, beta-blockers, and high doses of vitamin A or other retinoids have all been linked with TE . Dosage can also impact shedding, so you may see higher levels of hair loss if you start taking a higher dose of your medication.
A number of illnesses have been linked with TE. These include anaemia; hypothyroidism; hyperthyroidism; HIV; malaria; tuberculosis; and typhoid . While some of these diseases are rare in the UK, they persist elsewhere in the world, so it’s important to minimise the risk of contracting them when you travel.
Who can get telogen effluvium?
Since TE is caused by external risk factors like significant emotional stress and physical trauma, there’s little evidence to suggest that people of certain ages or genders are more at risk . That means telogen effluvium can affect anyone.
The condition appears to be more common in women, but this is mostly due to underreporting in men (female hair loss tends to have a greater psychological impact, leading to higher levels of reporting), and the link between telogen effluvium and postpartum hair loss .
Can Covid-19 cause telogen effluvium?
Telogen effluvium has been reported in a number of patients recovering from Covid, and is a major cause of hair loss after Covid . However, the exact nature of the relationship is still up for debate. It’s thought that the physiological stress of recovering from Covid can lead to temporary hair loss, as it may be linked to the severity of the condition.
Other potential causes are increased hair washing to prevent the virus from spreading, and lack of sleep associated with recovery anxiety.
Telogen effluvium diagnosis
Telogen effluvium can look similar to other types of hair loss (particularly alopecia areata and female pattern baldness, which are also often evenly spread across the scalp, as well as some types of scarring alopecia). As a result, a doctor or trichologist needs to conduct specific tests to diagnose telogen effluvium.
Common tests include:
- Scalp examination — this shows the extent of hair loss, and can diagnose TE vs alopecia areata, which tends to have a more patchy distribution 
- Hair pull test — this helps differentiate between TE and pattern baldness (TE has a positive hair pull result, while pattern hair loss has a negative result)
- Wash test — counting the amount of hair lost during washing can indicate TE or another cause
- Blood test — this can help diagnose a potential underlying cause, such as hypo/hyperthyroidism or anaemia
- Verbal test — a specialist will ask if you’ve experienced any triggering events in the last few months.
How much hair will I lose from telogen effluvium?
Telogen effluvium can cause you to lose between 30% and 50% of your hair . A hair pull or wash test can indicate what proportion of hair you’re currently shedding.
How long does telogen effluvium last?
Telogen effluvium is a temporary condition, but it can last for some time. It usually lasts between 3 months and several years, depending on the trigger and whether the condition is acute or chronic.
Acute sufferers can expect to see hair growth after around 3 months. If the condition is chronic, most people don’t see regrowth until at least 6 months after the onset of TE .
Hair can take a while to regrow following TE, but it usually regrows at the same rate as the rest of your hair.
What is chronic telogen effluvium?
Telogen effluvium is typically acute, and the effects end within a few months. However, in rare cases, the condition is chronic. That means it lasts much longer, with some patients reporting continuing hair loss years after diagnosis. A case of TE that lasts longer than 6 months is usually considered chronic .
Chronic TE is often associated with chronic illnesses, such as hypothyroidism, although in some cases there appears to be no trigger .
How to treat telogen effluvium
There is currently no treatment or cure for telogen effluvium. However, because the condition is temporary, there are things you can do to reverse the effects and promote hair growth.
Address the underlying cause
If you can pinpoint the reason for your TE, you can address this to speed up recovery. You may be able to address psychological factors with therapy, counselling, and/or medication. A doctor can diagnose and treat any underlying conditions (such as iron deficiency or hypothyroidism). They can also advise on whether you can adjust your medication dosage to manage TE.
Let it run its course
Research suggests that acute TE is self-limiting, and can stop by itself after around 6 months . If you wait it out, you may see hair growth from this time just by letting the follicles pass through the telogen stage into the growth phase.
Hair loss prevention drugs
Minoxidil has been proposed as a solution to speed up hair regrowth in those with telogen effluvium. This topical hair loss solution may prolong the anagen phase of the hair growth cycle, preventing hairs from entering the shedding phase prematurely . While more practical research is needed to confirm this link, one study suggests that minoxidil may also reduce hair shedding in those with chronic TE .
Eat a balanced diet
Diet is a factor in many TE triggers. Whether your TE is due to sudden weight loss, iron deficiency, or excessive vitamin A consumption, you may need to make dietary adjustments to speed up the recovery process. Eating a balanced diet can also keep the rest of your hair looking and feeling healthy, so it’s a vital part of any hair restoration strategy.
There’s limited evidence to suggest that vitamin supplements can improve telogen effluvium symptoms. Find out more in our complete guide to hair supplements.
How long does it take for hair to grow back after telogen effluvium?
When your hair begins to regrow after TE, it typically grows back at the same rate as the rest of your hair. TE doesn’t damage your hair follicles, so when the telogen phase is complete, most of the follicles should return to the growth phase, and start producing healthy hair again.
Depending on the length of your hair, it can take weeks or months for your hair to regrow completely.
What to do if you’re experiencing hair shedding
While TE is temporary and reversible, any kind of hair loss can cause significant distress. If you see excessive amounts of hair shedding — either in the shower or on your pillow — it’s time to talk to a trichologist. They’ll be able to diagnose the cause of your hair loss and put you on the road to recovery.
The sooner you get your hair loss checked out, the sooner you can start the regrowth process — so book a free hair loss consultation today.
- Telogen Effluvium: A Review
- A systematic review of acute telogen effluvium, a harrowing post-COVID-19 manifestation
- Telogen Effluvium
- Telogen Effluvium: A Review of the Literature
- Trichodynia and telogen effluvium in COVID-19 patients: Results of an international expert opinion survey on diagnosis and management
- Diagnosing and Treating Hair Loss
- Disorders of Hair
- Treatment of chronic telogen effluvium with oral minoxidil: A retrospective study
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