Understanding Hair Loss : Telogen Effluvium

How much how does the average person lose a day?
The answer to this often surprises people! It is actually normal to lose between 50-200 hairs a day with most people probably in the 50-100 hairs a day. We often notice when in the shower or brushing our hair but shedding is occurring throughout the day.
Most people have a general sense of what ‘normal’ is for them. It can be alarming to see high volumes of hair loss at one time. Actually, if you are ‘witnessing’ the loss- meaning you actually see the strands in your hands and they have the little white bulb at the end, then you are likely experiencing telegenic effluvium. This is a temporary cycle change to the hair where we go through a shedding phase. If you suddenly notice a patch of hair is just missing and it has a well defined shape to the patch like a circle or an oval, then you may be experiencing alopecia areata, an autoimmune type of hair loss. For those with a lot of inflammation and itching in their scalp, this can be autoimmune or the result of irritation from a product. It’s good to tell the difference between hair breakage (breaks easily with frequent chemical use) and loss (from the scalp). 
Many people note a seasonality to their hair loss. I often hear that some people ‘expect’ to shed in the fall for example. Season changes may act as a stress on our bodies that can trigger this cycle change to hair growth.   
Any stress on our body - physical, mental or emotional- can shift the cycling of our hair growth.
What is considered  "normal" for cycles of hair growth?
My routine discussion with patients is to review ‘normal’  hair cycles and the impact of stress on this pattern. Normally, 80-90% of our hair is growing while 10-20% is ‘resting’. The pattern is random and you will likely not notice this. When a stress impacts the body - anything qualifies, physical, mental or emotional- then the cycle shifts. Now it could be that 50% are growing and 50% are resting. Actively growing hairs are deeply ‘planted’ in the scalp. When they enter the testing phase it takes about 3-4 months for these hairs to start to fall out. The shedding occurs on a delay of about 3-4 months after the stress. Interestingly, the hairs only fall out when a new hair is growing behind it to push it out! Ironically, people are usually stressing out during the recovery phase because they panic that they will lose all of their hair. The new hair is fine and tapered and gets coarser and thicker as it grows longer (just like a blade of grass). It takes about a year to recover. This can be a long year!! If it is persistent or unclear what the trigger was, blood work can help identify reversible causes of hair loss from the thyroid or vitamin deficiencies.
The best treatment in my opinion is knowledge. Understanding hair loss is so important because the stress of hair loss often leads to more hair loss! If it is telogen effluvium then recovery will often occur without treatment and just time alone.  The most beneficial option for management is minoxidil. Although many recommend Biotin, it’s best to use with the caution that FDA issued an alert last year that it can affect lab tests.

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