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Abrupt Onset, Excessive Hair Fall – Telogen Effluvium

Body hair has played a key role in the evolutionary success of all warm-blooded creatures that inhabit the Earth. Heat insulation is perhaps the most crucial, but other important functions of hair are the communication of social and sexual maturity – such as a lion’s mane, or the sensory antennae that is the whiskers of cats; as vital camouflage with surroundings, in displays of aggression, or to promote scent dispersal of territorial and mating animals.

Man is the least hairy of the primates but body hair still aids as a thermal regulator; odour dispersion through armpits and groin – and perhaps most significantly over the past centuries – as a fashion and cosmetic adornment of the head.

Hair grows from follicles, which together with sweat and oil glands are appendages of skin tissue. It is estimated that a sexually-mature adult male possesses approximately five million hair follicles on his body; one million on the head and (on average) 100,000 in the scalp (Dawber + Van Neste: 1995).

All the hair follicles a person will possess during their lifetime are believed to be in place at the halfway point of a normal pregnancy. And whilst there has been much research into follicle ‘cloning’ – hair follicles cannot be regenerated by adult skin once they are lost.

Scalp follicle hair growth in humans is a continuous cycle which in normal hair growth comprises two main phases:

  • Anagen – the growth phase of 2-8 years; 85-90% of all hair is ‘anagen’ in normal circumstances.
  • Catagen/Telogen – the resting and shedding phase of the hair cycle are generally combined; ‘catagen’ duration is around 7 days and ‘telogen’ 2-3 months. Only 6-10% of hair is in ‘telogen’ at any given time.

Human hair follicles are NON-synchronised to prevent seasonal moulting, although different parts of the body have varying hair growth depending upon the season of the year (Van Neste + Lachapelle: 1989). Every follicle has an independent hair cycle and repeats this cycle 10-20 times over a person’s lifetime.

Telogen Effluvium/Defluvium (TE) was the diagnostic term to describe the rapid and excessive shedding of follicle scalp hair following pyrexia illness and fever. TE was also known as ‘post-febrile Alopecia’.

TE is now held to be a non-specific reaction to a wide variety of physiological and/or emotional stressors that synchronise up to 60% of all scalp hair follicles into a premature termination of ‘anagen’ phase – which then moves in to ‘telogen’ shedding phase.

Some common initiators of TE are:

  1. Acute illness – particularly when accompanied high febrile states (elevated body temperature); vomiting and diarrhoea – especially from contaminated food/water.
  2. Severe allergic reactions from any source, but most commonly from colour tints, perming solutions or topical treatments such as Minoxidil (usually with added Retinoic acid). These reactions may occur spontaneously or from incorrect application/exposure time, or NOT ‘patch’ tested prior to 1st-time use – OR the user (or their hair professional) has ignored early signs of irritation such as itching, burning or breathing difficulties.

Severe reactions are potentially life-threatening as they may lead to anaphylaxis and respiratory arrest, and medical advice must always be sought. Excessive hair shed in its various forms (Telogen Effluvium, Alopecia areata/totalis/ universalis) or hair breakage may occur even before the sufferer leaves the Salon.

Scalp scarring, follicle destruction and ongoing- skin hyper-sensitivity as permanent damage may also result.

3. Exposure to toxic chemicals due to inhaling or skin contact: These chemicals may be industrial forms (ammonia, chlorine, hydrochloric acid), or motor vehicle exhaust (i.e.: mechanics working in vehicle repair garages), or deliberately ‘sniffing’ the contents of aerosol cans; petroleum or gases.

4. Sudden emotional shock or prolonged and unrelenting mental distress.

5. Surgical or extensive dental procedures:  particularly when substantial blood loss or intra-operative complications have occurred.

6. The commencement or cessation of certain medication such as oral or troche’ hormonal therapy (OCP/HRT); injected or implanted contraceptives/HRT, thyroid medication, Statin drugs for hypercholesterolaemia; anti-androgen medication (such as Spironolactone), anti-convulsant/mood stabilising drugs (Sodium Valproate/Phenytoin Sodium or other like medication), anti-depressant medication (1), the use of certain performance enhancing or ‘body-building’ drugs (anabolic steroids).

 ‘Over-shooting’ the mark in the prescribing of thyroid or other medication which influences metabolic functioning will frequently result in a TE type hair shed & significant mood disturbance, palpitations & tremors (Chan: 2014).

Topical chemotherapy drugs for skin ‘cancers’ (BCC’s or Keratoses) – because they target rapid cell proliferation, sometimes result in a TE hair shed from the area/s of application.

7. The administration of intravenous, strong combination drugs or iron infusions such as antibiotics or chemotherapy or blood dialysis. Iron infusions are becoming an increasing popular method of rapidly raising female iron stores.

At this time tissue iron levels within the body dramatically elevate and remain high whilst the iron is being absorbed, stored in the organs, and ultimately utilised by the body. During this time significant free radical (ROS) damage is believed to occur which can potentially predispose to malignancy in later life (Chan: 2010).

Iron is very oxidative with a very reactive potential that can cause physiological ‘shock’ to the body from the high amounts rapidly administered. This will often activate a Telogen Effluvium in susceptible people.

Blood test results for iron levels at this time often present a false picture of ‘repletion’ – which then often quickly falls away to reveal a still inadequate storage level.

8. Rapid weight loss in a short period of time either by ‘crash-diet’ or illness. A dramatic change in one’s diet; any ‘fad’ diet that promotes the exclusive or excluded intake of certain major foods groups, or harsh detoxification diets.

