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Hair Shedding (Telogen Effluvium)
The hair filling your drain this week was committed to falling out two or three months ago, when something jolted a batch of follicles into rest at once: a fever, a baby, a crash diet, a breakup, a new pill. This is telogen effluvium: temporary, named, self-resolving, almost never the start of going bald. The job is to name the trigger, screen a few fixable causes with one blood panel, and wait. Shedding slows by month four; the hair returns by month nine to twelve.
Condition Evidence Moderate Chapter Lookmaxxing

Every follicle runs its own clock: years growing a hair, then three months resting before the next growth phase pushes it out. Normally that release is staggered, so a healthy scalp sheds fifty to a hundred hairs a day 1. A shock drives a large fraction into rest together, and three months later they let go on the same schedule, so the shed arrives in a clump 2. The hair coming out is finished and on time. The shedding is the past arriving on a delay, not the present accelerating.

The trigger is almost always in the 90 days before it began. The postpartum drop is the cleanest case: two in five women shed visibly three to six months after delivery 3. COVID produced a textbook wave, onset around eight weeks after symptoms 4. Crash dieting, a new drug (or stopping the pill), and severe stress all qualify 5. Two causes are worth a blood test: an off thyroid, which drives diffuse shedding in both directions 6, and clearly low iron โ€” though the biggest case-control study found no ferritin difference between chronic shedders and controls, so treat real deficiency but doubt the "push it over seventy for hair" target 7.

The timeline back, once the trigger has cleared:

  • Weeks one to four: no change, still shedding.
  • Months two to four: the count drops below its peak. You stop dreading the shower. Nobody else notices.
  • Months four to six: short, dark, fine new hairs stand up along the hairline; the part stops widening 2.
  • Months nine to twelve: the brush comes out near empty, and the hair is the hair you had before 9.

If the shed lasts past six months, or is unmasking a pattern loss underneath, topical minoxidil 5% twice a day is the backstop; the extra shed it causes in the first weeks is it starting to work 10.

The fine print โ€” when to skip it, and what people get wrong

Skip biotin. Every case of it helping involved an actual biotin-deficiency syndrome, which the everyday reader does not have; worse, high-street doses distort thyroid and heart-attack labs, so stop it two days before any blood draw 11. Extra protein or collagen does nothing unless you are severely underfed 12. Shampoo does not cause this; a shed that terrifies you in the shower is almost never visible to other people.

Still shedding at month nine? The trigger is still active, it was undiagnosed pattern hair loss all along, it has gone chronic (which can run years before resolving) 13, or biotin distorted your labs. See a dermatologist, not another GP; trichoscopy separates a shed from pattern loss cleanly 8.

References
  1. 1Headington JT (1993). Telogen effluvium. New concepts and review. Archives of Dermatology. link
  2. 2Malkud S (2015). Telogen effluvium: a review. Journal of Clinical and Diagnostic Research. link
  3. 3Lynfield YL (1960). Effect of pregnancy on the human hair cycle. Journal of Investigative Dermatology. link
  4. 4Mieczkowska K, Deutsch A, Borok J, et al. (2021). Telogen effluvium: a sequela of COVID-19. International Journal of Dermatology. link
  5. 5Rushton DH (2002). Nutritional factors and hair loss. Clinical and Experimental Dermatology. link
  6. 6Vincent M, Yogiraj K (2013). A descriptive study of alopecia patterns and their relation to thyroid dysfunction. International Journal of Trichology. link
  7. 7Olsen EA, Reed KB, Cacchio PB, Caudill L (2010). Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups. Journal of the American Academy of Dermatology. link
  8. 8Mubki T, Rudnicka L, Olszewska M, Shapiro J (2014). Evaluation and diagnosis of the hair loss patient: part I. History and clinical examination. Journal of the American Academy of Dermatology. link
  9. 9Hughes EC, Saleh D (2023). Telogen effluvium. link
  10. 10Perera E, Sinclair R (2017). Treatment of chronic telogen effluvium with oral minoxidil: a retrospective study. F1000Research. link
  11. 11Patel DP, Swink SM, Castelo-Soccio L (2017). A review of the use of biotin for hair loss. Skin Appendage Disorders. link
  12. 12Guo EL, Katta R (2017). Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatology Practical & Conceptual. link
  13. 13Sinclair R (2005). Chronic telogen effluvium: a study of 5 patients over 7 years. Journal of the American Academy of Dermatology. link
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