Hair Thinning After Menopause: Androgenetic Alopecia and Chronic Telogen Effluvium in a 58-Year-Old Woman
Hair thinning that develops gradually after menopause is a common yet distressing concern for many women. Hormonal changes can significantly affect the hair growth cycle, often leading to androgenetic alopecia (AGA) with overlapping chronic telogen effluvium (TE). At Reena Jogi MD in Katy and Houston, Texas, we specialize in diagnosing the underlying causes of hair loss and offering individualized treatment plans that align with each patient’s medical history and goals.
This case highlights a 58-year-old female with long-standing diffuse hair thinning following menopause.
Patient Presentation
The patient is an established 58-year-old woman who presented for evaluation of generalized scalp hair loss that has been gradually progressive over several years. The hair loss was described as moderate in severity, without associated itching, pain, or scaling.
She reported:
No current hair loss treatments
Prior use of Nutrafol for 6 months without improvement
Onset of hair loss around the time of menopause
No hormone replacement therapy due to a maternal history of breast cancer
Clinical Examination
A focused scalp examination was performed.
Key Findings
Diffuse, non-scarring hair thinning
Preservation of the frontal hairline
Widening of the midline part
Positive hair pull test indicating ongoing shedding
Overall findings were most consistent with androgenetic alopecia with superimposed chronic telogen effluvium related to hormonal changes.
Diagnosis
1. Androgenetic Alopecia (Female Pattern Hair Loss)
Female pattern hair loss is a genetically determined condition often exacerbated by menopause. It presents as diffuse thinning rather than focal bald spots and progresses slowly over time.
2. Telogen Effluvium
Chronic telogen effluvium contributes to excessive shedding and can coexist with androgenetic alopecia, particularly during periods of hormonal fluctuation.
Treatment Discussion
A comprehensive discussion was held regarding treatment options, taking into account the patient’s medical history, including the fact that she has only one kidney.
Medical Therapy Reviewed
Oral minoxidil
Spironolactone
Finasteride (post-menopausal use)
Supplements (Viviscal, Nutrafol, Votesse)
For spironolactone, risks such as hyperkalemia, dizziness, hypotension, and the need for potassium and renal monitoring were reviewed in detail. Given her renal history, it was recommended that she obtain clearance from her nephrologist before initiating any oral therapy.
Procedural & Device-Based Options
For patients unable or unwilling to take oral medications, alternative options were reviewed, including:
Low-level laser therapy (caps or helmets)
The benefits, risks, pricing, and need for maintenance therapy were discussed. The patient expressed interest in AlmaTED as a potential alternative or adjunctive treatment.
Treatment Plan
Baseline photographs obtained for monitoring
Prescriptions provided pending nephrology clearance:
Oral minoxidil 1.25 mg daily
Spironolactone 100 mg daily
Plan for baseline potassium testing and repeat labs if oral therapy is approved
Provided AGA educational handout detailing all treatment options
If oral medications are not cleared, proceed with AlmaTED treatments
Patient Counseling & Expectations
The patient was counseled that:
Female pattern hair loss is slowly progressive
Treatments focus on slowing progression and improving density
Results require consistency and patience
Combination therapy often yields the best outcomes
She was advised to contact the office if shedding worsens or if side effects occur.
Follow-Up
Follow-up visit in 6 months
Earlier evaluation if treatment is initiated or symptoms change
Expert Hair Loss Care in Katy & Houston, Texas
Hair loss after menopause is common—but highly treatable with the right approach. At Reena Jogi MD, we provide personalized care for women experiencing androgenetic alopecia, telogen effluvium, and complex hair loss conditions, offering both medical and procedural solutions.
