Hair Shedding does not Necessarily Mean Telogen Effluvium

Hair Shedding Can Mean Many Things !

So many young patients in their 20s and 30s with hair shedding that continues for 8 months or more have a diagnosis of androgenetic alopecia. The proportion with a diagnosis of androgenetic alopecia is higher yet in those whose blood tests come back fairly normal. There are too many patients and too many clinicians who continue to pursue the diagnosis of telogen effluvium for 9 months or more even when all blood tests are normal.

I agree that it’s quite likely that a patient who first develops concerns about excessive hair shedding may have a diagnosis of telogen effluvium. However, as more and more months go by, the chances that telogen effluvium is really the correct diagnosis starts decreasing and decreasing. At some point, we need to be willing to consider something else. The chances that androgenetic alopecia is the correct diagnosis starts increasing as time marches on. (The chances that some other diagnosis is also present starts increasing too in those with shedding problems that just won’t stop).

How many young patients age 20-40 are there across the world who have shedding that goes on and on who keep saying "Nobody can figure out how to treat my telogen effluvium!" So so many of these patients with chronic shedding problems have a diagnosis of androgenetic alopecia not telogen effluvium. How many patients are there on social media that are chasing down solutions for “telogen effluvium” when really what they have is androgenetic alopecia.

Yes, yes, patients with chronic shedding can have chronic telogen effluvium. Sure sure. But no no…. it’s actually not too likely of a diagnosis in someone age 18-35.

It's quite reasonable to consider telogen effluvium as the diagnosis for shedding in someone who has recently been shedding. As time goes by, we need to be open to consider other options if the shedding doesn’t stop. The diagnosis may still be telogen effluvium, of course, but the odds of this being the correct diagnosis are decreasing with every passing month - especially after 8-9 months has gone by and no clear trigger for shedding is found.