Drug influence - hair loss can develop when using certain prescription and over the counter drugs. The mechanism by which drugs might promote hair loss has not been investigated in detail, but it is known that this type of hair loss is reversible and anticipated that drugs are likely to alter the environment around the hair follicle, thereby affecting the division of cells - the cells lose their ability to develop and grow. When hair follicle enters the final stages of development - a stage of rest, hair root gradually separates and hair shaft falls out. This can happen after a few months of the start of medication till the hair loss becomes noticeable. Hair follicles will be forced to remain in this state till these drugs affect the body. Although the hair follicles on the scalp of the head over all suffer from the effects of drugs the most, sometimes eyebrow, eyelash hair, etc. may be affected too. Most drugs in the group of antibiotics, sedatives and antidepressants may increase the risk of hair loss.

Effects of chemicals / metals - as with drug induced Telogen Effluvium, the mechanism of chemical induced alopecia has not been investigated in detail. Some of the metals such as iron are actually beneficial to health until they reach toxic levels. As with almost all causes of effluvium, avoidance of the trigger factor permits gradual hair regrowth. Chemical or metal induced effluvium is not permanent. The major chemicals / metals that cause hair loss, include, but not limited to salts of lithium, thallium and gold, iodine, iron, aluminium, arsenic, boric acid, mercury, etc.

After surgery - major surgery is an extreme physical shock to the body. After surgery your body is struggling to repair itself. Most nutrients are diverted to repairing essential organs and reorganizing the structural integrity of the body. Hair follicles are not vitally important for survival so they often lose out as nutrients are diverted elsewhere. Without a good supply of nutrients the hair follicles slow down or even stop activity completely. This may lead to a progressive hair loss noticeable up to three months after the surgery has taken place. Also hair loss enhancement by surgical procedures may be linked to use of anaesthesia, blood transfusions, etc.

Pregnancy may be a key life event where hair loss can develop. Hair loss may begin during the last three month of pregnancy or it may begin after child birth. Hair loss is often a form of Telogen Effluvium but sometimes pregnancy can promote the onset of Alopecia Androgenetica in susceptible women. In non-pregnant women about 10% to 15%of hair follicles are in a Telogen resting state. During the late stages of pregnancy more and more hair follicles enter an Anagen growth stage until shortly before birth 5% or fewer hair follicles are in Telogen. After child birth up to 60% of these Anagen phase hair follicles switch off and enter Telogen all at the same time. The hair loss may become progressively worse for up to four months after child birth and it may persist for several more months as the hair follicles reorganize themselves and begin activity again. Pregnancy involves prolonged hormone levels, particularly estrogens. Estrogen is known stimulate hair follicles and maintain them in an anagen growing state. So in pregnancy the hair follicles are not allowed to cycle as they normally would. The hair follicles are forced to keep active even though they might normally want to have a rest as part of the hair cycle. After child birth the estrogen levels suddenly drop and hair follicles are finally allowed to enter Telogen all at the same time. Pregnant women are eating for two and a growing embryo consumes a lot of energy and nutrients. Deficiencies in certain vitamins and/or minerals can be the result if a diet is not adjusted to increase intake of required nutrients and Telogen Effluvium type hair loss may develop.

Contraceptive drugs - the hair loss may begin at almost any time after starting oral contraceptive use. Hair loss onset has been reported anywhere between one month to two years after starting contraceptive pill use. Telogen Effluvium from oral contraceptives can be temporary with recovery while the individual is still using the contraceptives. Sometimes the hair loss may persist for as long as the contraceptives are used. When oral contraceptives are suspected to cause hair loss the individual may be switched to a different medication to see if the hair state recovers. Temporary hair loss can occasionally develop up to one month after discontinuing use of contraceptive pills even though the individual had no hair loss symptoms while using the pill. It is assumed the sudden withdrawal of hormones from pill use is a disruption the body has to adjust to. Oral contraceptives suppress natural hormone production. After withdrawal of oral contraceptives the body must begin to produce estrogen and progesterone according to the natural cycle. Potentially, it may take time for the body to adjust and begin normal hormone production during which hormone levels may be a concentrations that adversely affect hair follicles.

