Why is it so hard after scalp-hair check, labs,history to tell AGA from CTE?Is stress induced shedding a real diagnosis?(photos)

Hair loss derm checked my scalp & hair (I'm in 17th month of..CTE?) Labs AOK. Ferritin 110. He said I had a lot of hair but he saw thin hairs; wasn't sure if it was from 1/2016 endoscopy shed. Wouldn't rule out AGA. I'm 51, had THICK hair. No AGA in close family. Heavy shed ended 10/2015; stabilized but with occasional upticks. Saw general imprvmt last 8 mos, but bangs, temples, widows peak seem thin again. I see less density in center part since Jan. Why can't anyone give likely diagnosis?

Doctor Answers 3

Hair loss -- PRP, Progesterone, Viviscal, Rogaine, Spironolactone

If you have alopecia from stress it will get better but oral viviscal, sprionolactone, and injections with steroids/PRP would be helpful.  If this is genetic loss, other treatments are needed.  Please see an expert.  Best, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews


CTE and AGA are often easily confused. Labs normal in both. Family history of hair loss similar in both. Hair check similar in both. Biopsy often unhelpful unless done properly (meaning transverse sections and measurement of terminal to vellus ratios).

CTE takes time to figure out. Info on family history of AGA is not useful at all in diagnosing AGA in women - especially at 51. AGA doesn't start in the 50s in women.

All in all, you'd need a careful examination. CTE is the most challenging of diagnoses. Your story does not fit well with typical CTE as general improvement over 8 months (meaning 240 days) would be unusual. Central part density reduction also unusual.

But you'd need to be seen by a dermatologist.

In general.

  1. CTE leads to fluctuations in shedding with shorter breaks
  2. Women often once had thick hair (very thick)
  3. Miniaturization not typical
  4. Onset is sudden
  5. Scalp sensations (tingling, burning) often present
  6. Pretty normal looking scalp exam or maybe significant temple recession in some
  7. Labs normal
  8. Some days 50 hairs lost; some days 350-400
  9. After 6-8 months, tends to reach a balance between shedding and growing and patients look similar month after month (despite massive shedding!!!)
  10. Biopsy done with horizontal sections show terminal to vellus ratios above 8:1 (whereas less than 4:1 for AGA)
  11. Central part width not typically widened in CTE

I understand how tough it is to get a diagnosis of CTE vs AGA. But they are very different conditions. 

Chronic TE

The pictures do not provide adequate visualization to make a diagnosis. You should follow-up with the doctors who have been treating you

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 25 reviews

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