TE and AGA: Commonly Confused.
Many individuals with hair loss attempt to self diagnose their hair loss. This is not generally a good means to get to the bottom of why one is losing hair. Nevertheless, it is common. A frequent scenario crops up in the early stages of androgenetic hair loss where one first sees an increase in the daily shedding of hair. The patient then wonders "Is this a telogen effluvium I am experiencing or is this genetic hair loss?"
TE or AGA: Three ways to figure it out
Understanding the answer to this question really takes into account a full review of many of the hair cycle changes during telogen effluvium as well as androgenetic alopecia. In short there's three ways that one can determine if they have a TE or AGA.
1) Time. A TE will improve with enough time.
First, time is the most definitive way albeit the slowest. If a patient's hair loss is from a resolving telogen effluvium, there should be a significant improvement in hair density over 6 to 9 months. For most with resolving TE, the hair density should be completely back to normal at that time. If this is actually androgenetic alopecia a worsening of hair density will likely occur over a 12 month period. At best, the hair density would probably be the same but it would be very unlikely for it to improve unless there was some components of seborrhoeic dermatitis that was adequately treated that led to a minor improvement of the overall appearance of the androgenetic alopecia.
2) Self diagnosis. A TE causes hair loss all over in a 'diffuse manner'
Another way to determine if this is a result of telogen effluvium or androgenetic alopecia is to perform self diagnosis. This is of course the most dangerous of all the options but nevertheless it's a common way. True androgenetic alopecia has less density on the top middle and front of the scalp compared to the back of the scalp. At least for males, true balding is a patterned hair loss. In telogen effluvium, the density is reduced equally all over the scalp. I would encourage anyone with hair loss to see his or her dermatologist to review whether a resolving TE or genetic hair loss is in fact what is going on.
3) Clinical Examination by a Dermatologist
A clinical examination by a physician is often a very good option to help an individual sort out if they have TE or AGA. One needs to consider the timing of the hair loss, when it occurred, factors leading up to the hair loss. But the most important is the scalp examination looking at exactly where the hair is being lost from and whether or not miniaturization of follicles is occurring. Miniaturization is a process whereby hairs get thinner and thinner in their diameter over time. This is frequently a features of androgenetic alopecia. It may be challenging to determine if miniaturization is present in the earliest stages of AGA. Nevertheless, it will become present over time in AGA whereas it will not in a true isolated telogen effluvium. If one has any concern about the diagnosis, then blood tests and a biopsy will complement the work up. Patients with a TE may have normal blood tests, so the presence of normal blood tests does not rule out TE. A biopsy performed with horizontal sections can give valuable information about the percentage of telogen hairs and the ratio of terminal to vellus hairs. A T:V ratio less than 4:1 is a feature of genetic hair loss. It is not a feature of TE. An increase in the proportion of telogen hairs above 15 % is often seen in a TE. This is not typically a feature of AGA.
Deciphering whether an individual has a TE or AGA can be challenging not only for patients but many clinicians as well. I would like to point out that the vast majority of males who are wondering about telogen effluvium or androgenetic alopecia generally turn out to have androgenetic alopecia. Exceptions exist of course. The early stages of androgenetic alopecia are associated with shedding which give a confusing clinical picture. The same is true with women as well although true effluviums are much more common in women than in men. Overall. I would encourage anyone to see a physician to review the accurate diagnosis.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887