Telogen Effluvium

The main symptom is shedding — far more hair than normal, everywhere on the scalp at once. Everyone loses 50 to 100 hairs a day. In telogen effluvium it is often two to three times that, and it is dramatic in the shower and on the pillow.

What it looks and feels like

Where it shows up

• The whole scalp, evenly. This is the defining feature.
• The front and the part line look worst, because that is where thinning shows first.
• Eyebrows and body hair are usually unaffected. If they are involved, something else is likely going on.

How it looks on different skin tones

The shedding itself is the same on every skin tone. What differs is how visible the thinning is: the greater the contrast between hair colour and scalp colour, the more obvious it looks, so dark hair on lighter skin and light hair on darker skin both show it sooner. On tightly curled hair, shed hairs often stay tangled in the rest rather than falling, so the shed can seem to arrive all at once on wash day. That is timing, not extra loss.

Heavy shedding has a few other causes. See Lookalikes near the bottom of this page.

Every hair follicle cycles between growing, resting and shedding. Normally around 85 to 90 percent of your hair is growing and only about 10 percent is resting, and because they are all out of step with each other, you shed a little every day without noticing.

Telogen effluvium happens when a shock to the body pushes a large group of follicles into the resting phase at the same time. A resting hair sits in place for about two to four months before it is pushed out by the new hair growing beneath it. That is why the shedding starts months after the event, and why it stops on its own — the follicles were never damaged, only knocked out of step.

The usual triggers are childbirth, a high fever or serious illness, surgery or general anaesthetic, rapid or extreme weight loss, starting or stopping hormonal contraception, a period of severe stress or grief, an underactive or overactive thyroid, and low iron stores. Some medications do it too. In many people, more than one of these lines up at once.

Most telogen effluvium resolves on its own, and nothing here shortens it much. What is here is worth using if a genuine deficiency is part of your picture, or if you want to cover the thinning while it recovers.

Most telogen effluvium needs no appointment. It is worth booking one if:

• The shedding has been going for more than six months.
• You cannot identify a trigger in the two to four months before it started.
• You are also tired, cold, gaining or losing weight, or your periods have changed — that points at the thyroid or at iron.
• Your part is genuinely widening or your scalp is showing, rather than just shedding.
• There are bald patches, redness, scaling, or soreness. That is a different diagnosis.
• You are shedding after starting a new medication.

What the visit gets you: a pull test that confirms what is happening, the small set of blood tests actually worth doing, and — often the most useful part — someone telling you whether this is telogen effluvium or early pattern hair loss, because those have completely different outlooks.

Prescriptions are not standard for a typical shed. They come into it when a treatable cause is found, or when pattern hair loss turns out to be part of what is going on.

Everything in this band is optional and none of it is proven to shorten a shed. It is worth knowing what is on offer, and what the evidence behind it actually is.

Telogen effluvium does not damage the scalp or the follicle, and it does not cause baldness.

• Missing an underlying cause. This is the real risk. An untreated thyroid problem or genuinely low iron will keep the shedding going and matters for your health beyond your hair.
• Unmasking pattern hair loss. A heavy shed can reveal thinning that was already starting. When the shed ends, most of the hair returns but the pattern thinning stays — and that is a different condition with different treatment.
• Chronic telogen effluvium. In a minority of people, mostly middle-aged women, the shedding runs for years in waves. Hair density usually stays reasonable. It is frustrating rather than dangerous.
• Being sold things you do not need. This is the most common harm on this list. The window between the shed starting and the hair returning is exactly where expensive supplements and treatments get bought, and then get credited with a recovery that was going to happen anyway.
• The psychological cost. Watching hair come out in handfuls is genuinely distressing, and being told it is temporary does not make that go away. It is a fair reason to see someone even when nothing needs treating.

Other things cause hair to come out or thin, and they are handled differently.

• Male or female pattern hair loss — gradual thinning over years, concentrated at the crown or along the part, rather than sudden shedding everywhere. Hair gets finer instead of falling out in handfuls. The two often overlap, which is why a shed sometimes reveals pattern loss that was already there.
• Alopecia areata — sharply edged round bald patches on smooth skin, not diffuse shedding. A diffuse form exists and can look identical, which is one reason a scope is used.
• Traction alopecia — thinning where hair is pulled tight by braids, weaves, extensions or a tight ponytail, worst at the hairline and temples. Early on it regrows. Left long enough, it scars.
• Scarring alopecia — the one that matters. Look for smooth shiny skin with no visible pore openings, redness, scaling or soreness. Those follicles do not come back, so delay costs hair permanently.
• Anagen effluvium — the abrupt hair loss of chemotherapy, which happens within days to weeks rather than months, and involves growing hairs rather than resting ones.
• Hair breakage — from bleach, relaxers or heat. The hairs are short and snapped, with no white bulb on the end. Shed hairs have that bulb; broken ones do not.