Telogen effluvium: why stress makes your hair fall out
You wash your hair and your hand is full. Or you see it on your pillow in the morning. It starts suddenly, without any clear cause. You don't have bald spots, but simply much more hair is falling out than usual. This is one of the most common forms of hair loss in men under forty, and also one of the least understood: telogen effluvium.
What is telogen effluvium?
Hair grows in cycles. The growth phase (anagen) lasts two to six years. After that, a hair enters the resting phase (telogen), to then fall out naturally after a few months and make way for a new hair.
Normally, about 85 to 90 percent of your hair is in the growth phase. The rest is in the resting phase. With telogen effluvium, your body throws this percentage out of balance. Due to a trigger, a large portion of the hair follicles simultaneously shift to the resting phase. Two to four months later, these hairs fall out, all within a short period.
So you don't lose hair because your hair follicles are damaged. You lose hair because your body has temporarily put them on pause.
What causes it?
Telogen effluvium is always caused by a physical or psychological trigger. The most common:
- Acute stress. A significant event, such as a divorce, death, or job loss, can be a trigger. The body responds to stress by reallocating energy, and hair growth is not essential for survival.
- Illness or fever. A severe flu, Covid-19, or another infection where you had a fever can lead to noticeable hair loss weeks later.
- Surgeries or medical treatments. Anesthesia and the recovery process after surgery are known triggers.
- Rapid weight loss or crash diets. If your body receives too few proteins or calories, hair growth is delayed. This is also seen with strict calorie-restricted eating over a longer period.
- Nutritional deficiencies. Iron, zinc, and vitamin D are most linked to telogen effluvium. Not every man with a deficiency gets it, but it can contribute when combined with other factors.
- Thyroid problems. Both an underactive and an overactive thyroid can cause hair loss.
The characteristic of all these triggers: hair loss does not start immediately. There is a two to four month gap between the cause and the moment you notice it. This often makes the connection difficult to establish.
How do you distinguish it from hereditary baldness?
That's the question most men ask themselves. And it's a valid question, because the treatment is fundamentally different.
Some characteristics that indicate telogen effluvium:
- Hair loss starts suddenly and is diffuse. It's not about a receding hairline or thinning on the crown, but generally thinner hair growth all over the head.
- You find hairs with a white bulb at the end. These are hairs that were in the resting phase and fell out at the normal time, not broken off.
- You can pinpoint a trigger. Think back: two to four months ago, were you very sick, did you have a difficult period, or did you lose weight rapidly?
- You are younger than forty and have no family history of baldness.
With hereditary hair loss (androgenetic alopecia), the pattern is different: it recedes at the temples, or the crown thins, and it progresses gradually over years.
Of course, both can occur simultaneously. Someone with a predisposition to hereditary baldness can also have telogen effluvium, which temporarily accelerates hair loss.
How long does it last?
In most cases, telogen effluvium resolves on its own. As soon as the trigger is resolved, the hair follicles return to the growth phase. This recovery takes an average of three to six months. The hair loss stops earlier than you see new hair growing, which can be confusing.
Chronic telogen effluvium, where hair loss persists for longer than six months, is less common and often has an underlying cause that has not yet been resolved, such as a persistent nutritional deficiency or untreated thyroid problems.
What can you do?
The first step is to figure out what the trigger was. If you have an obvious cause, such as a severe illness or a period of little food, you know that recovery will probably come on its own.
If you have no clear cause, a blood test is useful. In any case, have your ferritin (iron reserves), vitamin D, and thyroid function checked by your general practitioner. Ferritin is more important here than serum iron: you can have normal iron levels but still low reserves.
Ensure sufficient protein intake. Hair mainly consists of keratin, a protein. With too little protein intake, below 1 gram per kilogram of body weight per day, hair growth can be delayed.
Sleep, recovery, and stress reduction are not vague recommendations. Chronic sleep deprivation and prolonged stress keep cortisol levels elevated, which directly affects hair growth.
