Case Report: Female Pattern Hair Loss and Telogen Effluvium in a 47-Year-Old Woman

Patient Presentation

A 47-year-old woman presented as a new patient to Reena Jogi, MD with concerns of generalized hair thinning on the scalp. She reported a gradual onset of hair loss over the past year, moderate in severity, without associated scalp itching, pain, or scaling. Prior to her visit, she had tried several over-the-counter treatments, including vitamins, biotin supplements, and medicated shampoos, without significant improvement.

Like many women seeking treatment for hair loss in Katy and Houston, Texas, she expressed concern about potential side effects of prescription medications—particularly oral minoxidil—and wanted a thorough discussion of all available options.

Clinical Examination

A comprehensive dermatologic examination was performed, including careful inspection of the scalp and hair using dermoscopy. The patient appeared well-nourished, in no acute distress, and fully oriented.

On exam, there was diffuse thinning with increased involvement at the crown, consistent with female pattern hair loss (androgenetic alopecia). A positive hair pull test suggested active shedding, raising concern for a concurrent telogen effluvium, a common condition that often overlaps with androgenetic alopecia.

Diagnosis

Based on clinical findings, the patient was diagnosed with:

• Androgenetic Alopecia (Female Pattern Hair Loss)

• Telogen Effluvium (Diffuse Hair Shedding)

Given the mixed pattern of thinning and shedding, a scalp punch biopsy was discussed to further confirm the diagnosis and rule out other causes of non-scarring hair loss.

Personalized Treatment Plan

After an in-depth discussion of risks, benefits, and expectations, a multimodal treatment approach was selected. Treatment options reviewed included bloodwork to evaluate for vitamin deficiencies, topical therapies, oral medications, supplements, low-level laser therapy, platelet-rich plasma (PRP), and AlmaTED hair restoration.

The patient elected to proceed with medical therapy, including:

• Oral Minoxidil (1.25 mg daily)

  • Initiated after advising cardiology clearance

  • Counseling provided regarding potential side effects such as swelling, dizziness, unwanted hair growth, and shortness of breath

  • Education provided regarding expected temporary shedding in the first 8–10 weeks

• Oral Spironolactone (50 mg twice daily)

  • Chosen for its effectiveness in female pattern hair loss and hormonal acne

  • Baseline and follow-up blood work planned to monitor potassium and kidney function

  • Counseling provided regarding menstrual changes, breast tenderness, fatigue, and pregnancy precautions

For telogen effluvium, the patient was counseled that shedding is often self-limited, but treatments such as minoxidil, supplements, and laser therapy may help shorten recovery.

Additional Skin Findings

• Benign nevi on the scalp were identified and required no treatment, with counseling on routine self-skin exams and sun protection.

• Adult acne was also addressed, with spironolactone expected to provide benefit and topical tretinoin prescribed as part of her skincare regimen.

Follow-Up and Expectations

The patient was advised that female pattern hair loss is genetic and slowly progressive, but early treatment can significantly improve density and slow further thinning. She was scheduled for a 3-month follow-up to assess response to therapy, review lab results, and discuss procedural options such as PRP or AlmaTED if needed.

Expert Hair Loss Care in Katy & Houston, TX

At Reena Jogi, MD, we specialize in the diagnosis and treatment of female hair loss, including androgenetic alopecia, telogen effluvium, and complex overlapping conditions. Our clinic offers evidence-based medical therapies and advanced hair restoration treatments, tailored to each patient’s needs.

If you are experiencing hair thinning or shedding and are looking for a hair loss specialist in Katy or Houston, Texas, our team is here to help.