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Hair Loss/Telogen Effluvium - regrowth


QUESTION: Hi - I have had a good few years of emotional stress culminating in high anxiety and worry in late 2012, which I mainly have under control now.   Around this time I started noticing more hair on my shoulders, the car seat and blocking the plug when I washed my hair.

My hairdresser also mentioned it and we came to the conclusion it was caused by prolonged stress, in May of this year she noticed it was growing back, it has continued to grow, I now have lots of fuzzy, curly hair across the top of my head and fine hair along the hairline.

My question is on the colour change, I am 43 and around 40 I started having grey hairs, wiry and just a few running at the front of the sides of my hair.  I have shoulder length naturally wavy hair - dark blonde and have never died it.

My question is, the regrowth hair after the loss is a mixture of natural colour and of white/grey and I am noticing the underlayer of my hair has many more strands of white in it - I cannot easily tell if these are new hair growth or not.  The texture is also variable, the white hairs sometimes wiry and some fine like the coloured hair.

Is it usual for the regrowth to be mainly grey or perhaps I am not noticing the natural coloured hairs so much, I appreciate that the hair growth cycle has been messed up and maybe I am getting the grey hairs I would have had in a couple of years time.

Your advice/knowledge would perhaps help, I am getting anxious about the grey looking more and more, it seems quite a sudden awareness of grey sprinkled throughout and its a bit of a change and seems sudden.

Does this mean more will be going grey or maybe it wont be so noticebale once the pigemented hair grows thicker.  I would say it has grown about 3 inches in the last few months.  I am also anxious as to how I will know if the shedding has stopped completely?  Presume the regrowth 'halo' is an indicator all is in recovery?

Many thanks - I have started taking zinc, b vitamins, I think I have adrenal stress and wasnt sure if this would help.  I don't suppose the follicles recover and the grey hairs when they fall will revert to coloured!?

ANSWER: My advice is to first of all relax and be happy there is new hair growing back in no matter what color. The fact a higher proportion of them are white than what you normally were experiencing may be due to two possible mechanisms. First just from having CHT ( Chronic Telogen Effluvium-shedding) you can use up life cycles and therefore also push the hairs into old age which would normally be white hairs.  Or the chronic stress just selectively aged the pigment cells in the hair follicles. There is no way to know which of these is the cause. My suggestion is to add 5% minoxidil for men as a treatment only once a day in the morning as the last thing you do before combing your hair in the morning. Apply it just to the top of your head and not more than 1ml. This should stimulate the hairs to grow back faster . The new wiry texture will probably remain for another 6 months before the hair follicles get used to growing straight.  On occasion I have seen hairs darken after growing in as white but in most cases they remain white.

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QUESTION: Thank you so much for your speedy reply.

Not to stress is very good advice. My stress was initially to do with things I had no control over and this hair situation and the change to more grey has saddened me a bit, the toll almost visible when I was just feeling a bit brighter on myself. This of course is am attitude I will change now I understand a bit more what is happening.

I have lost my parents so have no idea the age they would and did (my mum dyed her hair) go grey so don't know if it was around now. No one to ask either but guess mid 40's is an age to expect graying - is that right?  Also if stress can effectively switch off the colour aspect of the follicle is it common for this to continue or can I expect to go Gray gradually at a natural pace now that my hair appears to be back into a cycle.

I guess I am trying to understand the science and reassure myself all is back to 'normal ' and I need not pay attention except for the lotion you mention and stay calm. As I said I have had adrenal fatigue/thyroid balance not official, as blood tests just within normal range. I know this effects hair. Do you feel I can assume all us back in rythum?

Thanks again

ANSWER: I would expect you to gradually start to turn grey. The acute change was due to acute severe emotional stress. The lotion is simply to hasten the regrowth of the hairs which are changing cycles.
You can read about normal hair cycles here
There are three phases of hair growth, and the hair follicle changes significantly from phase to phase. The three phases are the anagen phase, the catagen phase, and the telogen phase.

Anagen Phase: The anagen phase is the “growing” phase of a hair follicle. It begins with a miniaturized hair follicle that may or may not have recently shed the hair it was growing during the previous growth cycle. At the beginning of the anagen phase, the hair follicle starts to grow back to full size and extend deeper into the skin. A new hair bulb is formed at the base of the follicle, and inside the hair bulb specialized dermal papilla cells begin to grow a new hair shaft. If the old hair has not been shed already, the new growing hair helps “push” the old hair out of the follicle. As the new hair grows out from the base of the follicle, it extends beyond the surface of the skin and appears as straight or curly, and with a color that can be blonde or brown or red or gray. Scalp hairs grow about one-half inch per month during the anagen phase, for a period of time typically ranging from four to six years. This is a rapid rate of cellular growth compared to most other tissues in the body.

