38-Year-Old Female With Longstanding Temple Thinning — Androgenetic Alopecia With Telogen Effluvium Exacerbation
Hair loss in women is common, often distressing, and frequently underdiagnosed. At Reena Jogi MD Dermatology in Katy and Houston, Texas, we see hundreds of women each year who experience gradual thinning, hormonal shedding, or temple recession. This case report highlights a 38-year-old female presenting with years of progressive thinning, scalp sensitivity, and recent worsening — ultimately diagnosed with androgenetic alopecia (AGA) with a superimposed telogen effluvium (TE) trigger.
Patient Presentation
A 38-year-old established female patient presented with:
Moderate, gradually progressive hair thinning for several years
Temple thinning, worsening over the last 8 years
Scalp itching and tenderness
Hair washing 3× weekly
No current treatment, but has previously tried ketoconazole 2% shampoo and discontinued due to odor-related nausea
She has no history of concerning medical triggers and denies systemic symptoms. A dermoscopic scalp exam was performed during her visit.
Clinical Examination & Findings
The patient appeared well, alert, and in no distress. Scalp dermoscopy revealed features consistent with:
1. Androgenetic Alopecia (Female Pattern Hair Loss)
Notable thinning at the temples
Pattern consistent with genetically driven follicle miniaturization
History and timeline supportive of longstanding AGA progression
2. Telogen Effluvium Component
Reported recent shedding
Diffuse hair thinning and positive hair pull test, suggesting a TE overlay likely triggered by stress, hormonal changes, or scalp inflammation.
Together, these diagnoses explain both the chronic thinning and the intermittent shedding episodes.
Diagnosis
➡️ Androgenetic Alopecia (L64.8)
Female-pattern thinning with slowed follicle growth
➡️ Telogen Effluvium (L65.0)
Diffuse shedding with positive telogen hair pull
AGA + TE is a common combination — TE accelerates the shedding of already miniaturized hairs, making AGA appear suddenly worse.
Treatment Discussion & Plan
We provided a comprehensive review of evidence-based treatment options offered at Reena Jogi MD Dermatology in Katy and Houston:
1. Topical Therapies
Recommended to temples once or twice daily
Minoxidil remains the gold standard for stimulating follicle activity.
2. Oral Therapy
The patient elected to start:
⭐ Spironolactone 50 mg twice daily
Helps reduce androgen influence on hair follicles
Safe for healthy premenopausal women when monitored
Side effects discussed: menstrual changes, breast tenderness, dizziness, fatigue, mild potassium elevation
3. Supplements & Adjuncts Discussed
Nutrafol
Xtresse gummies
Low-level laser therapy cap
AlmaTED ultrasound-based hair restoration
These are excellent add-on therapies for women wanting to support regrowth, boost scalp health, or accelerate improvement.
4. Baseline Labs Ordered
To ensure no underlying systemic triggers are contributing to shedding.
5. Follow-Up
A follow-up visit is scheduled in 3 months to evaluate response and adjust the plan if needed.
Prognosis
With consistent adherence to spironolactone + topical minoxidil, most women begin noticing improvement within 3–6 months, with maximal results around 9–12 months. The patient was reassured that both AGA and TE are treatable conditions and that long-term maintenance produces the best results.
Residents of Katy and Houston seeking expert women’s hair loss treatment can benefit greatly from early intervention, appropriate diagnosis, and customized therapy plans like this one.
