Telogen Effluvium: Symptoms, Causes, and Treatments

Most patients report one or more of these well-documented features:

1. Increased daily shedding is seen as full-length hairs appearing in the brush, shower drain, or on the pillow (Headington et al., 1993).
2. Diffuse thinning causes an overall drop in hair density, especially at the crown and along the part line
3. Widened part line makes the scalp more visible in bright light, even when the hairline is preserved
4. Flat, limp texture occurs because fewer growing shafts are present to lift and support the hair
5. White “club” bulbs on fallen strands indicate the hairs exited in the telogen phase, not due to breakage

Women in the 25–45 age range notice diffuse thinning sooner than men because longer hair makes loss more visible. Post-partum shedding triples daily fall-out for six months. In children, common signs usually follow a fever; in seniors, they often track surgery or chronic illness.

Severe telogen effluvium brings dramatic visual change and emotional distress:

• Handfuls of hair come out with gentle tugging, and shedding reaches 300–500 strands per day (Malkud et al., 2015).
• Visible scalp appears in normal room lighting, especially at the crown and temples where density looks sparse
• Prolonged shedding that continues beyond six months is classified as chronic telogen effluvium
(Trueb et al., 2003).
• Emotional impact often includes anxiety, reduced self-esteem, and social withdrawal as hair loss becomes more apparent
• Slowed regrowth occurs when new hairs emerge thinner or later, especially if underlying iron or thyroid issues remain uncorrected

Post-partum women reach peak shedding near month three after delivery. Men with severe metabolic stress (e.g., crash diets) show faster onset but shorter duration. Chronic illnesses such as uncontrolled thyroid disease lengthen the severe phase in all demographics

A minority of patients experience less typical features:

• Loss of eyebrow or body hair suggests an extensive shift of follicles into telogen and indicates a more systemic pattern (Alonso et al., 2017).
• Scalp tenderness or burning without visible rash occur due to nerve hypersensitivity during periods of rapid shedding
• Patchy regrowth in mixed textures appears when new strands differ in thickness or color, especially in recovery phases
• Nail changes such as horizontal ridges (Beau’s lines) develop when systemic stress disrupts both hair and nail growth
• Recurring waves of shedding after minor triggers often signal a diagnosis of chronic telogen effluvium, not just temporary hair loss

Auto-immune conditions, severe nutritional deficits, or genetic clock-gene variants raise the chance of body-hair loss and nail changes. Older adults with multiple medications show more sensory scalp symptoms, while children rarely present rare signs unless systemic illness is severe.

The peak occurs in the shedding phase, roughly three months after the initial trigger. This timing aligns with the natural hair-cycle turnover: follicles need about 90 days to travel from the scalp base to the point where a comb dislodges them. Shedding slows once new anagen hairs push up from underneath, usually visible as fine, 1 cm “baby” strands around the hairline.

Telogen Effluvium is a stress-triggered hair loss where more follicles than normal enter the resting phase, causing diffuse shedding 2–3 months after the trigger.

• Postpartum hormone drop causes a sharp fall in estrogen levels after childbirth, which triggers synchronized shedding. Shedding typically peaks around 12 weeks after delivery.(Malkud et al., 2015).
• Acute viral illnesses, including influenza and COVID-19, activate systemic inflammation that pushes hair follicles prematurely into the telogen phase.(Alonso et al., 2017).
• Crash dieting or rapid weight loss, especially under 1,000 kcal/day, reduces protein and micronutrient supply, which slows follicular metabolism and disrupts the growth cycle.
• Iron or Vitamin D deficiency increases TE risk, with ferritin levels below 30 ng/mL linked to a 2x higher chance of prolonged shedding.
• Seasonal endocrine shifts caused by reduced daylight and melatonin changes in late summer raise TE rates by up to 30%, especially in women. This pattern often remains overlooked during medical evaluations.

How do common causes vary?

In women aged 25–45, hormonal and iron-related causes dominate. In adolescents, illness-induced TE is more common. Males often link TE to crash dieting or viral fever.

Telogen Effluvium is triggered by less common systemic stressors, many of which are overlooked in routine evaluations but disrupt the hair cycle at a cellular level.

• Heavy metal exposure from substances like mercury or arsenic damages follicular stem cells and often goes unnoticed until shedding becomes severe.(Barbieri et al., 2014).
• Zinc–biotin deficiency frequently presents with both hair loss and peri-oral dermatitis, especially in restrictive diets or chronic illness. (Guo et al., 2021)
• Shift-work insomnia and circadian disruption impair clock-gene expression, raising the telogen ratio and delaying regrowth response. (Alam et al., 2022)
• Rapid SSRI withdrawal disturbs serotonin-regulated follicular control mechanisms, resulting in sudden shedding within weeks (Shapiro et al., 2007).
• Chronic gut malabsorption, such as in celiac or Crohn’s disease, lowers nutrient availability over time. In one study, wearable sleep tracking showed a 76% spike in TE episodes among night-shift nurses following schedule rotation—a pattern rarely acknowledged in patient-facing care.

