Expert: Melanie Vonzabuesnig - 6/6/2009

Question
QUESTION: I am 40 year old male.  I have no history MPB in my family.  
I was diagnosed with telogen efflevium by my GP + Derm.
Started excessive shedding approx October 08 - Dec 08 @ 80 -100, then
Jan 09 - present @ 30 - 40 hairs. I definitely notice thinning,
most notibly in the cowlick, but no bald area. On the advice of the docs,
I started Rogaine in Nov 08 to assist w TE recovery. My shedded hair has
the bulb at the end, but last month started to notice a mix. Some
with, some without.

I'm beginning to get skeptical of the diagnosis due the time it's taken.
Is this a typical shedding timeframe for TE?  
Or does this shedding time + progress more representative of MBP?

I waited to go back to the docs due to insurance issues, beside they mostly
dismiss it.  I would really appreciate your honest advice.

Thank you.

ANSWER: Hello Dave: There is no set or usual amount of time that shedding lasts for telogen effluvium. It largely depends on the cause of the telogen effluvium and whether the underlying cause has been treated (or the body has adjusted.) The over-all health and well-being of the individual also must be considered. There are so many possible causes of telogen effluvium. Some are minor and others may require medical attention or other adjustments.  Telogen effluvium can become a chronic condition.
Excessive shedding is indicative of telogen effluvium rather than male pattern baldness. With MPB, rather than actual hair loss, the hairs become thinner and weaker, providing less scalp coverage.  Sometimes telogen effluvium does precede MPB.
It is impossible to count the number of fallen hairs per day. Although it is normal to lose 80-100 hairs per day, this hair loss is mostly unnoticed. As of now it seems the amount of fallen hairs you are noticing has decreased quite a bit. I am not an advocate of synthetic topical treatments. Essential oils are very potent and effective but they are natural and do not cause the adverse side effect of synthetic treatments. Discontinuing use of these synthetic treatments usually causes any new regrowth to fall out. That is not true of essential oil treatments.
Sincerely, Melanie Vonzabuesnig
Understanding Female Hair Loss
http://www.vzbotanicals.com/overcomefemalehairloss.html
My Hair Loss Story
http://www.vzbotanicals.com/mystory.html


---------- FOLLOW-UP ----------

QUESTION: Mrs Vonzabuesnig,

I understand that there are no certainties.  Just so, I am clear.  Are you saying that my hair loss progression is more characteristic of TE?  If so, is it possible to go bald with TE?  I would just like to come to peace with it or look at how I can manage it.

Thank you so much for your time and advice.

David

Answer
Hello David: Your hair loss does sound more like TE because of the excessive shedding rather than gradual, progressive thinning. Te causes diffuse hair loss, not total baldness. Although it can become severe and quite extensive. Because you are now losing less hairs than previously you may be at the end of your shedding. If you really are only losing 50 hairs per day, you are in good shape. A common test for telogen effluvium is called the "pull test" If you grab a small handful of hair and gently pull should end up with 1-4 hairs. If you do this on various areas of the scalp and consistently have more than 1-4 hairs it indicates telogen effluvium. The thinning areas that you are now noticing may be from the previous shedding.
Sincerely, Melanie Vonzabuesnig