Telogen Effluvium
Telogen effluvium (TE) is a condition in which a larger than normal number of hair follicles enter the resting (telogen) phase of the hair cycle at the same time, leading to increased shedding.
Importantly:
-
The hair follicles are not scarred or permanently damaged
-
They remain alive and capable of producing new hair
This means that:
Although shedding can be significant, regrowth is expected in most cases once the cycle normalises.
It is one of the most common causes of sudden hair shedding.
For many people, the experience feels unexpected:
-
“My hair is coming out everywhere”
-
“It feels like I’m losing handfuls”
Even though the underlying process is usually temporary, the change can feel dramatic.
What Is Actually Happening in Telogen Effluvium?
Hair grows in a cycle:
-
Anagen (growth phase)
-
Catagen (transition phase)
-
Telogen (resting/shedding phase)
At any given time, most hairs are in the growth phase (anagen).
In Telogen Effluvium
-
A trigger causes a shift in the hair cycle
-
More hairs than usual enter the telogen phase
-
These hairs are then shed around 2–3 months later
Why This Matters
There is usually a delay between cause and effect.
For example:
-
Illness in January
-
Shedding begins in March
This delay often makes it difficult to connect the trigger to the hair loss.
Key Point
Telogen effluvium is a timing problem in the hair cycle, not damage to the follicle.
The follicles remain intact and capable of regrowth.
What Does Telogen Effluvium Look Like?
Telogen effluvium typically presents as:
-
Diffuse shedding across the scalp
-
Increased hair fall when:
-
Washing
-
Brushing
-
Running fingers through hair
-
What Patients Often Notice
-
Hair coming out more than usual
-
More hair on pillows, in the shower, or on clothing
-
A reduction in overall thickness
-
A thinner ponytail
What You Don’t Usually See
-
No completely bald patches
-
No scarring
-
Hairline usually preserved
This helps distinguish it from other types of alopecia.
What Causes Telogen Effluvium?
Telogen effluvium is triggered by a disruption to the body’s normal balance.
Common Triggers
Physical Stress
-
Illness (including COVID-19)
-
Surgery
-
Significant weight loss
-
Nutritional deficiency (e.g. low iron)
Hormonal Changes
-
Postpartum period
-
Starting or stopping contraception
-
Thyroid dysfunction
Psychological Stress
-
Acute stress
-
Major life events
Medications and Treatment Changes
-
Certain antidepressants
-
Beta blockers
-
Retinoids
Hair Loss Treatment Changes
Changes in hair loss treatments can also trigger shedding:
-
Stopping minoxidil can lead to increased shedding
-
This reflects a shift in the hair cycle rather than damage
-
Similar shedding can occur when starting or stopping treatments that influence the hair cycle
This can feel concerning, but is usually temporary and self-limiting.
Important Point
In many cases:
-
A trigger can be identified
-
But sometimes no clear cause is found
Acute vs Chronic Telogen Effluvium
Acute Telogen Effluvium
-
Lasts less than 6 months
-
Often follows a clear trigger
-
Usually resolves over time
Chronic Telogen Effluvium
-
Persists beyond 6 months
-
May fluctuate
-
Often no clear ongoing trigger
If You Are Experiencing This — What Should You Do?
If you are noticing increased shedding, it is reasonable to seek assessment, especially if:
-
Shedding is ongoing
-
You are unsure of the cause
-
There are other symptoms (e.g. fatigue)
This allows:
-
Confirmation of diagnosis
-
Identification of potential triggers
-
Exclusion of other causes
Not all hair shedding is telogen effluvium — and accurate diagnosis matters.
How Is Telogen Effluvium Diagnosed?
Diagnosis is usually clinical, based on pattern and history.
Clinical History
-
Increased shedding
-
Onset 2–3 months after a trigger
Pattern
-
Diffuse thinning
-
Preserved hairline
-
No evidence of scarring on Trichoscopic examination
Hair Pull Test
-
May be positive
Trichoscopy
-
Increased telogen hairs
-
Uniform shaft diameter
Blood Tests
Used where appropriate:
-
Ferritin
-
Thyroid function
-
Other relevant markers
Diagnostic Nuance
Telogen effluvium can:
-
Overlap with other conditions (e.g. androgenetic alopecia)
-
Mask underlying pattern hair loss
This is why persistent symptoms should be assessed.