9. ‘Support Collapse’ of follicle hair growth due to nutritional, metabolic or hormonal levels no longer able to provide the ‘metabolic energy’ to sustain scalp hair follicle activity. As a NON-essential tissue in nutritional, metabolic or hormonal terms, scalp hair is often the 1st to reveal internal disturbance or deficiency by increased hair shed and or degraded hair shaft quality.

10. Severe shock or intense protracted stress: ‘stress’ is a common reason given for hair loss problems, but it’s usually only the most severe events which will trigger a TE hair shed or onset of Alopecia areata – or other autoimmune problem. The death or grave illness of a loved one, marriage or other relationship breakdown, harassment; business, employment or career termination with resultant financial anxieties are just some examples of the ‘types’ of emotional stressors likely to cause scalp hair loss.

11. Following childbirth (post-partum) or (sadly) miscarriage or pregnancy termination. Post partum alopecia in this TE form is considered the one true moult in humans, and results from the intense hormonal changes within a pregnant woman before and after childbirth.

Post-partum TE usually commences 8-10 weeks childbirth but when it commences and how severe the TE depends (from my clinical experience) on the following factors:

    • Whether or not the woman is breastfeeding
    • How ‘sleep-deprived’ she is with her newborn infant.
    • Her post-partum nutritional status

Commonly one-four months (average 2-3 months) after any of these experiences, the hair will begin to shed abruptly and be lost in excessive amounts for about 2-3 months before settling.

Whenever a telogen effluvium episode is triggered the shed is diffuse i.e.: hair fall from the entire scalp rather than focal or patchy loss. The rapidly dividing matrix cells of growing hair are very sensitive to nutritional, metabolic/hormonal or environmental disturbances – and often one of the first areas of the body to reflect disturbances in physiological functioning.

Ordinarily TE is considered a ‘temporary- self-correcting’ form of diffuse hair loss unless the scalp suffers ‘cicatricial (scarring) damage due to chemical reaction from applied topical products.

In certain circumstances an initiating incident may temporarily disrupt ‘anagen’ phasing rather than terminate it. The hair shaft continues to grow but is fragile where the interruption occurred. As the hair grows beyond its supporting follicle it fractures and breaks off at this weakened point (termed Trichorrhexis nodosa) approximately 4-6 weeks after the initiating incident (Olsen, EA: 1994). Over-processing of hair in perming or bleaching of hair is a common cause of this.


Whilst TE is generally a self limiting and ultimately self-correcting form of alopecia, hair is shed in massive amounts and the scalp quickly exposed as hair density falls to 40-60% of the density it previously was. The spectre of total hair loss is emotionally devastating to women of any age – particularly a post-partum mother; often sleep deprived and coping with a new baby.

A careful and detailed history should be reviewed by an experienced, qualified practitioner to establish the nature of the alopecia; it’s initiating trigger/s and time frame of shedding fall within the parameters of a TE diagnosis.

Reassuring the client that (in time) a full recovery of lost hair density is the expected outcome cannot be over-emphasised. A blood pathology test should be ordered to assess iron studies, (plasma or red cell) zinc, Vitamin D, Iodine, B12 etc. All levels need to be in the 50-75th percentile of respective reference ranges to facilitate a more rapid‘re-adjusting’ of follicle anagen phasing.

Activance Rhodanide (2) is a natural ‘leave-in’ treatment (the vitaminoid Rhodanide is the active nutrient) which is very effective in accelerating TE resolution. Unlike Minoxidil, Activance Rhodanide is completely safe for pregnant or lactating/breast-feeding (3) women to use (Minoxidil can be excreted in breast milk).

Photo-biotherapy such as ‘soft/cold’ low level laser light (LLLT) is in my experience most effective in TE shedding due to its anti-inflammatory and vaso-dilating (blood perfusion) properties.

To be therapeutically effective these laser appliances should be classified ‘3A’; be in the red light spectrum + wavelength vicinity of 660-780nm. Bio-available power output should be 60-100mW.

Continual hair shed over many months is often given the label ‘Chronic’ Telogen Effluvium’. In my opinion this is a NON-diagnosis – in the same vein as ‘stress’ or ‘irritable bowel’ – and ‘Chronic hair loss for investigation’ may be a more proactive provisional diagnosis.

The reason/s for hair loss in females is multi-factorial and linked to their nutritional-metabolic and/or hormonal ability to support hair growth. Thinning scalp hair density is frequently an early warning sign of internal disturbance such as iron deficiency, thyroid dysfunction or developing autoimmune condition (such as Lupus or autoimmune thyroiditis).

The amount of hair shed daily or over a week varies in all of us and is determined by a number of factors. Therefore the practical definition of excessive hair loss is ‘more than the individual would normally lose’.


  1. Hair loss from the taking of anti-depressant medication is often ambiguous with the mood ramifications that resulted in your Doctor prescribing it. Mood disturbance necessitating anti-depressant medication will almost always cause metabolic-hormonal disturbance which in turn adversely affects hair follicle growth. You should NEVER cease prescribed anti-depressant medication without consulting your family Doctor.
  2. Activance Clinician Formula is the most intense of the range, and shown to be very effective for slowing hair loss and supporting follicle hair growth. 
  3.  A breast- feeding Mother naturally produces minute amounts of Rhodanide to sterilise breast milk (Chan: 2016)

Copyright Anthony Pearce 2009 (revised September 2020)



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