60-Year-Old Female with Telogen Effluvium and Androgenetic Alopecia
Introduction
Hair loss in women is a common concern that can arise from multiple overlapping causes. At our dermatology practices in Houston and Katy, Texas, we often see cases in which Telogen Effluvium (TE) — a temporary shedding condition — occurs alongside Androgenetic Alopecia (AGA), a genetically influenced form of chronic hair thinning. This case features a 60-year-old woman presenting with diffuse hair loss triggered by underlying health factors.
Patient Case
A 60-year-old female presented with diffuse hair loss over the scalp that had been ongoing for approximately six months. She described gradual thinning and increased shedding, particularly along the mid-frontal scalp.
The patient had a history of thyroid imbalance and recent weight loss, both potential triggers for Telogen Effluvium. She had previously tried topical minoxidil and spironolactone, with limited success.
Examination
On examination, there was diffuse thinning without scarring, erythema, or scaling. A positive hair pull test confirmed active shedding of telogen hairs. No inflammatory changes or focal bald patches were noted.
Clinical Impression:
Telogen Effluvium (L65.0)
Underlying Androgenetic Alopecia (L64.8)
Discussion
The combination of Telogen Effluvium and Androgenetic Alopecia is common in postmenopausal women. TE typically results from physiological stressors — such as thyroid dysfunction, hormonal shifts, or rapid weight loss — causing hair follicles to prematurely enter the shedding phase. AGA, on the other hand, involves gradual miniaturization of follicles driven by genetic and hormonal influences.
The overlap of these two conditions often leads to accelerated thinning and visible scalp density loss, particularly in the central scalp and frontal regions.
Treatment Plan
After thorough discussion, the patient elected to begin a combination medical regimen consisting of:
Oral Minoxidil (2.5 mg daily)
Start with half a tablet daily for 1–2 weeks; increase to one full tablet if tolerated.
Patient was informed that initial shedding during the first 8–10 weeks is normal.
Counseled on side effects such as swelling, dizziness, and unwanted hair growth.
Oral Dutasteride (0.5 mg daily)
Discussed benefits for reducing DHT levels and stabilizing hair loss.
Reviewed potential side effects including decreased libido and teratogenic risk.
Low-Level Laser Therapy (Revian Cap)
Recommended as an adjunctive therapy to stimulate follicles and support regrowth.
Nutritional and Hormonal Optimization
Referred to OB/GYN for evaluation of possible hormone replacement therapy (HRT) to address underlying menopausal or hormonal factors contributing to TE and AGA.
Additional Findings
Sebaceous Hyperplasia: Small, yellow-orange papules on the cheeks consistent with benign overactive oil glands.
Treatment: Tretinoin 0.025% cream nightly to improve texture and prevent recurrence.
Counseling and Follow-Up
The patient was educated on the chronic, progressive nature of Androgenetic Alopecia and the typically self-limiting course of Telogen Effluvium. She was reassured that improvement may take 3–6 months, with full results visible at 6–12 months.
A 6-month follow-up was scheduled to monitor regrowth and evaluate treatment efficacy.
Key Takeaway
This case highlights the importance of identifying mixed-pattern hair loss in women and addressing both the underlying triggers (e.g., thyroid changes, stress, hormonal imbalance) and the chronic component (AGA). At Reena Jogi MD Dermatology in Katy and Houston, Texas, our approach combines medical therapies, scalp restoration procedures, and hormonal evaluation to optimize long-term outcomes. Call the office at 7134874061 now to book a consultation!
