Stress and Hair Loss: Understanding Telogen Effluvium

Stress and hair loss are connected, though not in the way most people expect. Hair does not fall out on the day of a shock. It sheds two to three months later, by which time the cause may be forgotten. The medical name for this delayed shedding is telogen effluvium.

What telogen effluvium is

Normally about 85 to 90 percent of the hairs on your scalp are growing and the rest are resting. A major stress on the body can push a much larger share of hairs into the resting phase at the same time. Resting hairs are shed after about three months, so a wave of shedding follows.

The follicles are not damaged. New hairs begin to grow as the old ones fall.

Common triggers

Everyday stress, such as a busy week, is not usually enough. Often several triggers add up.

What it looks like

• Hair comes out from all over the scalp, not in patches.
• You may lose up to around 300 hairs a day instead of the usual 50 to 100.
• Shed hairs are full length with a small white bulb at the end.
• The scalp looks normal: no redness, scale or scarring.
• Hair looks thinner overall, especially at the temples, but you do not go bald.

The usual timeline

1. Trigger.
2. Two to three months later: shedding begins.
3. Three to six months: shedding continues, then slows.
4. After that: short new hairs appear, and fullness returns over six to twelve months.

If the trigger continues, or shedding lasts longer than six months, it is called chronic telogen effluvium and should be assessed.

What helps

• Find and address the trigger where possible, with your doctor's help.
• Eat enough. Regular meals with protein, iron-rich foods, fruit and vegetables. See Nutrition and Hair Health: Nutrients Your Hair Needs.
• Be gentle with your hair. Wash as normal. Washing does not cause more loss; it only releases hairs that were already detached.
• Avoid tight styles, harsh treatments and high heat.
• Look after your general health: sleep, movement and whatever helps you to manage stress.
• Be patient. There is no quick fix, and most cases recover fully.

Supplements are helpful only when a deficiency has been confirmed. Check with a doctor before taking them.

Other stress-related hair problems

• Alopecia areata causes smooth, round bald patches. It is an immune condition that is sometimes triggered by stress.
• Trichotillomania is a repeated urge to pull out one's own hair. Support and treatment are available.

Both need professional advice.

When to see a doctor

See a doctor or dermatologist if:

• Shedding continues for more than six months.
• You cannot identify a trigger.
• You notice patches of hair loss, a widening part or a receding hairline.
• Your scalp is itchy, painful, red or scaly.
• You feel unwell in other ways, such as very tired or cold.

Blood tests can check for causes such as iron deficiency or thyroid disease. How to Track Hair Loss Before a Dermatologist Visit shows how to record the shedding before your visit.

Reassurance

Watching hair fall is stressful, and worrying about it can feel like a vicious circle. Remember that in telogen effluvium every shed hair is being pushed out by a new one. The same process explains shedding after childbirth, covered in Postpartum Hair Loss: What to Expect After Pregnancy. For the biology, see Hair Growth Cycle: How Hair Grows and Sheds, and to confirm that you are shedding and not breaking hair, see Hair Shedding vs Breakage: Key Differences.

Related on ArniSun

• Hair Shedding vs Breakage: Key Differences
• Hair Growth Cycle: How Hair Grows and Sheds
• Postpartum Hair Loss: What to Expect After Pregnancy
• How to Track Hair Loss Before a Dermatologist Visit
• Nutrition and Hair Health: Nutrients Your Hair Needs

Sources and further reading

• DermNet: Telogen effluvium
• American Academy of Dermatology: Do you have hair loss or hair shedding?
• Mayo Clinic: Hair loss