Stress induced hair shedding in Women: Is AGA actually the diagnosis that was missed?

Stress Induced Shedding vs Androgenetic Alopecia: Similar Look but Different Treatment

I’m often asked to evaluate patients who are thought to have hair shedding from stress. Some of these patients do, of course, have hair shedding from stress - but many do not. Many have a different diagnosis altogether. Many women who come through the office door with the view that their hair shedding is from stress leave the office with the understanding that stress is in fact, not the actual reason for their hair shedding. The real reason for many women is androgenetic alopecia (AGA), also known as female pattern hair loss.

The early diagnosis of androgenetic is challenging to recognize. Women with early AGA experience increased amounts of daily hair shedding compared to what they once had. The scalp still looks pretty full in the earliest stages and it’s just the shedding they are concerned about rather than any density loss. (Some are also concerned about density loss too). Their blood tests come back normal or fairly normal. . And when the physician turns to them and says - “have you been under a lot of stress lately?” - the answer is usually…. yes. Part of being human it seems these days is some level of stress. It would be unusual that someone with hair shedding is going to deny being under at least some amount of stress. Not impossible, but unusual.

The development of increased hair shedding in women who are experiencing increased stress does not necessarily equate to a diagnosis of stress induced hair shedding. It sure sounds like it should - but it doesn’t. Some stress has nothing to do with the hair shedding or sometimes the stress is actually the trigger that pushes the genetic hair loss along a little faster.

Diagnosing Early Androgenetic Alopecia

Diagnosing early androgenetic alopecia requires skill and expertise. It most certainly requires a dermatoscope (trichoscope) in order for the clinician or hair specialist to appreciate the hair follicles are becoming skinnier in certain areas. Early androgenetic alopecia usually shows hair thinning (or ‘miniaturization’) a bit more noticeably in the middle or top of the scalp compared to the very back. In contract, true stress induced hair shedding affects all the scalp fairly equally - and miniaturization is not a feature of this type of hair loss.

Stress Induced Shedding vs Shedding From Androgenetic Alopecia

Final Comments

Stress induced shedding can occur. there’s no doubt about that. But when I hear a patient make a comment they have stress induced shedding, my first reaction is to say (either to myself or to them) “How did you come to determine that?”

Getting an accurate diagnosis is important if one is to determine how best to treat the hair loss. Many patients who thought they had stress induced shedding but actually have early androgenetic alopecia find that certain treatments seem make the hair loss worse because the treatment is not actually addressing the AGA. The treatment itself may be creating a new Telogen effluvium that then actually accelerates that androgenetic alopecia or the treatment has no effect on the andrognetic alopecia and the androgenetic alopecia just moves forward causing further hair loss.

Many patients with stress induced hair shedding would benefit from asking the simple question “Is it possible that what I actually have is shedding from early androgenetic alopecia?”