Various diets - the cells of the hair follicle have a very high degree of metabolic activity. They are some of the most active cells in the body, dividing rapidly and producing a range of products. This exceptional rate of activity mean hair follicles are particularly sensitive to energy supply. Without the energy to fuel this high rate of activity the hair fibre production line must shut down. Telogen Effluvium is the result as the hair follicles enter a resting state waiting for the energy supply to be turned on again. Crash dieting over a long time period can potentially cause hair loss as hair follicles suddenly find they have a limited source of energy, vitamins, and minerals readily available to them. Poor diets also cause a drop in thyroid hormone production and this can also promote Telogen Effluvium. Hair loss is usually seen several months after starting the diet and persists for several months after diet completion. Telogen Effluvium may also be observed in people who have nutrient absorption problems as in celiac disease.

Lack of vitamins - hair follicle cells have a high rate of metabolism and all vitamin Bs are important in metabolic function. Vitamin B complex consists of several vitamins that are similar in their molecular structure and activity. The vitamin B complex includes B1 (thiamine), B2 (riboflavin), niacin (nicotinic acid), B6 (a group of related pyridines), B12 (cyanocobalamin), folic acid, pantothenic acid, and biotin. Of these biotin is arguably the most important for hair follicles as it's deficiency can potentially lead to a reduction in hair follicle activity and even extreme hair loss. Deficiency of vitamin C does not directly cause hair loss but it does affect skin quality and in turn the formation of hair fiber. When vitamin C is deficient, the cells of hair follicle canal, where the hair fibre pushes through to the skin surface, become overactive and a plug of keratin forms to block the hair canal. Hair from these follicles takes on an abnormal corkscrew shape. Vitamin C deficiency can indirectly promote Telogen Effluvium as it may lead to iron deficiency that may directly cause hair loss.

Lack of minerals - iron deficiency is relatively common with a typical western style diet and could be a common cause of Telogen Effluvium type hair loss. Women in particular are susceptible to iron deficiency due to the regular loss of iron rich blood in menstruation. Blood donation is also involves a significant loss of iron. Chronic iron deficiency also leads to symptoms of anaemia, spoon shaped nails, depression and general lethargy. Extreme zinc deficiency is associated with multiple symptoms including diarrhoea and eczema-like skin problems. Zinc is important in hair fibre production and a deficiency of this metal results in diffuse Telogen Effluvium of the scalp and body hair. Vegetarians are particularly susceptible to zinc deficiency as dietary zinc is most commonly supplied in meat and fish. Zinc deficiency can also occur in individuals who have chronic gastrointestinal diseases or who have undergone bowel resection surgery. Copper deficiency may indirectly promote Telogen Effluvium as low copper levels reduce iron absorption. Lack of copper in the diet may also directly affect hair quality. Hair fibre becomes thin and easy to break. Hair follicles reduce their Anagen growth phase resulting in a type of mild Telogen Effluvium where hair can still be present, but it does not grow very long.

Stress - both long term chronic stress, depression, and sudden intense anxiety may promote the onset of Telogen Effluvium. The hair loss may develop and become noticeable a few weeks to four months after the initial stress episode. The Telogen Effluvium persists for as long as the stress persists and hair loss may continue for several months after stress reduction. As hair follicles are surrounded and invaded by an intimate network of nerve cells potentially any adverse chemical activity in the nervous system might send adverse signals to hair follicles.

Infection - infectious agents can promote a Telogen Effluvium type most likely due to the general reduction in health. As the body becomes depleted of nutrients and changes in hormone patterns may occur, so the hair follicles find themselves in an unhealthy environment. They may reduce their hair growth activity or shut down all together and wait until their environment improves. Successful treatment of the infection and removal of the chronic immune stimulus allows the body to recover at which time hair regrowth should occur.

Chronic Telogen Effluvium often occurs in women who previously had a high hair density, very thick hair in their teens and twenties. Actual onset of this type hair loss is most common in those age 40-50, although it may occur in younger individuals. This form of hair loss is not permanent it can last up to 72 months. Very rarely has chronic Telogen Effluvium been reported in men. Unlike other types of Telogen Effluvium, the initial onset can be quite sudden. This form of hair loss can gradually become quite extensive over the entire scalp. Hair thinning at the temples can often be observed which is extremely unusual in women. The hair thinning may fluctuate over time. In chronic Telogen Effluvium there is a very high number of Telogen hair follicles. This means that a hair pull test is positive with many hair easily being pulled from the patient’s scalp. There are no miniaturized hair follicles or vellus hair fibres unlike Alopecia Androgenetica. There are no known cases of individuals with chronic Telogen Effluvium developing permanent hair loss or extensive bald regions. There is a suggestion that this high number of Telogen follicles is due to the follicles entering a synchronized cyclic hair growth rather than the usual mosaic pattern of growth cycles found in adult hair follicles.