Acute Hair Shedding After Birth Control Change: Telogen Effluvium in a 36-Year-Old Woman | Reena Jogi MD Dermatology in Houston & Katy, Texas

Hair loss can be alarming—especially when it begins suddenly and without an obvious cause. A 36-year-old woman recently visited Dr. Reena Jogi, board-certified dermatologist in Houston and Katy, Texas, for evaluation of diffuse, rapidly developing hair thinning that had persisted for four months. Her case highlights a common yet often misunderstood condition: telogen effluvium (TE).

Patient Presentation

The patient reported:

• 4 months of progressive, generalized hair thinning

• 1 month of shedding after switching birth control

• No scalp itching, burning, or pain

• No recent illness, hospitalization, or thyroid abnormalities

• Positive family history of hair thinning in her mother

A dermatoscopic scalp evaluation revealed diffuse shedding, and a positive hair-pull test confirmed active telogen effluvium.

Diagnosis: Telogen Effluvium Triggered by Hormonal Change

Telogen effluvium is a type of reactive hair shedding, often triggered by:

• Hormonal changes (including starting or switching birth control)

• Stress

• Illness

• Vitamin deficiencies

• Medication changes

In this case, the timing of shedding—beginning approximately one month after changing contraceptives—strongly supported a diagnosis of TE triggered by hormonal shift.

The patient’s shedding was distributed across:

• Posterior mid-parietal scalp

• Right central frontal scalp

• Left central frontal scalp

This pattern is consistent with classic telogen effluvium.

A scalp biopsy was discussed but deferred pending response to treatment.

Treatment Plan

After reviewing all medical and procedural hair-loss therapies, the patient preferred conservative medical treatment, choosing to begin spironolactone.

Medications & Instructions

⭐ Spironolactone 50 mg

Dosing plan:

• Week 1: 1 tablet daily

• After Week 1: Increase to 1 tablet twice daily (AM + PM)

• If tolerated: Option to take both tablets together

Possible side effects reviewed:

• Breast tenderness

• Menstrual irregularities

• Dizziness

• Fatigue

• Elevated potassium levels

• Absolutely contraindicated in pregnancy

Spironolactone was selected for its anti-androgenic benefits, particularly helpful when TE overlaps with early androgenetic alopecia.

⭐ Optional Adjunctive Therapies Reviewed

The patient was also counseled on additional options should she choose to escalate treatment:

• Minoxidil 5% solution

• Oral minoxidil

• Nutrafol or Viviscal supplements

• Low-level laser therapy (LLLT)

• PRP treatments

• Alma TED therapy

She expressed interest in PRP in the near future if shedding persists.

Prognosis & Follow-Up

Telogen effluvium typically improves within 4–6 months after the trigger is removed or hormone levels stabilize.

This patient was scheduled to return in 3 months to:

• Monitor shedding patterns

• Assess spironolactone tolerance

• Consider adding PRP or other therapies

Expert Hair Loss Care for Women in Houston & Katy, Texas

Hormonal hair shedding is stressful—but with the right evaluation and personalized treatment plan, most patients experience meaningful recovery. At Reena Jogi MD Dermatology, we specialize in diagnosing and treating female hair loss, including telogen effluvium, androgenetic alopecia, and more complex hair disorders.

If you’ve noticed sudden or progressive hair thinning, schedule an appointment at our Houston or Katy locations for expert care.