How to Tell If It’s Telogen Effluvium

Hair shedding can be alarming, especially when it seems to happen suddenly or in large amounts. Understanding how to tell if it’s telogen effluvium is important for anyone noticing increased hair loss. Telogen effluvium is a common, temporary form of hair loss that often follows a physical or emotional stressor. Recognizing the signs, such as diffuse shedding, changes to your hair part, and the presence of a white bulb at the end of shed hairs, can help you know when to seek professional advice. This guide explains the key symptoms, how to perform the hair pull test, and how to distinguish telogen effluvium from other types of hair loss. Always consult a dermatologist for a proper diagnosis and treatment plan.

What Is Telogen Effluvium?

Telogen effluvium is a temporary hair loss condition that occurs when a significant number of hair follicles enter the telogen, or resting, phase of the hair growth cycle prematurely. This shift is usually triggered by a physical or emotional stressor, such as illness, surgery, major life changes, or nutritional deficiencies. The result is a noticeable increase in hair shedding, often seen a few months after the triggering event.

Normally, about 85% to 90% of scalp hairs are in the active growth (anagen) phase, while 10% to 15% are in the resting (telogen) phase. In telogen effluvium, up to 70% of hairs can abruptly shift into the telogen phase, leading to excessive shedding. This condition affects people of all ages and genders but is especially common among women aged 30 to 60. Unlike some other forms of hair loss, telogen effluvium does not cause total baldness and usually resolves once the underlying cause is addressed.

Common Signs of Telogen Effluvium

Recognizing the signs of telogen effluvium is key to understanding whether your hair loss fits this pattern. The most prominent symptom is diffuse shedding, where hair falls out from all over the scalp rather than in patches. This shedding often becomes noticeable on your pillow, in the shower, or when brushing your hair.

Another common indicator is a widening of the hair part, especially on the top of the head. Unlike patchy or localized hair loss, telogen effluvium typically does not affect the hairline or cause complete baldness. The overall density of your hair may appear reduced, but the scalp remains covered.

Diffuse Shedding Explained

Diffuse shedding refers to hair loss that is spread evenly across the scalp, rather than concentrated in one area. In telogen effluvium, this means you may notice increased hair on your pillow, in the shower drain, or on your hairbrush. Most healthy people lose up to 100 hairs per day, but with telogen effluvium, this number can rise to 300 or more.

Unlike some other types of hair loss, diffuse shedding does not create bald patches. Instead, the hair appears thinner overall, especially on the top of the head. This pattern helps distinguish telogen effluvium from conditions like alopecia areata, which causes patchy loss.

Changes to Your Hair Part

One subtle but telling sign of telogen effluvium is a widening of your hair part. As more hairs shed from the top of the scalp, the part line may gradually become more visible. This change is often most noticeable when styling your hair or looking at your scalp in bright light.

Unlike pattern hair loss, which typically causes a receding hairline or distinct thinning at the temples or crown, telogen effluvium affects the entire scalp. The part may appear wider, but the hairline itself usually remains intact. Monitoring changes in your part can help you track the progression of shedding.

The Hair Pull Test: How It Works

The hair pull test is a simple technique used by dermatologists and individuals to assess active hair shedding. This test involves gently tugging on a small section of hair to see how many strands come out. It can provide valuable clues about whether you are experiencing excessive shedding consistent with telogen effluvium.

While the hair pull test is not a definitive diagnostic tool, it is a helpful first step in evaluating hair loss at home. If the test suggests increased shedding, it is important to consult a healthcare professional for further evaluation and diagnosis.

Performing the Test at Home

To perform the hair pull test, start with clean, dry hair that has not been washed or brushed for at least 24 hours. Select a small section of about 40 to 60 hairs, typically from the top or sides of your scalp. Hold the section close to the scalp and gently but firmly pull outward.

Count the number of hairs that come out. Losing fewer than four hairs is generally considered normal. If you consistently pull out four or more hairs, this may indicate active shedding, such as telogen effluvium. Repeat the test in different areas of the scalp for a more complete assessment.

What Do the Results Mean?

If the hair pull test results in four or more hairs coming out each time, this suggests that you may be experiencing telogen effluvium or another shedding disorder. In telogen effluvium, the shed hairs often have a white bulb at the root, which is a key identifying feature.

It is important to note that the hair pull test alone cannot confirm a diagnosis. Many factors can influence hair shedding, including recent washing, brushing, or chemical treatments. If you notice excessive shedding or are concerned about your results, seek evaluation from a dermatologist for a more thorough assessment.

Looking for the White Bulb

One of the classic signs of telogen effluvium is the presence of a white bulb at the end of shed hairs. This white bulb is made of keratin and represents the root of a hair that has completed the telogen phase. Finding these bulbs on fallen hairs can help differentiate telogen effluvium from other causes of hair loss.

Examining shed hairs for the white bulb is a practical way to gather more information about your hair loss. However, not every hair with a white bulb means you have telogen effluvium, as some normal shedding also includes these bulbs. Consistent findings of many hairs with white bulbs, especially alongside diffuse shedding, strengthen the suspicion of telogen effluvium.

What Is the White Bulb?

The white bulb is a small, club-shaped structure found at the root end of hairs that have completed the telogen phase. It is composed of keratin and is not a sign of disease or infection. In telogen effluvium, a higher proportion of shed hairs will have this white bulb, reflecting the shift of many follicles into the resting phase.

