Chronic Telogen Effluvium in a 76-Year-Old Woman Following AFib Episode and Mounjaro Therapy
Telogen effluvium (TE) is one of the most common causes of diffuse hair shedding, particularly in older adults who may experience fluctuating health conditions or medication changes. At Reena Jogi MD in Katy and Houston, Texas, we frequently evaluate patients with persistent shedding to determine underlying triggers and build personalized treatment strategies.
This case presents a 76-year-old woman with chronic hair shedding following an episode of atrial fibrillation and while taking Mounjaro for diabetes—both potential contributors to TE.
Patient Background
The patient is a 76-year-old female, established with the clinic, presenting with 8 months of diffuse hair loss. She described the shedding as:
Moderate in severity
Gradual in onset
Diffuse across the scalp
Current Treatments
She has been using:
Ethica topical for 1 month (recommended by hairdresser)
Relevant Medical History
Atrial fibrillation (AFib) episode prior to onset of shedding
Currently taking Mounjaro, a medication known to cause or worsen hair shedding in some individuals
Clinical Examination
A full examination included inspection of:
Scalp and hair with dermatoscopy
Head and face
Findings
Well-developed, well-nourished
Alert, oriented ×3
No acute distress
Diffuse hair shedding
Positive hair pull test, especially notable on the left superior parietal scalp
No scarring or inflammation noted
These findings are most consistent with chronic telogen effluvium.
Diagnosis: Chronic Telogen Effluvium
The timing of symptoms supports TE triggered by:
Recent AFib episode (physiologic stress)
Mounjaro, which is associated with increased shedding in some patients
Age-related changes in follicular cycling
Because TE persists when the underlying trigger is chronic or unresolved, this presentation aligns with chronic TE.
A punch biopsy was recommended to further confirm the diagnosis if needed.
Treatment Discussion & Counseling
A comprehensive discussion covered all major treatment options, including risks, benefits, and expected outcomes.
Reviewed Treatment Options
Oral minoxidil (pending cardiology clearance due to AFib)
Spironolactone
Finasteride / dutasteride
Low-level laser therapy (Theradome, laser caps)
Nutritional supplements (Nutrafol, Viviscal)
PRP therapy vs. AlmaTED
Because TE is shedding—not scarring—the goal is to stabilize the hair cycle and support regrowth.
Medications Selected
✔ Dutasteride 0.5 mg Daily
The patient elected to begin dutasteride, with full counseling provided.
Dutasteride Counseling Included:
Possible side effects:
Breast tenderness
Low libido
Mood changes
Depression
Medication is teratogenic
Importance of adherence and consistent daily use
✔ Ask Cardiologist About Oral Minoxidil
Given her AFib history, consultation with her cardiologist is required before considering oral minoxidil due to potential cardiovascular effects.
✔ Continue Topical Minoxidil 5%
Recommended as a safe and effective option for chronic TE.
General Counseling Provided
Education on Telogen Effluvium
TE is a hair-shedding condition caused by physiologic stress, illness, medication changes, or metabolic shifts
Most cases resolve within several months, but chronic triggers may prolong shedding
Treatment focuses on supporting follicle recovery while triggers stabilize
When to Contact the Office
Worsening shedding
Lack of improvement with treatment
New symptoms or medication side effects
A TE handout was given for home review.
Follow-Up Plan
The patient will return in 6 months for reevaluation of shedding, density, and response to dutasteride. If shedding persists, additional interventions such as PRP or low-level laser therapy may be considered.
Conclusion
This case illustrates the complexity of chronic telogen effluvium in older adults, especially when medical conditions and medications play a role. With proper evaluation, patient education, and a tailored treatment plan—including cautious introduction of medications like dutasteride—patients can achieve stabilization and improved hair density over time.
At Reena Jogi MD in Katy & Houston, Texas, we specialize in diagnosing and managing both chronic and acute hair loss, ensuring each patient receives individualized care at every stage of their health journey.
