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Hair Loss/Telogen effluvium and male pattern baldness


QUESTION: Dr Peter, so the main difference between Male pattenr baldness and telogen effluvium (acute or chronic) is that one see increased shedding of hair in Telogen effluvium i.e more than 100 hairs fallen out per day (in both acute and chronic), whereas, in male pattern baldness there is no increased shedding of hair, there is just miniaturization of hair follicle in norwood pattern? Correct? And another difference is that in telogen effluvium ( in both acute and chronic) hair pull test is positive? Correct?

ANSWER: Yes and yes.

chronic telogen effluvium causes the hairs to use up the predetermined number of hair cycles they were programmed to have so when someone has repeated episodes of TEs it is possible for them to use up as many as 10 life cycles in a year. With each life cycle being about 5 years in length it is possible for someone to look 70 when he is only 50.
Here is an excerpt from Chapter 4 in my book "Hair Loss Answers"

Chapter 4 – Other Hair Loss Causes   STRESS

"Examples of sudden severe emotionally stressful events include the death or terminal illness of a family member or close friend, marriage, divorce, and unexpected job loss. Severe physiological stressful events shock the body, and some examples are heart attacks, major surgery, and illnesses with prolonged high fever such as malaria, viral pneumonia, and severe cases of the flu.

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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QUESTION: 1)Sir i can see minitarized hair follicles and i m norwood class 2A, also baldness runs in my family history so i m 100% sure that i have genetic hairloss. The thing is that i do not have increased shedding and i lost 50-100 hairs per days, so all these thing indicates that I just have male pattern baldness and NO telogen effluvium na?

2) Sir does oral biotin 5mg plays any role in androgenic alopecia or telogen effluvium?

3) Sir although i know that finisteride is specifically designed for male pattern baldness , but is it also helpful in telogen effluvium?

ANSWER: !. Yes -- it seems you just have inherited male pattern baldness from what you have described without a TE. You mentioned losing hair from having IBD and if that was the case then it would have been from having a shedding of a lot of hairs called a Telogen Effluvium.

2.Only if you have some rare disease which prevents absorption or if you eat a lot of raw egg whites. There is more than enough Biotin in even the poorest diets to grow hair. When you look at someone starving with malnutrition you see skin and bone and a lot of hair on their heads.

3. It helps prevent the telogen effluvium from causing male pattern baldness to show up early. It does not stop the cause of the TE nor does it make it go back into anagen faster. Minoxidil is the medication which works as a crutch for weak hairs and will trigger hairs in a TE back into a normal Aanagen growth phase.

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QUESTION: Sir if we have male pattern baldness and when we begin its treatment with finisteride/dutasteride and minoxidil , at that time do we see increase shedding of hair?

NO...I have patients ask me that question frequently because they read it on the internet. In my experience there is no shedding in the first months due to the medication. Some patients are shedding when they first see a doctor of hair loss and when they are given a prescription for the medication they complain they still have loss the first month. All those hairs lost in the first month were already dying and on their way out of the scalp. When a hair decides to stop growing and restart a new life cycle it takes 4 to 6 weeks for that hair to migrate up and out. So hair loss you see today is from hairs that were changing their cycle one month ago.

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


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


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

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