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In the recent 1-2 months I have realised accelerated hair loss in the temple region, light sweeping motion during shampoo will cause about 30 strands to fall out, localised mainly to the frontal region. My hair appears to be less dense, each strand is comparatively thinner in these regions (looks like miniaturization ), the hairline is also slightly receded compared to old photos. Prior to this 2 months I have been losing hair when I am styling my hair, but I was not to concerned back then, probably because did not scrutinise my scalp/hairline, like I am doing now.
I DO NOT have any pattern hair loss family history from both paternal and maternal side. My dad has a M-shaped hairline which is stable. Similarly I have inherited the M shaped hairline since young.
I went through a GA keyhole surgery in late June this year so I am not sure if the hair loss could be stress related.
I had a habit of sweeping my fringe up and tying it tight under the clinical cap for about 2 years. A habit which I have since changed 2 months ago.
I am not sure how time sensitive is it to start any treatment for MPB, especially since I seem to have some confounding variables? Is it worth waiting out?
From your description, it does sound like you may have telogen effluvium. In telogen effluvium, there is increased hair loss due to a preceding stressful event, such as high fever, crash dieting and emotional stress. The surgery in June may be a triggering event.
By definition, hair fall is considered abnormal if there is loss of over 100 strands of hair a day. This condition is usually self limiting and the hair fall usually last for 2 – 4 months . The new hairs will eventually grow out.
There are also underlying medical problems like iron deficiency and thyroid problems that cause an increase in hair fall, so blood tests may be needed to rule out an underlying medical cause.
The description of hair miniaturization is usually associated with male pattern hair loss. In male pattern hair loss, the loss is usually gradual and it usually does not result in a sudden increase in hair fall.
For male pattern hair loss, it is better to treat earlier than later, as treatment prevents progressive worsening and thinning of hair, and may lead to new regrowth of hair.
I do think it would be good for you to see a dermatologist to determine if the problem is predominantly telogen effluvium or male pattern hair loss, or a combination of both and if further treatment is needed.
Dr Colin Theng
The history you present could point to a combination of androgenetic alopecia (male patterned hair loss) as well as telogen effluvium related to surgical stress.
Few other questions:
1. are you on any medication or supplements?
2. have you undergone an examination by a doctor familiar with alopecia?
3. what is your age?
It is commonly thought that visual thinning starts to become noticeable when your hair mass index drops below 0.5 i.e. you’ve lost 50% of hair volume (this is a simplistic explanation and other indices guide hair restoration differently)
I recommend a thorough examination using a phototrichogram and dermatoscopy – true telogen effluvium (stress induced hair loss) will not show significant miniaturized hair shafts and affects the entire scalp uniformly.
It does sound like your hair loss is progressing quickly and the progression of AGA can be multifactorial. Seek advice from a doctor familiar with hair restoration as soon as possible to diagnose and treat the hair loss appropriately.
Dr Joshua Chong
ASRA Medical Clinic