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.