Can a serum help?
Telogen effluvium is primarily an internal problem, so a serum does not resolve the cause. But once the trigger is removed and the hair follicles return to the growth phase, external support can be beneficial.
Ingredients like Redensyl and caffeine, as found in the Hairborn Growth Serum, work on the hair follicles themselves. They stimulate the anagen phase and improve blood circulation in the scalp. This is not a substitute for addressing the cause, but it can support the recovery process once your body is ready to grow hair.
When to see a doctor?
Consult your general practitioner if hair loss persists for more than six months, if you cannot identify a clear trigger, if hair loss is accompanied by other complaints such as fatigue or weight change, or if you also notice hair loss in your eyebrows or other body parts.
A dermatologist can perform a trichoscopy or biopsy to confirm the diagnosis if there is any doubt.
In short
Telogen effluvium is temporary hair loss that begins two to four months after a trigger. In most cases, it resolves on its own once the cause has been removed. It differs from hereditary baldness in pattern, timing, and recovery. A blood test, sufficient protein, and addressing the underlying cause are the most meaningful steps.
Frequently Asked Questions
Does telogen effluvium only affect women, for example after stopping the pill?
No, telogen effluvium is not gender-specific and can occur in men due to various physical or psychological triggers, irrespective of hormonal events specific to women such as childbirth or stopping the pill. In men, stress, illness, and nutritional deficiencies are the most common triggers.
Is there a difference in recovery time between telogen effluvium due to illness and due to stress?
Not necessarily a big difference in total duration, but with illness, the trigger is often a one-time event and clearly resolved, whereas ongoing stress can sometimes have a longer effect if the underlying situation doesn't change. This can practically prolong the recovery time.
Can you have telogen effluvium and hereditary hair loss at the same time?
Yes, that is possible, and it is sometimes difficult to distinguish without investigation. An indication is that the diffuse loss of telogen effluvium can be superimposed on an existing pattern of a receding hairline or thinning crown. When in doubt, a dermatologist with trichoscopy provides the clearest picture.
Should you stop exercising if you have telogen effluvium?
No, moderate physical activity does not need to be stopped and can even help reduce stress. However, avoid extreme overexertion without sufficient recovery, as this itself can be a physical stressor.
Can you have a deficiency that is not found through blood tests?
Yes, some deficiencies or underlying causes are harder to detect with standard blood tests, such as subtle hormonal fluctuations or early thyroid problems. In cases of persistent unexplained hair loss, more extensive examination by a doctor may sometimes be necessary.
Is telogen effluvium in men different from the postpartum variant in women?
The underlying mechanism, a shift of hair follicles to the resting phase, is the same, but the trigger differs. In women after childbirth, the hormonal change after pregnancy is the cause, while in men, stress, illness, or nutritional deficiencies are more often the cause.
Can you see for yourself what percentage of your hair is in the resting phase?
No, that cannot be determined with the naked eye. A trichogram, where a dermatologist examines hairs under a microscope, is necessary to accurately determine what percentage of your hair is in which phase.
What if the trigger, such as work stress, is still present?
As long as the trigger remains present, hair loss can persist or even worsen. In that case, addressing the underlying stress, for example through professional help or adjusting your work situation, is a necessary step before recovery can properly begin.
Can you prevent telogen effluvium during a planned surgery?
Complete prevention is not guaranteed, as your body's reaction to surgery cannot be fully controlled, but good nutrition and sufficient rest around the procedure may contribute to a milder reaction. Discuss any concerns with your treating physician beforehand.
Is chronic telogen effluvium the same as permanent hair loss?
No, chronic telogen effluvium means that the increased shedding lasts longer than six months, usually because the underlying trigger has not yet been removed, but the process remains reversible in principle once the cause is addressed. It is therefore not the same as a permanent, lasting form of hair loss.