When examining shed hairs, look for a rounded, pale structure at one end. This is distinct from the gel-like sheath seen in growing (anagen) hairs. The presence of the white bulb helps confirm that the hair was naturally shed, not broken. This feature is a useful clue but should be interpreted alongside other signs and symptoms.

How to Know If It’s Not Something Else

Not all hair loss is telogen effluvium. Other conditions, such as androgenetic alopecia (pattern hair loss), alopecia areata, or scarring alopecias, can cause shedding or thinning. Understanding the differences is crucial for accurate identification and appropriate management.

Telogen effluvium is characterized by rapid, diffuse shedding without patchy bald spots or a receding hairline. If you notice bald patches, scarring, or other unusual symptoms, it may indicate a different condition. A dermatologist can help distinguish between these possibilities using clinical evaluation and diagnostic tools.

Other Causes of Hair Loss

Several other conditions can mimic or overlap with telogen effluvium. Androgenetic alopecia, also known as male or female pattern hair loss, typically causes gradual thinning at the crown or temples and may involve a receding hairline. Alopecia areata leads to sudden, round patches of complete hair loss, often with smooth, bare skin.

Other causes include scarring alopecias, which can result in permanent hair loss and visible scalp changes, and medical conditions like thyroid disorders or iron deficiency. Each type of hair loss has unique features, so recognizing the pattern and associated symptoms is essential for proper diagnosis.

Differential Diagnosis and Why It Matters

Differential diagnosis is the process of distinguishing telogen effluvium from other hair loss disorders. This step is important because treatment and prognosis vary depending on the underlying cause. A dermatologist will consider your medical history, pattern of shedding, and any associated symptoms to narrow down the possibilities.

In some cases, additional tests such as blood work, scalp biopsy, or trichoscopy may be needed to confirm the diagnosis. Accurate identification ensures that any treatable underlying conditions are addressed and helps set realistic expectations for hair regrowth and recovery.

How a Dermatologist Can Help

Consulting a dermatologist is the best way to confirm whether you have telogen effluvium. Dermatologists are trained to recognize the subtle differences between various types of hair loss and can perform a thorough scalp examination, review your medical history, and order appropriate tests if needed.

In addition to clinical evaluation, dermatologists may use specialized diagnostic tools, such as trichoscopy, to examine the scalp and hair follicles in detail. This approach helps rule out other causes and guides the most effective management plan.

Using Trichoscopy in Diagnosis

Trichoscopy is a noninvasive imaging technique that allows dermatologists to view the scalp and hair shafts under magnification. This tool helps identify characteristic features of telogen effluvium, such as uniform hair shaft diameter and increased numbers of empty follicles, without the need for a biopsy.

Trichoscopy can also help distinguish telogen effluvium from other conditions like androgenetic alopecia, which shows miniaturization of hair follicles. By providing a detailed view of the scalp, trichoscopy supports a more accurate and confident diagnosis.

What to Expect During a Medical Evaluation

During a medical evaluation for hair loss, your dermatologist will begin by taking a detailed medical history, including recent illnesses, stressors, medications, and family history of hair loss. A physical examination of your scalp will assess the pattern and extent of shedding, as well as the condition of the skin and hair follicles.

Diagnostic tests may include the hair pull test, trichoscopy, blood tests to check for nutritional deficiencies or thyroid issues, and, in rare cases, a scalp biopsy. Your provider will explain the findings and recommend appropriate next steps, which may include addressing underlying triggers, monitoring hair regrowth, or considering topical treatments. Open communication with your dermatologist ensures the best possible care and outcome.

Frequently Asked Questions about Telogen Effluvium

Can telogen effluvium be reversed?

Yes, telogen effluvium is usually a temporary condition. In most cases, once the underlying trigger is resolved, hair regrowth begins naturally. The majority of acute cases resolve within six months, and hair density returns to normal over time.

How long does shedding last?

Shedding from telogen effluvium typically starts two to four months after the triggering event and lasts for about six months. In most cases, hair regrowth begins as soon as the shedding phase ends, but it may take several additional months to notice significant improvement.

Does stress always cause telogen effluvium?

While stress is a common trigger, telogen effluvium can also be caused by physical illness, surgery, hormonal changes, nutritional deficiencies, or certain medications. Not every case is linked to emotional stress.

Can you stop telogen effluvium with shampoo or supplements?

No shampoo or supplement has been proven to stop active telogen effluvium. Addressing the underlying cause, such as correcting a nutritional deficiency or managing stress, is the most effective approach. Some supplements may help if a specific deficiency is identified, but always consult a healthcare provider before starting new products.

Will all my hair grow back?

In most cases, hair regrowth occurs once the trigger for telogen effluvium is resolved. The prognosis is very good, with the majority of people experiencing full recovery. However, in rare cases, not all hairs may regrow, especially if there is an underlying chronic condition.

Can telogen effluvium turn into permanent hair loss?

Telogen effluvium itself does not cause permanent baldness. However, if another underlying condition is present, such as androgenetic alopecia, some permanent thinning may occur. Chronic telogen effluvium can persist for months or years but rarely leads to complete hair loss.

Is it safe to dye your hair while shedding?

Dyeing your hair during a shedding episode is generally considered safe, but harsh chemical treatments may increase breakage or scalp irritation. If your scalp is sensitive or inflamed, it is best to wait until shedding subsides before coloring your hair.

How do I track my hair shedding at home?

Tracking hair shedding can be done by collecting and counting shed hairs over a 24-hour period or by monitoring the amount of hair lost during washing and brushing. Keeping a hair diary and taking regular photos of your scalp can help you and your dermatologist assess changes over time.