Is my shedding normal in AGA? Or do I have TE?

Question

I went to a dermatologist and a hair transplant doctor they gently pulled hair from my scalp and looked over my family history and they both said I have AGA hair loss. I forgot to ask them these questions. So I was shedding really bad when I would get out of the shower I had a hand full wet of miniaturized thin hairs. Is that normal in AGA? What is happening? Is that TE?

Mehmet Erdogan, MD · Answer

This is a very common source of confusion. AGA can cause shedding, even though it’s primarily a miniaturization disorder. In AGA, hairs have a shortened growth phase and are loosely anchored, so they can shed easily and even come out with gentle pulling. A positive hair-pull test is not specific to telogen effluvium and can be seen in active AGA. Finasteride does not treat true TE, which is why Dr. Donovan is correct; however, it stabilizes AGA by reducing DHT, prolonging the growth phase, and preventing premature cycling. The fact that your shedding stopped after starting finasteride strongly suggests that the shedding was AGA-related (or AGA with a superimposed TE) rather than pure TE.

Marco Barusco, MD · Answer

Hello,

Shedding miniaturized, thin hairs is a common sign of AGA (androgenetic alopecia). In AGA, hair follicles shrink over time, producing thinner hairs that eventually fall out as part of the hair cycle. While telogen effluvium (TE) can coexist with AGA and cause additional shedding, the presence of miniaturized hairs strongly points to AGA as the primary cause. Your doctor can confirm if TE is also contributing and guide you on treatment options to stabilize the hair loss.

Best regards,
Dr. Marco Barusco

Ryan Goerig, MD, FAAD · Answer

You could have AGA, TE or both. It really depends if you have had any acute stressors in your life about 3-8 months ago, which is usually the timeframe for TE to take hold of the hair and cause shedding. I would definitely get on the right medical therapy and/or non-invasive procedures to see if you can stop the shedding. If shedding decreases and growth resumes, or is at least halted, that pretty much means you have some sort of background AGA. Also make sure you take enough Vitamin D as a very low level can affect hair growth in my experience.

Steven C. Chang, MD · Answer

Thank you so much for your inquiry! I hope I will be able to help and shed some light on this important issue/question. Typically, the hair loss associated with TE (telogen effluvium... temporary and oftentimes due to stress) is diffuse and even. The hair loss from AGA (androgenetic alopecia... male pattern baldness in men) follows a recognizable pattern. TE is general temporary whereas AGA is permanent and progressive. With the pull test, one would expect to find less hairs removed in the case of AGA than with TE. The time course of TE tends to have a more distinct onset/event and occurs more suddenly/over a shorter period of time than with AGA. However, since in early and relatively aggressive cases of AGA, it can still be hard to distinguish AGA from TE, a scalp biopsy and blood tests can be done to shed light on the answer. Keep in mind too that AGA and TE are not mutually exclusive. You might have a certain degree of AGA that is progressing and have a transient/temporary case of TE as well, thus aggravating your hair loss at the moment. The hair lost from TE is normally temporary and you will grow that hair back. Sadly, the hair lost from AGA is not unless medications are taken to halt the progress or promote hair growth.

Audrey G. Bauer, MD · Answer

In AGA, your hair cycle (which everyone has) results in decreasing caliber of hair and depth of follicle with each successive cycle.  We call this process "miniaturization".  This process can be extremely slow (over years) or relatively quick (months)  Normal daily shedding (50-100 hairs per day) may not be increased in numbers of hairs shed, but the returning/regrowing hair will become thinner and smaller until it stops regrowing entirely. While you still have hairs/follicular units, it's possible to slow or stop the process using medications such as finasteride and minoxidil, or by using low level laser caps.  In TE, the hair loss is just a sudden increase in daily shedding owing to your hair cycle shifting so that a greater percent of your hair is in the drop phase (telogen).  With TE, there should not be significant miniaturization.

Is my shedding normal in AGA? Or do I have TE?

Answers (5)

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