Minoxidil for Telogen Effluvium: Do I need to use it forever?

Minoxidil for Treating Telogen Effluvium: Forever?

Telogen effluvium (TE) is a hair shedding condition. Individuals with telogen effluvium experience increased daily shedding than they may have normally experienced. Rather than losing 50-100 hairs per day, affected individuals lose well over 100 hairs and some lose upwards of 400-1000.  The main causes of TE are low iron levels, thyroid problems, stress, crash diets, illness within the body (i.e. systemic illness), and medications. These are all 'triggers' for TE.

Is minoxidil a treatment for TE?

Before addressing whether minoxidil is a trigger for TE or not, let's look at the primary treatment for TE. TE is best treated by addressing the trigger for TE. If low iron is the cause of the TE, the iron must be replaced. That is the primary treatment. If hypothyroidism (low thyroid hormone levels) is the primary cause of a TE, the affected patient needs thyroid replacement as their primary treatment. 

Minoxidil is NOT the first choice for TE, but certainly can be a choice in those individuals for which the diagnosis can't be found. This statement is important because for 50 % of individuals with TE, we can't find the cause of the TE.  For some people, despite the blood tests, and review of their history, a clear 'trigger' can't be identified.  Minoxidil can help the hair cycles return to normal and facilitate the establishment of more normal shedding patterns.  Minoxidil helps some people with such unknown shedding but not all.

Is the use of minoxidil life long for TE?

Minoxidil is well known for being a 'lifelong' treatment for patients with androgenetic alopecia (male and female pattern hair loss). If someone with androgenetic alopecia uses minoxidil and gets a benefit and then decides to stop the treatment, they will lose all the benefits they gained by using the treatment. Their use is lifelong. For patients with androgenetic alopecia, minoxidil can not be stopped. 

Fortunately, these same rules do not apply to all patients with TE. But they do apply to some. In many cases, however, minoxidil can be tapered and then stopped as hair follicles regain normal cycling patterns.  If an individual decides to use minoxidil to treat their TE from their crash diet, the minoxidil can be tapered and stopped once a normal diet resumes.  The use in these situations is not lifelong.

One needs to keep in mind that before starting minoxidil for a TE, they must ask themselves what they have done to figure out the cause of the TE and what they have done to treat that cause. Second they need to ask their dermatologist if they have any amount of androgenetic alopecia that goes along with their suspected TE. A patient with androgenetic alopecia who does not realize they have AGA is going to be in for a bit of a surprise when they think about stopping minoxidil after their TE has resolved - shedding is going to start up all over again and things may even get worse. The hair demands to know where the minoxidil went !

Finally, even if one has TE and no component of AGA, it’s not always easy in every case to stop minoxidil. If the cause of the TE was not known and chronic TE is a possibility, the hair may just likely have the minoxidil around. It’s worth trying to stop, but one must keep in mind that some types of TE are harder to come off minoxidil than others.

Conclusion

For patients with a true TE, minoxidil use is not always life long. After the trigger for the shedding is fixed, shedding will often return to normal and minoxidil can be stopped. If there is any component of androgenetic alopecia, minoxidil might either not be used in the first place, or an understanding must be present that use could be lifelong.