Telogen Effluvium: Here’s How to Tell If Your Hair Loss Is From Stress (With Images)

It’s normal to lose about 50 to 100 hairs a day. But what if you notice clumps of hair in your brush or shower drain? 

There’s a common type of temporary hair loss called telogen effluvium, or hair shedding. This hair thinning can affect anyone at any age, but it seems to be more common in women. 

Telogen effluvium is reversible, and most people experience complete hair regrowth within 6 to 9 months. 

Why does telogen effluvium happen?

Telogen effluvium usually happens about 3 months after some type of stress or change in the body.

To understand why telogen effluvium happens, it helps to know how the normal hair cycle works. In a healthy scalp, most hairs are in a growing phase (anagen), while about 15% are in a resting phase (telogen). After about 4 months in the resting phase, a new hair begins to grow underneath and pushes the resting hair out.

When the body experiences a serious stressor, many scalp hairs can suddenly switch from the growing phase to the resting phase. After 3 or 4 months, all the hairs in the resting phase fall out around the same time as new hair starts to grow in, leading to hair shedding. And when this happens, you may notice that your hair looks thinner.

What causes telogen effluvium?

The kinds of stressors that cause telogen effluvium can be physical and emotional. Some examples include:

• Serious infection or illness, like from COVID

• Surgery

• Emotional stress or trauma

• Childbirth

• Crash diets or starvation

• Malnutrition or low protein intake

• Hypothyroidism or hyperthyroidism

• Low iron levels (iron deficiency) 

• Certain medications, like beta blockers, isotretinoin, and carbamazepine

What do symptoms of telogen effluvium look like?

Hair loss during telogen effluvium usually involves less than half of your scalp hair. But you can still lose anywhere from 300 to 500 hairs a day. And this can show up as clumps of hair on your pillow, in your hairbrush, or in your shower drain. You may also notice that hair falls out easily when you run your hand through your hair. 

But telogen effluvium isn’t always noticeable. You may notice hair thinning gradually over time. This can be throughout the whole scalp, or focused in certain areas, like your temples. You can take pictures of your hair to get a better idea. Here are some images of what telogen effluvium can look like.

Telogen effluvium isn’t linked to other symptoms, like scalp flaking, itching, redness, or any type of rash. In fact, people with telogen effluvium typically have a healthy scalp.

How do you diagnose telogen effluvium?

Your primary care provider or dermatologist can usually diagnose telogen effluvium just by asking you some questions about your recent health and examining your scalp.

They may also do a hair “pull test” in several parts of your scalp. This involves gently tugging on a clump of about 50 hairs. If three or more telogen hairs consistently come out with each pull, this could mean telogen effluvium. 

In rare situations, you might need a skin biopsy in the area of hair loss to confirm the diagnosis and make sure hair loss isn’t happening for another reason (like alopecia areata or androgenic alopecia).

You may also need bloodwork to make sure your hair shedding isn’t caused by an underlying condition, like hypothyroidism or iron deficiency.

How is telogen effluvium different from alopecia and other types of hair loss?

There are many causes of hair loss beyond telogen effluvium. Getting the diagnosis right will help you know what to expect and get the best treatment. 

Here are some other common causes of hair loss and how they compare to telogen effluvium.  

Alopecia areata

Alopecia areata is an autoimmune condition that causes hair loss. Hair loss happens in coin-sized round patches. 

Androgenic alopecia 

Androgenic alopecia (female- or male-pattern hair loss) is the most common type of hair loss. It is caused by a combination of age and genetics. In women, this hair thinning typically starts at the top of the scalp. In men, it typically starts at the front hairline.

Traction alopecia

Traction alopecia is hair loss that happens as a result of pulling, like from tight hairstyles. Often you can see hair thinning around the hairline (near the edges of the scalp). 

How long does hair loss from telogen effluvium last?

Hair loss from telogen effluvium can last anywhere from 3 to 6 months. Hair will start to grow back after this. But it may take several months more for your hair volume to feel normal again — especially if your hair is longer. Most people will regain all of their hair within 6 to 9 months.

How do you treat TE? 

Most cases of telogen effluvium improve on their own without any treatment. There’s no specific treatment for telogen effluvium other than patience.  

If hair shedding is caused by a specific underlying condition, then treating that cause will help hair volume return to normal. 

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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