Telogen Effluvium

Telogen effluvium.  It sounds so much more intriguing than stress related hair loss.  Everyone likes cool names.  Physicians are no different.  The closest I got to taking a Latin class in college was a Classics for Jocks class where a professor fond of helping football and hockey players with a passing grade in a fun class taught a course on the classic Latin and Greek literature.   Still, I like the sound of Latin sounding names for medical conditions, especially when I can both remember and spell them.

I enjoy telling my patients who have this condition what is going on because it’s an interesting condition, it’s not serious, it gets better with time and patients can easily understand the cause and course of the problem. This week in the office a very pleasant woman came in with this condition, and although not happy to hear that there was nothing I could do to help, she at least appreciated a diagnosis, and was relieved to hear that her hair would grow back.

Each hair on our body has two major periods in its lifespan. Each hair starts growing and continues to grow for an average of 3 years, the phase called anagen.  Then the growth stops, and the hair follicle enters the phase called telogen.  At any one time 5-10% of a person’s hairs are in telogen.  After about 3 months, and this period of time varies widely from one person to another, the hair in telogen falls out as a club hair.  It’s called this because the root of the hair if looked at microscopically has a rounded, thickened, club-like appearance.  A hair pulled out in anaphase has a ragged, ripped-out looking root microscopically.   On average 1-200 scalp hairs are shed daily. I don’t think I have enough hair left to lose that many.

Certain major stresses and conditions can shock a large percent of the body’s hairs to stop growing and enter telophase simultaneously.  This phenomenon is called telogen effluvium.  When this happens, a few months later a large percentage of an individual’s hair can be shed as club hairs over a few weeks or months period of time.  It can be very disturbing to the person losing their hair.  The classic stress to cause this is childbirth, and in the days when I did maternity care it was not uncommon for me to see women in the office a few months after delivery distraught that they were losing lots of scalp hair.  Other stresses that can cause this are major surgery, high fever, serious illness, major emotional stress, and rapid weight loss.  Medical conditions associated with telogen effluvium are anorexia nervosa, iron deficiency, hypothyroidism, and the sudden conditions mentioned above.

This is a good news/ bad news situation to tell patients about.  The good news is that it is completely reversible, and usually resolves in a few months.  The bad news is that is quite a while before the hair grows back, and that there is nothing to do to speed the process along.  In my experience although many patients come to the office thinking hypothyroidism is the cause of their hair loss this is very rarely the problem.  Emotional of physical stresses are more common causes.

If there is anything good about telogen effluvium, it’s that it has a cool name, and you can impress your friends by telling them a snazzy name for your condition.  You might as well take advantage of the little things.  There’s not much else you can do except wait for your hair to grow back.

11 Responses to Telogen Effluvium

  1. Hello Doctor,
    I was diagnosed with Telogen Effluvium from cessation of my birth control pill. It was like clockwork, I stopped the pill, 3 months later my hair fell out. It lasted for 3-4 months, and it is now shedding normally.

    I dont see all of it growing back yet, only some of it. Will it most likely grow back in more time? It has only stopped shedding two months ago.

  2. Shellie: These are questions I cannot try to answer in this forum. Without examining him it is really tough to give you advice. You may want to seek another opinion or see your doctor again and be more insistent about getting your concerns addressed. DrP.

  3. My son (almost 2) has been diagnosed with telogen effluvium due to constant viruses he had back to back. It has now been 10 weeks and while we see some thickening it is still thin in a lot of areas. He had thick thick thick hair before. The texture of his hair has changed and it seems very dry and he has lots of fly aways. Is this normal? Also, the length is growing. We fohawk his hair so you cant really see his scalp and he now looks like a rooster its so long when we do that. Is that normal with telogen effluivium? We had one dr tell us he has alopecia totalis and would loose all his hair in 3 months (said this without examining him and just standing accross the room). Thanks for your help

  4. My sons is 4 his hair fell out when he was 3 it took a yr to grow back and now its falling out again help me please

  5. hey, i experienced major hair loss because of my stupid diet (i was anorexic) – i got diagnosed in oct 2010 and have since then started eating and re gained weight. by March 2011, my hair had really started growing back, lots of little baby hairs and only a few longer hairs coming out but since April, the baby hairs have started coming out, everytime i brush or wash my hair, i seem to be shedding all my new hairs 🙁 i have been checking online and on a few sites notice that it mentions the first re growth after anorexia will consist of fine hairs which will grow a couple of inches and then shed again in order for healthier hairs to grow back in their place? is this true? if yes then guess i will keep waiting but are you able to tell me when this shedding of new hairs will stop as it has been ongoing for 3 months no? Thanks and sorry for the long winded post! x

  6. Sounds like you made a good choice to visit your doctor. I cannot give individual help on this site, but telogen effluvium related to the wt loss is almost certainly in the list of things to consider.

  7. Hey Doc, I’m a 17 year old male. Over the past couple of months, I’ve been experiencing RAPID hair loss. Last June, I went on what I would call a crash diet, and I lost about 45 pounds in 3 months. Then December/Januaryish, I noticed some shedding, then lots and lots of shedding. Each of the fallen hairs has a white bulb on the end of them, and when I do the pluck test(which works on all of my scalp EXCEPT for a 1 inch thick section on the very back of my scalp) I get at least 5 hairs. I got eleven last time. I went to my doctor on Tuesday, and he thinks I have a thyroid condition (cold hands and feet, 56 bpm pule rate, insomnia, fatigue, the works) This is a big deal to me and I really want some insight.
    Thanks!

  8. Good questions without good answers. In my experience the trigger for this phenomenon is usually short term, not an ongoing event, and the hair loss persists for a few months, then nothing for a few months, and hair regrowth over a year or two. I didn’t research for this answer though. If you have longer term hair loss I’d see your doctor to evaluate for other possible causes. Good luck.

  9. Hi Dr. Pullen,
    How long does it take for the telogen hair to regrow? Also, will it not grow until the trigger has been eliminated. For example if the Telogen Effluvium was triggered by emotional stress, will the hair that has been shed only regrow once the stress has been eliminated?

    Thanks,
    John

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