The Emotional Impact — and Why It Matters
Telogen effluvium can feel extremely distressing, particularly because of the amount of shedding.
Even when the process is temporary, people often experience:
-
Anxiety
-
Loss of confidence
-
A sense of loss of control
This is understandable.
For many people, reassurance and understanding the process can help reduce that uncertainty.
Which Treatments for Telogen Effluvium Actually Work?
In most cases, treatment focuses on addressing the underlying cause.
1. Identify and Correct the Trigger
-
Nutritional deficiencies
-
Hormonal imbalance
-
Medical conditions
2. Time and Reassurance
-
Shedding often improves gradually
-
Regrowth typically follows
3. Minoxidil (Selected Cases)
-
May support regrowth
-
More relevant if overlapping with androgenetic alopecia
4. Supportive Measures
-
Adequate nutrition
-
Gentle hair care
-
Avoid unnecessary hair trauma
A Realistic Perspective
Telogen effluvium is not:
-
a scarring condition
-
a condition that destroys follicles
It is:
-
a temporary disruption of the hair cycle
With time, most people see recovery because the follicles remain capable of regrowth.
Which Approach Is Right for You?
This depends on:
-
Duration of shedding
-
Presence of triggers
-
Whether other conditions are involved
A Practical Framework
-
Confirm diagnosis
-
Identify trigger
-
Address underlying cause
-
Monitor recovery
Ongoing Monitoring
Follow-up may be helpful to:
-
Confirm improvement
-
Ensure regrowth
-
Reassess if shedding continues
Key Point
Telogen effluvium is:
-
Common
-
Often temporary
-
Non-scarring
If there is one takeaway:
The follicles remain intact, and regrowth is expected in most cases.
In Summary
Telogen effluvium is a disruption of the hair growth cycle leading to increased shedding.
It is usually triggered by a physiological or psychological stressor and is often reversible.
Because the follicles are not damaged, hair regrowth is expected in the majority of cases.
Frequently Asked Questions
How long does telogen effluvium last?
Usually up to 6 months, though recovery may take longer.
Will my hair grow back?
Yes, in most cases. The follicles remain intact.
Why did shedding start months after a trigger?
Because of the delay in the hair cycle.
Can stopping minoxidil cause shedding?
Yes. This reflects a change in the hair cycle, not damage to the follicles.
Can it become permanent?
This is uncommon.
Do I need treatment?
Not always — many cases resolve naturally.
Authored by: Dr Gwen Adey BDS MFDS RCS
Date first published:
Androgenetic alopecia (pattern hair loss) is a progressive condition in which susceptible hair follicles gradually shrink in response to androgens—particularly dihydrotestosterone (DHT). This leads to shorter, finer hairs and, over time, visible thinning across characteristic areas of the scalp.
It is the leading cause of hair loss worldwide, with well-established patterns:
In men: recession at the temples and crown
In women: diffuse thinning over the top of the scalp with preservation of the frontal hairline
While extremely common, it is often misunderstood. Androgenetic alopecia is not simply “cosmetic”—it is a biological process with a defined mechanism, and one that can be assessed and managed based on current scientific evidence.
What Is Actually Happening in Androgenetic Alopecia?
Androgenetic alopecia is driven by a process known as follicular miniaturisation—a gradual transformation of healthy, thick terminal hairs into finer, shorter hairs over successive growth cycles.
At a biological level, three key processes are involved:
1. Genetic Sensitivity to Androgens
Hair follicles in certain areas of the scalp (particularly the top) are genetically programmed to be more sensitive to androgens such as dihydrotestosterone (DHT).
This sensitivity—not the absolute level of hormones—is what drives the condition.
2. Progressive Shortening of the Growth Phase
Each hair grows in cycles. In androgenetic alopecia:
-
The anagen (growth) phase becomes shorter
-
The telogen (resting/shedding) phase becomes proportionally longer
Over time, hairs do not grow long enough or thick enough to maintain coverage.
