How do you identify TE with AGA?

Hello,

TE and AGA can occur together. TE causes widespread shedding and can be triggered by factors like stress, medications (including SSRIs), or illness. AGA, on the other hand, involves progressive miniaturization of hair follicles and is genetic. Your description of aggressive AGA at 17, stabilized by finasteride, suggests AGA as the primary condition.

If Prozac triggered TE, it may have accelerated your hair loss, making AGA more noticeable. Starting Lexapro could theoretically cause TE, but it’s unlikely to impact AGA directly. Monitoring with your doctor can help ensure stability while on treatment.

Best regards,
Dr. Marco Barusco

Both TE and AGA regularly occur together. Often, a TE shed (from a trigger such as medications) will alert someone to hair loss and then dermoscopy examination will also reveal AGA in addition. The SSRI medications are not triggering the AGA. These medications can trigger TE and a biopsy would tell you if both are occurring at once. TE-related shed self-resolves after 1-2 years if the trigger is stopped. If you also have AGA, then that will be treated with medications such as finasteride/minoxidil so that the thinning does not continue to progress.

Thank you so much for your question, and an excellent it is indeed! Yes, TE can occur in the setting of AGA and it can be very difficult to identify the two and the contribution of each at any given moment in time. However, TE is temporary and the hair lost will eventually return. Granted, in your case, since you began taking finasteride, it could account for some return of hair due to AGA as well. In the end, you may not ultimately know just how much of your hair loss was attributed to AGA and how much was due to TE. The pattern of your hair loss could shed some light on your specific situation, however. Hair loss due to TE tends to be diffuse and even. If your hair loss was concentrated in the typical areas seen with AGA, it can give you an idea just how large a role AGA played in your specific case.

Hello I'm Dr. Wipawan Vathananai, a co-worker of Dr. Kulakarn Amonpattana, from BHI Clinic, Bangkok, Thailand. Regarding your concern;
1. How do you identify if a patient is experiencing TE with AGA?Answer - AGA has a pattern in which hair loss starts at the front of the scalp to the back with or without hair loss on the vertex. Whereas TE will manifest in losing hair of the whole scalp. This is the majority of the situations.
2. Can they both occur together?Answer - Yes, especially if an individual is under extreme stress either it's physical or emotional. Stress can trigger TE and also speed up AGA.
3. I was on Prozac and I happen to have aggressive AGA when I was age 17. I want to get on lexipro but since I was on Prozac when I developed AGA I can't determine if an SSRI did this to me. After I got off Prozac the shedding continued until I got on finasteride. I haven't had shed in 6 years. Which would lean towards AGA but I don't know if Prozac triggered TE which triggered it and then AGA begin.Answer - Prozac is one of the most common SSRI which can cause hair loss. Regarding AGA, it is very difficult to determine which one is the culprit in your situation. I would recommend you to use finasteride along with topical or oral minoxidil and see what happens.
In case you are still worries about TE, you can get some screening tests for anemia, thyroid disorders, and total vitamin D to exclude correctable causes of TE.

You may definitely have both androgenetic alopecia and TE. Indeed, antidepressants can provoke TE. Additionally, you may be experiencing worsening of AA because it is a progressive disease. In such cases, the distinction is often made with close observation and multiple follow-up visits. In some cases, the medication in question should be stopped to understand if it is a reason for shedding, but I would definitely NOT advise you to cancel SSRIs without consulting your psychiatrist. Doing a thorough blood workup may help to identify a possible underlying reason for TE. Finding a reliable board-certified dermatologist specializing in hair loss and regularly seeing him/her is the best advised I can give in this case.