Finding much more hair than usual in the shower, on your pillow or across the bathroom floor? If it started suddenly, you could be dealing with stress-related shedding. The medical name for it is telogen effluvium.
The shedding can seem to start almost overnight, which understandably makes people worry. In most cases, though, telogen effluvium is temporary. It doesn't cause bald patches or a receding hairline, and whilst dramatic, it does not result in you losing all of your hair.
The confusing part is that the shedding often starts months after the event that triggered it.
What stress hair loss looks like
Telogen effluvium is a sudden rise in shedding across the whole scalp. It's normal to lose somewhere between 50 and 100 hairs a day as part of the natural hair cycle. With telogen effluvium, that number can climb to 300 or more, which is why the shedding feels so obvious all at once.
Typical signs include:
- The shedding is diffuse. Hair thins evenly across the top and sides rather than in patches or at the hairline.
- Shedding hairs often have a small white bulb at the root, which is typical of a telogen hair.
- The hair shaft looks healthy and remains the same thickness from root to tip.
Because the shedding happens across the entire scalp, you're more likely to notice a thinner ponytail and diffuse volume loss rather than a single bald spot.
Why it happens
Hair continually cycles through periods of growth, transition and rest.
Around 85 to 90% of your hair is in the growing phase, called anagen, at any one time, and this lasts between two to seven years on average. The rest is in a resting phase, called telogen, which lasts a few months before the hair sheds and a new one grows in its place.
A physical or emotional shock can push a large number of growing hairs into the resting phase early. Those hairs stay in the follicle for two to three months, then shed together.
That delay is why telogen effluvium can be difficult to trace back to its cause. By the time the shedding starts, the illness, stressful period or other trigger may have happened two or three months earlier.
Importantly, the follicles are usually still capable of producing new hair. Unlike scarring forms of hair loss, telogen effluvium doesn't permanently destroy the hair follicle.
Common Triggers
Telogen effluvium can develop after a significant physical or psychological stressor.
Common triggers include:
- Severe or prolonged psychological stress, such as bereavement, divorce or a long period of burnout
- A high fever or infection, including COVID-19 or the flu
- Childbirth, as oestrogen levels drop sharply after delivery
- Major surgery or a general anaesthetic
- Rapid weight loss, GLP1s, crash dieting or low protein intake
- Low iron, thyroid problems or other nutritional deficiencies
- Starting or stopping certain medications
Often there's one clear trigger. Sometimes several smaller ones stack up over the same few months.
How long stress hair loss lasts
Acute telogen effluvium lasts less than six months, and in most cases it resolves on its own.
Once the trigger has passed, excess shedding usually settles within three to six months. New growth typically starts as the shedding eases.
Hair grows slowly, around 1 cm a month. So even once new hairs are growing, it can take several months before your overall density looks noticeably better. Most people see a meaningful difference between six and twelve months.
If the shedding continues beyond six months, or comes and goes over a longer period, it's known as chronic telogen effluvium.
Chronic shedding is more common in midlife women and should be investigated for an ongoing trigger or evolution into another form of hair loss such as androgenetic alopecia.
When it might be something else
Not all excessive shedding is telogen effluvium, and more than one type of hair loss can happen at the same time
See a hair-loss specialist if:
- The shedding continues for more than six months
- You notice a widening parting, thinning at the crown or a receding hairline, which can point to female or male pattern hair loss
- The hair loss is patchy rather than spread evenly
- Your scalp is red, flaky, itchy or sore
- You have other symptoms such as fatigue, which can suggest low iron or a thyroid problem
Assessment usually involves your medical history, a scalp examination and, where appropriate, blood tests. Depending on your history and symptoms, blood tests may include ferritin, thyroid function, vitamin B12, vitamin D or zinc.
What helps
Treatment starts with working out what triggered the shedding.
If the trigger has resolved, the hair cycle will usually gradually return to normal.
In the meantime:
- Have your bloods checked rather than reaching for supplements blindly. If testing identifies iron deficiency, thyroid dysfunction or another underlying issue, treating it can help remove an ongoing trigger. Taking biotin without a deficiency is unlikely to fix telogen effluvium.
- Make sure you're eating enough overall, particularly enough protein, if the shedding followed dieting or rapid weight loss
- If you’re dealing with ongoing stress, build regular stress management into your day. Exercise, meditation, mindfulness, yoga nidra, dancing and spending time with people you feel close to can all help reduce stress.
- Handle your hair gently, and keep washing and styling as normal. Washing doesn't cause the shedding and avoiding it could actually make it worse.
- There's also an element of waiting. Acute telogen effluvium usually improves without treatment once the trigger has resolved.
Minoxidil may also be considered to support regrowth and is one of the best-studied treatments for stimulating hair growth. It prolongs the anagen, or growth, phase of the hair cycle and can help follicles enter active growth.
DOSE Shedding was developed by Consultant Dermatologist Dr Sharon Wong for this stage of recovery. The formula contains 6% minoxidil alongside caffeine, and anti-oxidants niacinamide and melatonin - ingredients selected by Dr Wong specifically for excessive shedding.
Find out more about DOSE Shedding here.
The Bottom Line
Telogen effluvium can look dramatic, but the follicles are usually healthy and capable of regrowing hair. In most cases, the shedding settles once the trigger has passed. If it doesn't, that's when it's worth investigating further.
If you think stress-related shedding could be behind what you are seeing, the DOSE online consultation is a quick way to find a treatment matched to you. The consultation takes a few minutes and is private.
Start your DOSE online consultation.
FREQUENTLY ASKED QUESTIONS
How do I know if my hair loss is from stress?
Telogen effluvium usually causes increased shedding from all over the scalp rather than one distinct patch. The shed hairs may have a small white bulb at the root and are usually normal, full-thickness hairs.
It typically starts two to three months after a trigger such as illness, significant stress or childbirth.
How long does stress-related hair loss last?
Acute telogen effluvium lasts less than six months and usually resolves once the trigger has passed.
The heavy shedding usually eases over several months. Because hair grows slowly, recovering your previous density can take six to twelve months.
Shedding that continues for longer than six months is considered chronic telogen effluvium and should be assessed.
Will my hair grow back after telogen effluvium?
For most people, yes.
Telogen effluvium doesn't usually damage the follicle, so hair can grow normally again once the trigger has resolved. Returning to your previous density can take six to twelve months because new hair needs time to grow to a visible length.
Can telogen effluvium become permanent hair loss?
Telogen effluvium itself is temporary.
Sometimes telogen effluvium makes underlying pattern hair loss more noticeable, particularly widening through the parting or thinning at the crown.
If shedding continues beyond six months, or you're developing a clear pattern of thinning, see a hair-loss specialist.
Does washing my hair make the shedding worse?
No. Washing doesn't cause telogen effluvium.
The hairs coming out during a wash were already going to shed. Avoiding washing only means more hair comes out at once the next time, so it's best to keep washing and styling as normal.
