After male-pattern baldness, which accounts for over 90% of hair loss in men, a condition called telogen effluvium (TE) is the most common form of hair loss. But what is TE and how does it differ from the other most common cause of hair loss?
What Is Telogen Effluvium?
The early stages of male- and female-pattern baldness can actually be classified as telogen effluvium, but from there, the two conditions take very different paths. The biggest difference is that telogen effluvium is often temporary and is completely reversible.
The hair follicles on the scalp don’t produce hair all of the time. Instead, follicles cycle through a growth stage. They produce hair for a while (usually two or more years), then “rest” for a month or two before growing hair again.
At any given time, about 80 to 90% of hair follicles are in an active “anagen” state, meaning that they’re growing hair. The other 10 to 20% are in a resting “telogen” and are not producing hair. TE occurs when there are more follicles in a resting state than normal, resulting in shedding or hair loss.
Types of Telogen Effluvium
There are several types of telogen effluvium. In some cases of TE, hair follicles may have entered a resting state because of environmental factors. After a period of shedding and thinning, these hair follicles will generally return to an active state and start to regrow hair again.
Other times, hair follicles enter their natural resting state and stay there longer than normal. As more and more hair follicles enter a state of rest, fewer follicles are left to grow hair, which leads to a slow thinning of the hair.
Sometimes, hair follicles enter their normal active state, but the growth cycle is stopped short for some reason. The result is the persistent shedding of short hairs that have not grown to their full natural length.
The Causes of Telogen Effluvium
Telogen effluvium can be caused by many different factors — not all of which are known. Sometimes, TE is a response to the sudden change in hormone levels associated with childbirth. The hair follicles temporarily go into “shock” and stop growing hair for a short period of time.
Other environmental causes that can trigger TE include vaccinations, changes in medication, extreme dieting or surgery. In most cases, when the body heals and recovers from the trauma, so do the hair follicles, and hair begins to regrow on its own.
In other cases, a more long-term condition can lead to longer-term TE. Chronic illness, stress or nutritional deficiencies are common causes of persistent telogen effluvium. Some doctors believe that a vegetarian diet — or a diet deficient in iron, zinc and other vital nutrients and vitamins — can cause TE. Though supplements can be taken to replace these nutrients, some, like iron, are toxic at high doses and can lead to further hair loss if taken in excess. Other conditions like thyroid disorders can also lead to TE.
Differing Patterns of Hair Loss
Male-pattern baldness follows a distinct pattern of receding and thinning hair that begins at the front of the hairline and progresses until just a rim of hair — or in some cases no hair — remains. The condition is triggered by the male hormone dihydrotestosterone (DHT), a byproduct of testosterone. Some individuals have hair follicles that are sensitive to DHT, and after years of exposure, the follicles simply shrink and stop producing hair.
Telogen effluvium, on the other hand, does not typically feature recession at the hairline. Instead, the condition presents as thinning hair all over the scalp. The thinning can be more severe in some areas than others or can be evenly dispersed across the scalp. Usually, the hair on top thins more than hair on the sides and back of the head. Most people with telogen effluvium do not lose all of their hair.
Treatments
Telogen effluvium is reversible when the underlying cause is effectively treated. Male- or female-pattern baldness can be slowed or stopped with treatments but cannot be reversed.
Finasteride (the generic name for Propecia) has been approved by the FDA to lower DHT levels and stop the progression of hair loss caused by male-pattern baldness, but successful treatment is largely dependent on early intervention. Minoxidil (loniten) has also shown to effectively regrow some hair when applied directly to the scalp, but it does not affect the hormonal causes of hair loss and the results are therefore temporary.
In most cases, TE will clear up on its own when the underlying condition is treated — although there are many cases for which no cause is ever determined. Your dermatologist may prescribe Minoxidil to help regrow some of your hair until the cause of your TE can be accurately diagnosed.
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