Could this be TE and/or AGA and does this even slow down? (Photos)

Question

33 year old female old stress and stopped high androgen birth control. Massive shedding since Nov 2017 and continues. Haven’t found a derm that is knowledgeable about hair loss. Say TE. However most recent blood test for DHEAS is elevated at 336. Pics show miniaturization? I have lost half my hair.

Jason Emer, MD · Answer

This needs an in-person evaluation. I suggest seeing a hair loss expert now to evaluate and go over your condition and provide you information about your best treatment options. There are great non-invasive options like prp/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

Jonathan Kulbersh, MD · Answer

I recommend getting a consultation with a cosmetic dermatologist with experience in hair restoration and maintenance. There are some great options for hair restoration and maintenance like prp injections which can stimulate hair growth. Hope this helps.

Jeff Rapaport, MD · Answer

In  my opinion, you need to find a hair loss expert who will do a good history, examination, blood work and biopsy. Your photos are suggestive of diversity in hair shaft sizes and miniaturization which is seen with androgenic alopecia. This does not rule out some sort of overlap as women quite often have multifactorial hair loss. A scalp biopsy would provide additional information.

Jeff Donovan, MD, PhD · Answer

It’s quite possible you have AGA and maybe some TE but we don’t diagnose hair loss based on a photo of 50 hairs. One needs to see the other 50,000-90,000. Telogen effluvium is not reliably diagnosed with dermoscopy - it is diagnosed with proper clinical history taking and examination. The photos submitted show a variation in size and one upright regrowing hair or new anagen hair. There are two apprarent broken hairs which need further assessment. Contact the American Academy of Dermatology or the American Hair Research Society for a list of dermatologists who specialize in hair loss.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You provide a scalp microscope image,and indicate you are 33-year-old woman, and believe you lost half your hair. You also indicate that you have had massive hair shedding since November 2017, and have stopped high androgen birth control pills. You are asking if the photo shows miniaturization, and if you have telogen effluvium or androgenetic alopecia.
I can certainly give you some guidance about this, with just a single photo for reference, and without a physical exam. I’m a Board Certified Cosmetic Surgeon and Fellowship-trained Oculoplastic Surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I’ve been performing hair transplants since I started my practice, and have been prescribing finasteride to male pattern hair loss patients since 1997. I’m also the founder of TrichoStem Hair Regeneration Centers, based on a system we developed for non-surgical treatment of pattern hair loss for men and women.
First of all, you seem understand the difference between hair shedding, which is related to telogen effluvium, and hair thinning, which is related to female pattern hair loss. Although I don’t see a lot of miniaturized hairs in your photo, a photo alone of one area of scalp is not enough to diagnose female pattern hair loss. There are many causes of hair loss in women, actually more than men, and telogen effluvium as well as female pattern hair loss can happen at the same time. Telogen effluvium does not require treatment, but the severe stress that caused it does need management. Diagnosis for female pattern hair loss cannot be determined even with a full microscopic exam alone, and does require scalp biopsies. I usually have two scalp biopsies done from two different parts of the scalp to properly diagnose female pattern hair loss before treatment is considered.
If female pattern hair loss is confirmed, it can be treated and managed. With proper diagnosis before treatment, we have had over a 99% success rate in female pattern hair loss treatment, by visibly thickening thinning hair, and stimulating growth from dormant hair follicles with our Hair Regeneration treatment. This PRP+ACell injection treatment is customized for each patient based on gender, current age, age of onset of hair loss, degree of hair loss, and medical history. Patients can stop using spironolactone, as well as minoxidil, but some patients are weaned off minoxidil to prevent sudden hair shedding.
You indicated that there is no doctor in your area experienced with diagnosing female pattern hair loss, but it is important to find one, even if you need to travel, for a proper diagnosis. Once  a definitive diagnosis is made with scalp biopsies, treatment can be considered to help increase hair coverage. I hope you found this information helpful. Thank you for your question.

William Rassman, MD (retired) · Answer

The photo show minimal miniaturization, I use 20% of the hairs must be miniaturized to call it miniaturization.  The best way to determine how much hair you lost is to do a HAIRCHECK test and then repeat it 6 months later. Many times what you think is happening is not really happening with regard to how much hair you lost.  Female hair loss is difficult to both diagnose and treat. We treat many women with thinning and without a diagnosis with Scalp Micropigmentaiton, see below

Could this be TE and/or AGA and does this even slow down? (Photos)

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