How do rare causes vary?

Rare TE causes appear more in specific occupations (e.g., miners, night-shift staff) and patients with undiagnosed gut issues. Pediatric cases are very uncommon unless linked to toxic exposure or gastrointestinal disease.

Yes. Both physical and emotional stress can directly trigger telogen effluvium by disrupting the natural hair growth cycle.

When the body experiences intense stress—such as illness, trauma, anxiety, or grief—it releases cortisol and inflammatory messengers that interfere with follicle signaling. This pushes a large number of hairs from the growth phase (anagen) into the resting phase (telogen) all at once. Shedding usually starts two to three months after the stressful event.

Even short-term stress can trigger TE if it overlaps with other risk factors like low iron or poor sleep. Studies show that people with high cortisol reactivity shed significantly more during hair-pull tests, especially during periods of acute mental fatigue or emotional instability. In many cases, the person doesn’t connect the stress to the hair loss because of the delayed response.

Hair restoration is rarely needed for telogen effluvium and only becomes a viable option once active shedding has stopped for at least nine months. For residual bald patches that never refill—often after medication-induced or postpartum TE—Sapphire FUE hair transplant relocates stable follicles from the donor zone to restore density permanently

Turkey is popular for high graft counts and cost-efficiency; Vera Clinic in Istanbul pairs Sapphire FUE with oxygen-rich aftercare that boosts graft survival and shortens recovery.

Seek medical care when shedding lasts longer than six weeks, exposes scalp in normal light, or comes with burning, itching, or loss of eyebrows and lashes. These red-flag symptoms indicate iron-deficiency anemia, thyroid disease, or autoimmune activity rather than routine post-stress shedding; early evaluation allows lab tests and targeted therapy before density drops further.

A hair analysis should be taken if shedding exceeds 100–150 hairs per day for more than 3 months, especially if the trigger is unknown or the scalp begins to show through the hair.

Hair analysis reveals the anagen-to-telogen ratio, helping differentiate Telogen Effluvium from conditions like diffuse alopecia areata or early-stage androgenetic alopecia. In healthy scalps, over 85% of follicles are in the growth phase. If analysis shows more than 25–30% in telogen phase, it’s diagnostic of TE. Trichoscopy detects miniaturization, scaling, or perifollicular discoloration, which TE alone does not cause. These distinctions are crucial for treatment decisions—especially when TE overlaps with deficiencies like ferritin 30 ng/mL, TSH abnormalities, or low vitamin D.

Telogen effluvium diagnosis is made through a combination of patient history, physical examination, and tests that evaluate the proportion of hair in the shedding phase.

• Medical History: Reviewing the patient’s recent health events links illness, childbirth, crash diet, medication change, or acute stress (≤ 3 months) to the onset of shedding and serves as the first-line step for every TE case.
• Physical Examination: Clinical inspection of the scalp checks for diffuse, non-scarring thinning and rules out inflamed or patchy alopecias that mimic TE
• Hair Pull Test: Performing a gentle traction on 50–60 hairs reveals telogen activity if more than 10% release easily (Rebora et al.); the test is repeated during follow-ups to assess progress.
• Trichogram / Hair-Root Analysis: Microscopic examination of plucked hairs quantifies growth phases; telogen bulbs over 25% support TE and the test is used when diagnosis is uncertain or shedding persists beyond eight weeks.
• Phototrichogram: Capturing two high-resolution images of the same 1 cm² scalp area 48 hours apart helps measure new growth and cycling; this method is ideal for monitoring recovery in subacute or chronic TE.
• TrichoScan: Using software-assisted dermoscopy, TrichoScan calculates hair density and shaft diameter to distinguish chronic TE from early androgenetic alopecia (Hoffmann et al.); it’s recommended when shedding lasts longer than six months or miniaturization appears.

Yes. Consistent sleep-wake schedules, early-morning daylight, balanced macronutrients, and daily stress-relief practices (yoga, box breathing, brisk walks) lower cortisol and nudge resting follicles back into growth. People who track their heart-rate variability and keep it above 70 ms—an easy target with regular exercise and mindful breathing—often see a shedding plateau two weeks sooner than those who focus only on topical care.

Early telogen effluvium regrowth signs include delicate “peach-fuzz” sprouts along the part, tighter grip when gathering a ponytail, and fewer strands released during gentle pull tests; these changes usually surface by week eight when lifestyle tweaks accompany medical fixes like iron or thyroid correction.