3. Gradual Follicle Miniaturisation
With each cycle:
-
Hair shafts become thinner and less pigmented
-
Follicles produce vellus-like hairs instead of terminal hairs
-
Eventually, some follicles may become dormant
This is why patients often notice:
-
“My hair is still there—but it’s thinner”
-
“My scalp is becoming more visible”
-
“My hair won’t grow as long as it used to”
It is a Patterned Process — Not Random Hair Loss
One of the defining features of androgenetic alopecia is that it follows predictable, anatomically defined patterns:
-
The frontal scalp and crown are typically affected
-
The back and sides are relatively resistant
This reflects underlying biological differences in follicle behaviour across the scalp.
Understanding this process is key—because effective management is not about “stimulating hair growth” in general, but about targeting the specific biology driving follicle miniaturisation.
Who Does Androgenetic Alopecia Affect — and When Does It Start?
Androgenetic alopecia can affect both men and women, but the age of onset, pattern, and progression differ.
In Men
-
Can begin as early as the late teens or early 20s
-
Often first noticed as:
-
Recession at the temples
-
Thinning at the crown
-
-
Progression is typically gradual but continuous
By age 50, around 50% of men will have clinically significant androgenetic alopecia, with prevalence increasing steadily with age.
In Women
-
Usually presents later than in men, most commonly:
-
From the 30s onwards
-
Increasing around perimenopause and menopause
-
-
Typically appears as:
-
Diffuse thinning over the top of the scalp
-
With preservation of the frontal hairline
-
By age 50, approximately 25–40% of women are affected to some degree.
Early vs Late Onset — Why It Matters
Earlier onset often indicates a stronger genetic predisposition and may be associated with:
-
Faster progression
-
Greater lifetime hair loss
Later onset tends to be more gradual, particularly in women, but can still become significant over time.
A Lifelong Process, Not a Sudden Event
Androgenetic alopecia does not typically present as sudden shedding. Instead, patients often describe:
-
“My hair has been getting thinner over years”
-
“My parting is widening”
-
“It doesn’t feel as thick as it used to”
This slow progression is why it is often noticed late—but biologically active much earlier.
The next step is distinguishing androgenetic alopecia from other causes of hair loss—because not all thinning follows this pattern, and accurate diagnosis is essential before considering treatment.
How is Androgenetic Alopecia Diagnosed?
Diagnosing androgenetic alopecia should be done by a Dermatologist. Diagnosis is primarily clinical, but accurate confirmation requires a structured assessment. It is important to remember that not all hair thinning is androgenetic alopecia, and successful management depends on getting the diagnosis right.
1. Clinical History
A detailed history often provides the first clues:
-
Gradual onset over months to years
-
Family history of similar hair loss
-
Absence of sudden shedding (which can suggest conditions like telogen effluvium)
In women, it is also important to ask about:
-
Menstrual history
-
Menopause
-
Symptoms of androgen excess (e.g. acne, hirsutism)
2. Pattern Recognition
Androgenetic alopecia follows predictable patterns:
-
Men: recession at the temples and thinning at the crown
-
Women: widening of the central part with diffuse thinning over the top
These patterns can be helpful in distinguishing from other conditions, but it is not always clear.
3. Trichoscopy (Scalp Dermoscopy)
This is one of the most useful tools in clinic.
Typical findings include:
-
Variation in hair shaft diameter (miniaturisation)
-
Increased number of thin, vellus-like hairs
-
Reduced density in affected areas
These features are considered hallmarks of androgenetic alopecia and can often confirm the diagnosis without the need for biopsy.
4. Hair Pull Test (Supportive, Not Diagnostic)
A gentle traction test may be performed:
-
Usually negative or only mildly positive in androgenetic alopecia
-
Strongly positive results suggest alternative diagnoses (e.g. active shedding disorders)
5. Blood Tests — When Indicated
Blood tests are not required to diagnose androgenetic alopecia, but may be used to:
-
Exclude other contributing factors (e.g. iron deficiency, thyroid dysfunction)
-
Assess hormonal profiles in selected female patients
6. When Is a Biopsy Needed?
Rarely required, but considered if:
-
The diagnosis is unclear
-
There are signs of scarring or inflammation
-
Hair loss is atypical or rapidly progressive
-
Key Point
Androgenetic alopecia is usually confirmed through a combination of:
-
History
-
Pattern recognition
-
Trichoscopic findings
Not every patient with thinning hair has androgenetic alopecia—and not every androgenetic alopecia patient presents in a textbook way.
Once the diagnosis is confirmed, the next question becomes: what can realistically be done—and what does the evidence actually support?
