Shedding up to 100 hairs a day is normal, but hair falling out in handfuls can be a sign of an underlying problem with your hair growth cycle. One of the most common conditions that cause excessive hair loss is telogen effluvium. This condition can occur in both men and women, but it’s more common in women. To understand this condition and identify it, it’s important to know how the hair growth cycle works. We consulted Laura Palmisano, PA-C, and Diana Palmisano, PA-C of Schweiger Dermatology Group’s Penthouse location in NYC to explain TE.
There are three phases in the hair growth cycle. The first is anagen, where hair follicles are actively growing new hair fibers. About 80 to 90% of the hair follicles on a healthy scalp are in the anagen phase, which can last for several years. After the anagen phase, follicles enter the transitional catagen phase. The final stage is telogen, where dead hair is shed. After 30 days in telogen, follicles return to anagen and growth.
“The telogen phase is the ‘resting phase’ where the hair is not actively growing but rather sitting dormant or ‘resting’ in the follicle,” the Palmisano sisters say. “TE occurs due to early entry of hair in this resting phase (telogen phase). In this phase, telogen hairs begin to rapidly shed.”
Telogen effluvium occurs when more hairs than normal go to the telogen stage and stay there for some reason. This means that more hairs are falling out than usual, and the hair isn’t being replaced with new strands. Luckily, telogen effluvium is usually temporary. Very often, excessive hair loss and thinning can actually be completely reversed with proper treatment. Read on to learn more about the causes, symptoms, and the best telogen effluvium treatments.
What Causes Hair Loss and Telogen Effluvium?
You may already know that stress and hair loss are connected, and the most common trigger of TE is severe stress. An event that “shocks” the hair follicles into the resting stage when they shouldn’t be is the most common cause of telogen effluvium. Hair loss from stress occurs typically 2-3 months after a negatively emotional event, so it may not be immediately evident that stress is the cause of your hair loss.
“TE has been noted to occur after stressful events both physically, environmentally and emotionally,” the Palmisano sisters reveal. “There are many triggers but some most common causes are stress, drugs, and diet. Short-term TE most often happens postpartum to women after giving birth. This is due to a sudden change in hormone levels at birth, shocking the hair follicles leading them to shut down for a period of time.”
“Accidents/physical trauma, crash dieting, and surgery also shock the hair follicles into hibernation,” they continue. “Similarly some drugs do as well, such as antidepressants.”
It’s important to remember that hair loss isn’t caused by only one thing. Telogen effluvium could be caused by several of these, often occurring at the same time.
Telogen Effluvium Symptoms
The most common symptom of telogen effluvium is excessive and alarming amounts of hair loss and shedding. The first signs you might notice are more hair than usual on your pillow or in your drain. You might also find your hair coming out in handfuls during a shower or when you brush your hair—much more than usual. Some of the most significant hair loss is often during washing, brushing, and even running your hands through your hair.
Though some hair loss is normal during these activities, the shedding from telogen effluvium will be noticeably more —and you may find patches of hair thinning. Telogen effluvium hair loss typically does not cause a receding hairline, since the loss can come from all over the scalp. For women, it is often typical for the majority of the loss to be around your hair part. “There is never a complete loss of hair. However, in severe cases, decreased density and volume can be noticeable,” the Palmisanos share.
If you’re worried your hair loss might be telogen effluvium, there are a few tests doctors can perform. Most of the fallen hair will have distinctive, club-shaped roots that are easily visible under a microscope. And if needed to diagnose, a small scalp biopsy can identify the condition and the health of the hair follicles.
Telogen Effluvium Treatments
The good news about telogen effluvium is that it is almost always reversible. “After obtaining a clear and concise history and exam, we reassure our patients that this isn’t permanent,” they say. “Telogen effluvium can become chronic and we encourage supportive care for the scalp. Some in-office therapies include red light treatments and PRP (platelet rich plasma) injections. Other home therapies include a restorative hair vitamin such as Nutrafol, proper diet and self-care, management of stress, and, [if the problem] is ongoing, over-the-counter Minoxidil.”
The Schweiger Dermatology duo shared the story of one telogen effluvium patient who was able to regain her hair wellness with Nutrafol’s natural Core formula. “A female patient in her mid-forties who was healthy, active, extremely fit, career driven, and a busy mother of an adolescent boy embarked on a new job opportunity that required her to become bi-coastal,” they share. “After a few months, the stress from the move and emotional distress from being far away from her son caused her hair to rapidly shed. She suffered terrible telogen effluvium .”
“The telogen effluvium itself caused her to feel so depressed. After failed visits with specialists and various hair loss remedies, she started on Nutrafol. Within 4 to 6 weeks, her hair shedding decreased and new hair began to grow. She resigned from her position and returned to New York to be with her son full time and took a new job. Three years have now passed and she is happy with full, abundant hair! She continues to take Nutrafol on her ‘maintenance’ dose of two pills daily.”
For many short-term cases and those caused by something like surgery, no treatment is required. The shedding should slow and then stop naturally. New hair should regrow in about 3 to 6 months, and you don’t have to do anything.
When it comes to stress-related telogen effluvium, the best treatment is to better manage stress. People have success with meditation, yoga, counseling, reading, or taking walks to help manage stress and hair loss. By better managing your stress, you can reverse telogen effluvium and enjoy healthy hair.
There are many other treatment options depending on the cause, such as:
- An iron-rich diet
- Nutritional supplements
- Non-surgical hair replacement
- Hormone replacement therapy (if the cause is menopause)
- Counseling to address excessive stress
Outlook for Telogen Effluvium
The outlook for telogen effluvium is good. It is a common condition that is most often easily reversible. Even with chronic telogen effluvium, there won’t be complete baldness, and hair regrowth is still possible. If you’re worried your hair loss could be from telogen effluvium, contact your dermatologist to begin treatment options.