Telogen effluvium is a type of temporary hair shedding caused by stress, shock, or trauma. Research suggests it’s the most common cause of diffuse non-scarring alopecia (androgenetic alopecia also known as pattern baldness remains the number one cause of general hair loss for both genders) [1]. Unfortunately, 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 [2].
So how can you tell if you have telogen effluvium (TE), either as a result of emotional stress, COVID-19, or another underlying condition? Learn more about telogen effluvium, including the symptoms, causes, and treatments.
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:
Examples of patients experiencing diffuse hair loss from telogen effluvium. Image credit: Wiley Online Library
Telogen effluvium sometimes occurs alongside trichodynia, another stress-related hair and scalp condition. Trichodynia is characterised by pain and itchiness on the scalp.
Some hair loss is normal, especially when washing your hair. Find out how much hair loss in the shower is normal.
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 [3]. 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 hair to prematurely enter the telogen hair phase [3]. 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.
Severe stress or emotional shock is one of the biggest contributors to telogen effluvium. Grief, depression, or psychological trauma can all cause TE. The onset of telogen effluvium is usually delayed, with hair loss usually occurring around 3 months after the trigger event [1]. 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 telogen effluvium. This includes surgery, childbirth, and significant or sudden weight loss (typically as a result of anorexia nervosa). Find out more about hair loss after surgery.
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 telogen effluvium [4]. Dosage can also impact hair 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 to telogen effluvium. These include the following:
It should be noted that 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.
Since telogen effluvium 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 [3]. 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. This might be due to the nature of female hair loss which tends to have a greater psychological impact. This personal impact is believed to lead to higher levels of reporting in addition to the link between telogen effluvium and postpartum hair loss [2].
Telogen effluvium has been reported in a number of patients recovering from COVID-19 and is a major cause of hair loss after Covid [5]. However, the exact nature of the relationship is still up for debate. It’s thought that the physiological stress of recovering from COVID-19 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 can look similar to other types of hair loss (particularly alopecia areata and female pattern hair loss, 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:
Telogen effluvium can cause you to lose between 30% and 50% of your hair [6]. A hair pull test or wash test can indicate what proportion of hair you’re currently shedding.
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 hair thinning is due to acute telogen effluvium or chronic telogen effluvium.
Individuals suffering from acute telogen effluvium can expect to see hair growth around 3 months after the onset of hair shedding. Unfortunately, in individuals suffering from chronic telogen effluvium, hair regrowth probably won’t be seen until at least 6 months after the onset of TE [7].
Hair can take a while to regrow following telogen effluvium, but it usually regrows at the same rate as the rest of your hair.
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 telogen effluvium [1].
Chronic telogen effluvium is often associated with chronic illnesses, such as hypothyroidism, although in some cases there appears to be no trigger [1].
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.
If you can pinpoint the reason for your hair shedding, 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, for example, you are suffering from conditions such as an iron deficiency or hypothyroidism. They can also advise on whether you can adjust your medication dosage to manage telogen effluvium.
Research suggests that acute TE is self-limiting, and can stop by itself after around 6 months [3]. If you wait it out, you may see hair growth from this time just by letting the hair follicles pass through the telogen stage into the growth phase of the hair cycle.
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 [3]. 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 [8].
Studies also suggest MSM can improve hair loss symptoms caused by telogen effluvium. MSM, or methylsulfonylmethane, is a supplement that has antioxidant properties and can minimise hair breakage.
Diet is a factor in many telogen effluvium 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. Learn more about if vitamins for hair growth actually work.
When your hair begins to regrow after telogen effluvium, it typically grows back at the same rate as the rest of your hair. Unlike other forms of hair loss, telogen effluvium doesn’t damage the hair follicle. Therefore, when the telogen phase is complete, most of the hair 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.
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 hair regrowth process — so book your hair loss consultation today to learn more about what you can do to help stimulate hair growth.
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