Yes, but only as supportive care. Telogen effluvium home remedies—iron-rich meals, midday vitamin D, 180-rpm scalp massage, and caffeine or rosemary rinses can shorten the shedding phase once the main trigger has been fixed.

Night-shift nurses who paired morning sunlight and breathwork with dietary changes lost hair for two weeks less than those relying on food alone, underscoring that routine tweaks matter more than any single “miracle oil” (2023 sleep-tracker study).

Follicles still need basics such as ferritin above 30 ng/mL and balanced thyroid hormones; without those, telogen effluvium self-care rarely lifts density past baseline. People who blend these habits with doctor-guided therapy usually spot baby hairs at the hairline by week eight, while those leaning on home remedies alone often wait three to four months longer for comparable coverage.

Most cases of telogen effluvium last between 3 to 6 months, with active shedding peaking around week 12 and gradually tapering off as new hair enters the growth phase. However, the duration depends on the underlying cause and whether it’s been fully addressed.

Acute TE—caused by one-time events like surgery, fever, or childbirth—typically resolves within 6 months. In contrast, chronic TE, often linked to ongoing issues like iron deficiency, thyroid imbalance, or emotional stress, persist for 9 months or longer.

So how long does telogen effluvium last depends on the specific condition and the patients. Some patients see regrowth within 8 weeks, especially if ferritin levels normalize quickly or topical treatments are started early. Others continue to shed intermittently if triggers like poor sleep, crash dieting, or unresolved anxiety remain—factors often missed in rushed clinical exams but frequently reported in long-term TE cases.

1. Acute Telogen Effluvium

Acute TE begins suddenly after a one-time shock—high fever, childbirth, or surgery—and lasts fewer than six months. It accounts for roughly 70 % of all TE cases seen in dermatology clinics, with postpartum shedding the largest subgroup. Once the trigger is removed, follicles re-enter growth together, so regrowth is often clear by month three. Fever-driven cytokine surges, rapid estrogen drops, or blood-loss anemia typically set it off, and shedding peaks near week 12 before tapering as new hairs push through.

Once the trigger is removed, follicles re-enter growth together, so regrowth is often clear by month three. Fever-driven cytokine surges, rapid estrogen drops, or blood-loss anemia typically set it off, and shedding peaks near week 12 before tapering as new hairs push through.

Acute TE is not contagious; only the precipitating illness (for example, flu) spreads. Density loss shows as a “see-through” crown, yet cosmetic volume usually rebounds within six months—especially in postpartum women whose ferritin climbs above 80 ng/mL during recovery, a detail that often predicts two-week faster regrowth.

2. Subacute Telogen Effluvium

Subacute TE sits between acute and chronic forms, with shedding that resolves in six to nine months but arrives in two noticeable waves. It appears in about 15% of TE patients, frequently after back-to-back stressors such as an infection followed by crash dieting.

Shedding lasts longer than in acute TE yet still ends on its own, whereas chronic TE continues or relapses past nine months. Sequential triggers keep follicles in rest—first illness, then nutritional strain—so many notice a second shed just when they expect recovery.

Subacute TE is not transmissible. Volume improves more slowly than in acute TE; some strands regrow finer for one cycle, a change often mistaken for permanent thinning.

3. Chronic Telogen Effluvium

Chronic TE is defined by persistent or recurring diffuse shedding that continues for longer than nine months. It represents roughly 10–15 % of TE cases and is more common in women over forty who have low-grade iron deficiency or subtle thyroid drift. Shedding ebbs and flows rather than stopping, meaning density gains lag because new hairs enter growth while others keep falling.

Ongoing Chronic Telogen Effluvium factors—subclinical hypothyroidism, shift-work sleep disruption, or ferritin that never climbs past 50 ng/mL—maintain a high telogen ratio, and patients describe “good weeks and bad weeks” instead of a single peak.

Chronic TE itself is not contagious; however, household members sharing night-shift schedules or restrictive diets face similar risk. Extended shedding shrinks ponytail diameter by up to 30 %, and density often dips further in late summer when shorter daylight subtly lowers melatonin—a seasonal pattern rarely highlighted yet noted in long-term cohort logs.

Telogen effluvium (TE) is a diffuse, reversible hair-shedding disorder triggered by metabolic or emotional stress, whereas most other alopecias show focal loss, scarring, or direct follicle damage. It differs from other types of hair loss in many ways.

Unlike alopecia areata, TE leaves follicles intact and the scalp skin normal; unlike traction alopecia or trichotillomania, it is not caused by mechanical force; and unlike tinea capitis or scarring alopecias, it produces no inflammation, scaling, or permanent follicle destruction.

Shedding in TE peaks 8–12 weeks after the trigger, then resolves once iron, thyroid, or cortisol levels normalise—making it the only common alopecia that “times out” predictably once the body’s stress chemistry resets.