Catagen Phase: Following the anagen phase, the hair stops growing and the hair follicle starts shrinking. This “regression” period is called the catagen phase. During the catagen phase the lower part of the hair follicle slowly disintegrates, and the hair follicle requires less nourishment from the blood supply. The structure of the hair bulb at the base of the follicle disappears, and the dermal papilla cells separate from the base of the follicle. The miniaturized hair follicle has a looser “grip” on the hair shaft, and normal body movement, grooming, or bathing may result in the hair shaft being shed at this time. The catagen phase for scalp hair follicles lasts about two to three weeks.

Telogen Phase: After the hair follicle has stopped shrinking, it enters the telogen or “resting” phase, which lasts for another three months, or so. During the telogen phase the follicle appears inactive, and the hair shaft may also be shed during this period. Shedding hairs are a normal part of the cycle of hair growth. Shed hairs may appear on bedding, on clothing, in combs and brushes, and many shed hairs simply go down the drain after shampooing. The point is that some hair loss every day is normal.

and Telogen Effluvium loss here

Stress can cause a type of hair loss called telogen effluvium. This condition is not caused by the general accumulated stress of ordinary interactions with people at home and at work, but rather by sudden severe emotional or physiological incidents. Severe stressful events can cause some or most actively growing hair follicles to prematurely shift into the regression phase, and then the resting phase, during which the hairs fall out easily.

There is usually a delay of a few weeks to a few months before the shedding is noticeable, but after this delay the shedding seems to occur quite suddenly. Because the shedding is delayed, this type of hair loss is often a mystery to the person suffering the condition. The stressful event that triggered it is frequently forgotten, and it is rarely thought to be connected with the “new problem.”

Examples of sudden severe emotionally stressful events include the death or terminal illness of a family member or close friend, marriage, divorce, and unexpected job loss. Severe physiological stressful events shock the body, and some examples are heart attacks, major surgery, and illnesses with prolonged high fever such as malaria, viral pneumonia, and severe cases of the flu.

In most cases of telogen effluvium, the hair follicles recover and soon shift back to the regular growth cycle.

However, repeated instances of telogen effluvium can result in premature hair loss in people predisposed to lose their hair late in life. The average growth cycle of a hair follicle takes about five years, but each follicle is “genetically programmed” for only a limited number of growth cycles. For example, if a particular hair follicle were “genetically programmed” for only ten growth cycles, after about fifty years that follicle would stop producing new hairs. When all the follicles at the hairline or crown of the head are “genetically programmed” this way, a receding hairline or bald spot appears after all the growth cycles for the follicles in those areas have been cycled through.

Each incidence of telogen effluvium uses up one “life” of the affected hair follicles. So instead of having a receding hairline or bald spot at age fifty, the hair loss may occur a few years earlier. This is not a significant issue if telogen effluvium occurs once or twice in a lifetime; however, accelerated hair loss can result from repeated severe stressful events, if each instance triggers a new round of telogen effluvium.

I had a patient who was totally bald when I met him at age seventy, and he had lost all his hair by age twenty-two. He had worked on the Panama Canal fifty years earlier, and for two straight years starting when he was twenty he suffered repeated bouts of severe fever from episodes of malaria. Each time he suffered from malaria induced fever he experienced telogen effluvium, lost what hair he had, and his hair follicles lost another “life.” After ten or fifteen malaria stress cycles, at the age of twenty-two, he had the hair he would have had at age seventy. Which unfortunately for him was no hair at all.

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QUESTION: Thank you, that explains the process of hair growth well.  I guess there are unknown factors involved re the programme of the cyles for follicles etc but as my mother didn't lose her hair by 65 I guess I might have some cycles to go.

I did have a shock last year, I am not sure what happened exactly, my sister was suffering post natal depression and was about to visit me from overseas with her son to look after them, it was the anniversary of my mothers death some 4 yrs previously.  I had a stress response with tighening of muscles in my neck and shoulder and subsequent pain problem which needed physical therapy, then my sister arrived for 2 months.  The hair began to shed around the time she left.  So this makes sense.

I sincerely hope that the shedding was a one time event as I can see from the above that it can repeat - it's good to know its not just 'ordinary' stress, maybe more shock.  I also had two incidences of dental infections in that year.  My system was severely stressed.

Thank you once again.

You are welcome-- It does seem you have a very good chance to get most of your lost density back BUT you need to be patient since hair only grows 1/2 inch per month.
 Don't get fixated on how much hair is there day to day as that would be the equivalent to sitting outside and watching the grass grow. It is imperceptible day to day but rest assured it will grow.

Hair Loss

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Peter J. Panagotacos, <B>M.D.</B>


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.


I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website

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