Chronic telogen effluvium is said to be self-limiting in the long run; the natural history of this condition, however, has not been investigated prospectively. Four women, aged between 18 and 64 years and diagnosed with chronic telogen effluvium between 1996 and 1997, were followed up prospectively for a minimum of 7 years. One (previously reported) woman diagnosed in 1998 developed female pattern hair loss confirmed on biopsy specimen within 18 months that was partially reversed by spironolactone. The remaining 4 women continued to experience chronic diffuse telogen hair shedding that fluctuated in severity. However, serial photography demonstrated no visible reduction in hair density, and serial scalp biopsy specimen showed no follicular miniaturization. Although 4 out of 5 of our patients showed no tendency toward development of female pattern hair loss or to spontaneous improvement, further work is required to define the natural history of chronic telogen effluvium and the relative risk of developing female pattern hair loss.