Which Treatments for Androgenetic Alopecia Actually Work?
There are only a small number of treatments with credible clinical evidence for androgenetic alopecia. Most fall into two categories:
-
Targeting the underlying biology (androgens and follicle miniaturisation)
-
Supporting follicle function and hair cycling
Understanding this distinction is key—because many widely marketed treatments do neither.
Treatments with Strong Evidence
1. Minoxidil (Topical)
Minoxidil
-
Widely studied and licensed for androgenetic alopecia
-
Prolongs the anagen (growth) phase and increases hair diameter
-
Works in both men and women
What to expect:
-
Stabilisation of hair loss is more common than dramatic regrowth
-
Results take 3–6 months to become noticeable
-
Continued use is required to maintain effect
2. Finasteride (Oral, Men)
Finasteride
-
Reduces conversion of testosterone to DHT, the key driver of follicle miniaturisation
-
Strong evidence for slowing progression and improving density in men
What to expect:
-
Most effective for maintaining and thickening existing hair
-
Requires ongoing use
-
Requires careful discussion of risks and suitability
3. Platelet-Rich Plasma (PRP)
-
Uses concentrated growth factors derived from the patient’s own blood
-
Increasing body of evidence supports improvements in hair density and thickness
What to expect:
-
Works best in early to moderate androgenetic alopecia
-
Requires a course of treatments and maintenance
-
Outcomes vary depending on protocol and patient factors
4. Low-Level Laser Therapy (LLLT)
-
Medical-grade light devices (e.g. laser caps/helmets)
-
Thought to improve cellular energy production within follicles
What to expect:
-
Modest but measurable improvements in some patients
-
Requires consistent, long-term use
-
Often used as an adjunct rather than standalone treatment
A Realistic Perspective
No treatment “cures” androgenetic alopecia.
The goals are typically to:
-
Slow or stabilise progression
-
Improve hair thickness and density
-
Preserve existing follicles for as long as possible
Early intervention generally leads to better outcomes—because once follicles are lost or severely miniaturised, they are more difficult to recover.
The key question then becomes: which of these treatments is appropriate for you, based on your stage, pattern, and goals?
Which Treatment Is Right for You?
There is no single “best” treatment for androgenetic alopecia. The right approach depends on stage of hair loss, pattern, biology, and personal preferences. A structured, individualised plan is far more effective than a one-size-fits-all approach.
Step 1: Identify Your Stage
Early Thinning
-
Subtle reduction in density
-
Hair still present but finer
Typical approach:
Goal: Stabilise early and preserve as much hair as possible
Moderate Hair Loss
-
Visible scalp through hair
-
Noticeable recession or widening part
Typical approach:
-
Combination therapy:
-
Minoxidil
-
Finasteride (men, if appropriate)
-
PRP course + maintenance
-
-
Adjuncts (LLLT, microneedling)
Goal: Slow progression and improve density where follicles are still active
Advanced Hair Loss
-
Large areas of thinning or baldness
-
Long-standing follicle miniaturisation
Typical approach:
-
Medical treatments may still help preserve remaining hair
-
Consideration of:
-
Hair transplantation
-
Cosmetic options (fibres, scalp micropigmentation)
-
Goal: Realistic improvement + preservation, not full restoration
Step 2: Consider Your Biology
Not all patients respond in the same way. Key factors include:
-
Genetic sensitivity to androgens
-
Duration of hair loss
-
Age and hormonal status
-
Scalp health and follicle viability
This is why two people with similar-looking hair loss can respond very differently to the same treatment.
Step 3: Define Your Goals
Different patients want different outcomes:
-
Stabilisation only → often achievable with medical therapy alone
-
Thickening and cosmetic improvement → combination approaches
-
Maximal restoration → may involve surgical + medical strategies
Clarity here avoids unrealistic expectations and guides appropriate treatment selection.
A Practical Framework
In most cases:
-
Foundation:
Evidence-based medical therapy (e.g. minoxidil ± finasteride) -
Advanced options:
Transplant or cosmetic camouflage when needed
Key Point
The earlier treatment is started, the more options are available—and the better the likely outcome.
If you’re unsure where you sit, the most useful first step is a structured assessment—looking at pattern, progression, and follicle behaviour—so that any treatment plan is based on evidence, not guesswork.