Shedding, both normal (60-100 hairs per day depending on washing frequency) and increased (in the early days of onset androgenetic alopecia and telogen effluvium) is common knowledge to the majority of us. But I want to introduce a new concept to many of you suffering from androgenetic alopecia and telogen effluvium: the idea that shedding may not occur in a vacuum.
Dr. Jeff Donovan, a US and Canadian board-certified dermatologist specializing in the treatment of hair loss, has presented a new diagnosis associated with increased shedding: Accelerated Follicular Miniaturization from Prolonged Shedding (AFMPS).
Telogen Effluvium results in an increased number of hairs entering the telogen, or resting phase. The additional shedding of telogen hair usually occurs 3-4 months after triggers or various stresses, however, even if you notice an increased shedding of telogen hair, it does not necessarily imply TE is present, and so the etiology must be established to diagnose.
To diagnose TE we examine elements like endocrine disorders (including low thyroid function), nutritional disorders (including low iron and crash dieting), and drugs (including beta blockers, lithium, serotonin inhibitors, BCP, and Coumadin). We also consider triggers such as psychological and physical stress, seborrheic dermatitis, and severe scalp psoriasis.
The traditional thought with TE is that hair will be fully restored to its original density and volume, once we can remove or move beyond any of the possible triggers.
Telogen Effluvium or Androgenetic Alopecia?
We know shedding from telogen effluvium can be delayed (occurring a few months after the stressful incident) or chronic (unresolved), and we also know shedding can increase in the early stages of androgenetic alopecia.
Okay, so we have shedding, which is it? TE or AGA?
Maybe it is both, which Dr. Donovan diagnoses as Accelerated Follicular Miniaturization from Prolonged Shedding (AFMPS).
With telogen effluvium, the “party line” is that shedding does not cause permanent hair loss. However, what we now know is that repeated cycles of shedding speeds up the onset of androgenetic alopecia in patients WHO ARE GENETICALLY PREDISPOSED to develop genetic hair loss. Did you get that? It happens only in patients who are genetically predisposed to develop genetic hair loss or in women FPHL. (Although this can occur in men it is usually seen in women.) If you look at the hair you are shedding; longer hair is usually the result of TE, as hair shedding from AGA is characteristically shorter.
Scenarios to Consider
You could have postpartum shedding, BCPs, thyroid issues, have taken other medications, and your hair density never returned to normal. In each of these situations, there can be repeated cycles of shedding, which speeds up the process of miniaturization, and ultimately accelerates the age when the beginning of genetic hair loss is recognized. It is not that any of these situations “caused” the ultimate genetic hair loss. It is more so with repeated shedding; the onset or beginning occurred earlier (even a decade earlier) than would have been seen.
So, does everyone who sheds ultimately develop AFMPS? As Dr. Donovan puts it, “NO. Many women after pregnancy find their hair returns to close to normal density. Also after chemo many return almost to normal. Some patients shed after a trigger, and the hair does return back to normal but not for everyone.” This is why it is critical to limit shedding in those who are predisposed to genetic hair loss.
If you’re looking to resolve shedding issues or any other condition, please don’t hesitate to contact us for a consultation.