Over the weekend, I received an email from a woman who asked me “what exactly is TE or telogen effluvium like?” I wrote back and asked for a bit of clarification, but she meant what I thought and she assumed that she had meant it. Basically, I wanted to know what the hair of a person with ET will look like and if there are any patterns or appearances in the hair or scalp that would indicate that the shedding or hair loss is due to ET rather than something else. I will talk about these things in the next article.
What does hair loss due to telogen effluvium look like?: Sometimes there are changes in hair texture before shedding begins. This is because the affected hair goes into the resting stage and these strands are no longer deeply embedded in the scalp or properly nourished. Therefore, the result is loose or unruly hair that doesn’t quite lie flat.
Once shedding really starts, you may not notice any volume change or thinning spots at first. Most people start out with a lot more hair than they think, so it takes a certain shedding period before the changes are noticeable to others. You may see worn or fallen hair hanging by the ends and friends, co-workers, or complete strangers pulling your hair out of your clothing (which can be quite embarrassing). You may also see that your scalp is pink or red because many follicles are affected at once.
After a while, you may start to see some thinning in areas that aren’t as thick at first, like your bangs, temples, or crown. Now, some people will panic and think they have AGA or androgenic alopecia, but this is not always the case. Often those areas have less hair to begin with, so they will thin out more quickly than other areas. Generally speaking, however (although there are very common exceptions), people with ET will generally have general or diffuse shedding and loss, whereas people with genetic loss will have a pattern loss that is mostly limited to the upper body, temples, and the crown.
Over time, it can be increasingly difficult to tell the difference between TE and AGA simply by looking at the hair and scalp. Because prolonged shedding is going to thin your hair, even if it grows back steadily. Now, with telogen effluvium, the quality and quantity of your new growth shouldn’t be negatively affected, unless you have some inflammation issues. Therefore, the regrowth you have should be relatively healthy and thick. However, because something is causing your hair to continue its cycle through the resting phase, your new growth may not have the impact you might have hoped for because the growth simply cannot keep up with the loss.
What’s the deal with the white bulb? Does the white bulb mean that I definitely have telogen effluvium?: I get asked the question very often. People really want reassurance that this shedding might one day stop, so they are very hopeful that the white bulb at the end of the hair is indicative of temporary shedding. However, the truth is that almost all forms of hair loss have the white bulb. The exception is if you actually pluck your hair from your scalp.
But, the hair that has reached the end of its life cycle will fall out and that bulb is right where it is no longer embedded and nourished. If you pluck out one of the hairs right now, you’ll see a brown sheath around the tip. This is still healthy growing hair and that is the difference. That hair did not find a natural end. But your hair doesn’t know why it’s being forced into the resting phase. It just knows that it is in this phase and responds accordingly.
Now, if the bulb is a bit yellow and it’s large, it may be a buildup of sebum which, depending on how often you wash your hair, may be indicative of androgens negatively affecting and clogging the hair and scalp. . However, it’s pretty easy to tell the difference because the sebum buildup looks more like a plug and is much larger than the white end most of us see.
