Hair shedding for the past 6 months - is this FPHL or due to stress? (photos)

Short answer: Your history (major stressors, irregular cycles) and 6-month diffuse shedding fit telogen effluvium (TE) more than female pattern hair loss (FPHL). Your photos show a visible part but no obvious patterned miniaturization at the midline/vertex. That said, TE can unmask early FPHL—so monitor.
How to tell
TE: shedding starts ~6–12 weeks after a trigger (illness, stress, crash diet), diffuse thinning, hair pull often positive; usually stabilizes by 6–9 months then regrowth.
FPHL: gradual >12 months, widening central part/miniaturized hairs on dermoscopy; family history common.
What to do now
Track & wait: take part-line photos monthly; most TE improves within 6–9 months after the last trigger.
Start minoxidil 5% foam once daily (can speed TE recovery and treats early FPHL). Expect increased shed in weeks 2–6 → then stabilization.
Scalp care: wash regularly; consider ketoconazole 2% shampoo 2–3×/week (helps inflammation/hormonal scalp).
Check labs & fixables: ferritin (goal ≥40–70 µg/L), CBC, TSH, vitamin D, B12, zinc; review calories/protein (≥0.8–1 g/kg/day). Supplement iron only if low ferritin.
Hormonal screen if symptoms: persistent cycle issues, acne, chin hair → ask about PCOS; treat underlying issues.
Lifestyle: stress reduction, gentle detangling, avoid tight styles/heat.
When to re-evaluate
Shedding persists >9–12 months, or part keeps widening → ask for dermoscopy (look for miniaturization) ± scalp biopsy to rule in FPHL.
Sudden bald patches, scarring, pain, or scaling → earlier review.
Bottom line: Most consistent with TE from stress, with good odds of recovery. Use minoxidil + correct any deficiencies now, and reassess if shedding hasn’t settled by the 9–12-month mark.

Hello,

I’m sorry to hear about the challenges you’ve been facing. Telogen effluvium (TE) is often triggered by stress, significant life changes, or emotional trauma, and it’s encouraging that your doctor has identified this as the likely cause. TE typically resolves once the underlying triggers are addressed, though it can take several months for shedding to stop and hair to regrow.

Focus on managing stress, maintaining a healthy diet, and giving your body time to recover. If shedding persists beyond 6–12 months, consider revisiting your doctor for further evaluation.

Best regards,
Dr. Marco Barusco

Your trichoscopy photos clearly show miniaturization, which is the hallmark finding of FPHL. FPHL leads to thinning/miniaturization of hair shafts over time. However, your history of stressors and shedding indicate telogen effluvium. TE is diagnosed with a positive hair pull test indicating high shed. It is likely that you have two processes going on based on the data you have provided.

I'm truly sorry to hear about the passing of your grandmother and the challenges you've been facing, including the breakup.

It's not uncommon for stress to manifest in various ways, and your dermatologist's diagnosis of Telogen Effluvium (TE) could very well be a result of the emotional strain you've been under. Stress is known to disrupt the normal hair growth cycle, leading to increased shedding. Additionally, stress can absolutely cause irregularities in your menstrual cycle.

It's important to prioritize self-care during this difficult time. Seeking support from friends, family, or a mental health professional can be beneficial in managing stress and its impact on your overall well-being.
Take care, and I wish you strength and healing as you navigate through these challenging moments.

Experiencing hair shedding for 6 months could be linked to stress and Telogen Effluvium (TE). Stress from life changes can trigger TE, causing hair follicles to enter a resting phase and shed more. Irregular periods and stress's impact on hormones could contribute. Focus on stress management, a balanced lifestyle, and seeking support. While temporary, consult a dermatologist for guidance and monitor progress, or make an appointment with us for detailed consultation. Remember, self-care aids hair health.

Stress can cause temporary hair loss and shedding, but it will regrow back within 6 months to 1-Year. If hair loss continues to persist beyond a year without regrowth, then it can be caused by genetics or other factors.

Based on the information you’ve shared and the history of stress and recent life changes, it sounds like your dermatologist’s diagnosis of Telogen Effluvium (TE) is accurate. TE occurs when a significant physical or emotional stressor disrupts the hair growth cycle, causing more hairs than usual to enter the shedding phase (telogen). This often manifests as diffuse hair shedding that can last for several months before stabilizing.

Hello I'm Dr. Wipawan Vathananai, a co-worker of Dr. Kulakarn Amonpattana, from BHI Clinic, Bangkok, Thailand. First of all, I am so sorry for your loss. Regarding your concern about your hair, it is possible that what you're having is TE caused by the stress. However, there are also some correctable causes which should be investigated such as anemia, iron deficiency, thyroid disorder, autoimmune disorders, and vitamin D deficiency. I would recommend you to see a dermatologist if your hair loss isn't getting better.

Hello and thank you for your question. There are many factors in hair loss and difficult to tell looking at pictures. You mentioned seeing your dermatologist but I suggest going to your primary care and have some comprehensive bloodwork done. After your bloodwork is done it might shed some light on what’s going on. I wish you the best of luck.
Dr. T

Upon analyzing your trichoscopy images, it's evident that there are numerous normal hair shafts, accompanied by a scattering of thinner hair shafts. Remarkably, this observation holds true for both AGA and telogen effluvium. In such cases, the passage of time can become an invaluable factor to identify a correct diagnosis.
Understanding your family's hair loss history can prove light on whether a hereditary component is at play. Moreover, a comprehensive blood work analysis can eliminate the possibility of underlying causes for hair loss.
In certain instances, a meticulous observation strategy could be the most suitable initial approach. This enables you to monitor the progression, thereby permitting a more informed decision-making process.