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Hair Loss/CTE and shedding after stopping Rogaine

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QUESTION: I am a 43 yr old female who has been dealing with what I believe to be chronic telogen effluvium for the last 4+ years.  During that time I corrected my low ferritin (with better diet/iron supplements) and high TSH (with Synthroid).  I also used Rogaine for over 2 years.  I first used the 2% solution, then used the 5% solution.  During that time I still shed a lot on and off (300+ hairs per day).  Then due to unbearable scalp irritation, I quit Rogaine cold turkey 5 months ago.  3 months after quitting, I noticed an increase in shedding, but now 5 months after quitting, it is ridiculous (400 hairs per day).  My part is significantly widening and I'm very concerned.  All the shed hairs have the little white bulb at the end so I know it is telogen hairs.  My questions are:

1)  After quitting Rogaine, how long does the shedding typically last?

2)  Are the hairs I'm shedding now both the ones that Rogaine helped grow as well as the hairs that were already good?  

3)  Will any of it grow back to bring me back to baseline (i.e., where I should have been had I never started Rogaine)?

4)  If so, how long will it take to grow back to baseline?

5)  Are there any natural products I can use to help stimulate growth?  I have heard that Jamaican Castor Oil is good.  What are your thoughts on that product?

Thanks so much in advance.

ANSWER: 1. The shedding normally starts four to six weeks after stopping minoxidil and usually goes back to normal a few months later.

2. The hairs lost now are probably a mix of both the ones which were kept alive by the artificial stimulus to the hair shaft by minoxidil plus the natural attrition due to AGA.

3. How much grows back varies tremendously between patients primarily because there are many different causes for the loss in many patients such as PCOS. Poly Cystic Ovary Syndrome leads to a lot of hair loss which is chalked up to being normal AGA due to a TE or two.

4. Hair cycles are about 5 years long growing 1/2 inch per month. Once your hair loss has stabilized you are looking at a year or two before the hair is long enough to style as you did before.

5. Natural products frequently contain antioxidants which may help longevity of hair growth and a number of oils such as Extra Virgin Olive Oil and now Jamaican Castor Oil have been used. They do not seem to work well enough for most people to become more than a passing fad in most cases, although olive oil has been used a few thousand years for this purpose.

6. I recommend you see a dermatologist to have your condition evaluated and maybe your primary care doctor to see if your hormones are out of balance.

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

QUESTION: Thanks.  Over the past 4 years, I've been to MANY doctors (primary care, OB/GYN, dermatologist, rheumatologist, endocrinologist, a hair transplant doctor, etc..) and have had every test in the book.  

At one point, my ferritin was super low (11), but I'm now taking iron supplements and it is up in the 90s now.  For my thyroid, my TSH levels were a little high, but they were still in the range of normal and my free T4 numbers were normal.  Then I went to an endocrinologist, and she diagnosed me with sub-clinical hypothyroidism and I started taking Synthroid.  Once I got those numbers stabilized (TSH around 2) I saw the shedding stop and lots of regrowth for a period of 6 months. Unfortunately I lowered my Synthroid dosage (and my TSH went up again) and 3 months later saw the shedding again.  Then I upped my dosage and got the TSH back down and the shedding lessened 3 months later... Then I went off the Rogaine and I am shedding way more than I have in the last 4 years.

Note that my dermatologist also did a scalp biopsy last year.  Unfortunately in my case, the results were kind of inconclusive.  My shedding had temporarily stopped during that month, so it didn't show Telogen Effluvium, so all they said is that "in a clinical setting, the results are suggestive of mild AGA".

Anyhow, I was shedding on and off with the Rogaine over the past 2 years (other than the 6 month period I mentioned above) which is why I thought it wasn't doing anything for me.  But now it sounds like you are saying all this hair I'm losing now won't come back (b/c I'm losing the ones that Rogaine kept alive and more from AGA).  So I feel like I'm just going to keep shedding and shedding and have no hair left soon.  The shedding I'm having now has been really bad for 3 months now.  If it is due to minoxidil stoppage, shouldn't the shedding for that have been done by now?

Answer
I'm sorry to learn of the multiple causes for having lost hair. It really complicates the treatment and frustrates not just the patient but the doctors treating you as well because they cant put their finger on one etiology for the loss. One of the most common conditions I see is Chronic TEs or Chronic Hair Loss for any reason leading to AGA which the patient states doesn't exist in her family. The problem is that the chronic using up of the limited preprogrammed number of life cycles each hair has can cause a 30 year old woman to have the same density her 90 year old grandmother has.
An example of that is a 70 year old patient of mine who told me he developed Malaria at age 20 and he went completely bald in one year. He told me no one in his family ever lost their hair until they were in their 70s.
From Chapter 4 in my book Hair Loss Answers-which you can read for free online
http://www.hairdoc.com/hair-loss-anwers/chapter-4-other-hair-loss-causes/

"In most cases of telogen effluvium, the hair follicles recover and soon shift back to the regular growth cycle.

However, repeated instances of telogen effluvium can result in premature hair loss in people predisposed to lose their hair late in life. The average growth cycle of a hair follicle takes about five years, but each follicle is “genetically programmed” for only a limited number of growth cycles. For example, if a particular hair follicle were “genetically programmed” for only ten growth cycles, after about fifty years that follicle would stop producing new hairs. When all the follicles at the hairline or crown of the head are “genetically programmed” this way, a receding hairline or bald spot appears after all the growth cycles for the follicles in those areas have been cycled through.

Each incidence of telogen effluvium uses up one “life” of the affected hair follicles. So instead of having a receding hairline or bald spot at age fifty, the hair loss may occur a few years earlier. This is not a significant issue if telogen effluvium occurs once or twice in a lifetime; however, accelerated hair loss can result from repeated severe stressful events, if each instance triggers a new round of telogen effluvium.

I had a patient who was totally bald when I met him at age seventy, and he had lost all his hair by age twenty-two. He had worked on the Panama Canal fifty years earlier, and for two straight years starting when he was twenty he suffered repeated bouts of severe fever from episodes of malaria. Each time he suffered from malaria induced fever he experienced telogen effluvium, lost what hair he had, and his hair follicles lost another “life.” After ten or fifteen malaria stress cycles, at the age of twenty-two, he had the hair he would have had at age seventy. Which unfortunately for him was no hair at all."

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Peter J. Panagotacos, <B>M.D.</B>

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery.

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I have 30 years experience in the field of medical and surgical Hair Restoration and am Board Certified in Dermatology and Hair Restoration Surgery. More information can be found at my website www.hairdoc.com

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