Case Report: Managing Telogen Effluvium in a 64-Year-Old Female Patient
Hair loss can be one of the most distressing concerns for patients, especially when it develops gradually over many years. At our dermatology practice in Houston and Katy, Texas, we often see women experiencing diffuse hair shedding due to telogen effluvium (TE), a temporary but noticeable condition that can overlap with other types of hair loss.
Patient Presentation
A 64-year-old female presented as a new patient with a chief complaint of generalized hair loss that had been ongoing for several years. She described the hair loss as moderate in severity, gradual in onset, and persistent.
Prior to her visit, the patient had already been using several therapies, including Propecia (finasteride), minoxidil, and Nutrafol supplements. Despite these measures, she continued to notice ongoing shedding, prompting further evaluation.
Clinical Findings
A comprehensive examination of the scalp, head, face, and neck revealed:
Diffuse shedding most consistent with telogen effluvium
A positive hair pull test for telogen hairs, particularly at the left superior parietal scalp
No signs of erythema, scarring, flaking, or scaling
Laboratory evaluation confirmed normal iron and ferritin levels, helping rule out iron deficiency as a trigger.
Treatment Plan
After discussing her history, clinical findings, and treatment options, the following plan was established:
Continue oral minoxidil at ½ tablet daily (off-label use for hair loss).
Increase oral finasteride to 5 mg daily for improved efficacy.
Counseling on expected results, including the gradual nature of improvement and the importance of consistency.
Reviewed potential side effects of minoxidil (hypertrichosis, dizziness, edema) and finasteride (decreased libido, sexual side effects, teratogenicity).
Recommended evaluation by her gynecologist regarding hormone replacement therapy as she is undergoing menopause.
Discussed adjunctive treatments, including supplements (Nutrafol, Viviscal), low-level laser therapy (Theradome), and platelet-rich plasma (PRP) therapy.
Plan for follow-up in 3 months to assess progress and determine whether a biopsy may be necessary if shedding continues.
Patient Education
The patient was counseled that telogen effluvium is often a self-limited condition, triggered by stress, illness, medications, thyroid disease, or nutritional deficiencies. With supportive care, most patients experience stabilization and regrowth within several months.
By combining oral and topical therapies with lifestyle and hormonal evaluation, we aim to optimize outcomes and improve her overall hair density.
Conclusion
This case highlights the importance of personalized management of telogen effluvium, particularly in women with overlapping factors such as menopause. Through a combination of oral minoxidil, finasteride, and supportive therapies, patients can achieve meaningful improvement and regain confidence in their hair health.
If you are experiencing hair loss in Houston or Katy, Texas, our clinic provides advanced diagnostic tools and customized treatment options, including oral and topical therapies, supplements, laser treatments, and PRP.
