Sudden Hair Shedding and Thinning in a 35-Year-Old Female — Telogen Effluvium and Early Androgenetic Alopecia
Background
A 35-year-old woman presented as a new patient to Reena Jogi MD Dermatology with a primary complaint of hair loss on the scalp. The shedding was generalized and moderate in severity, with a sudden onset several months ago. She denied any scalp pain, itching, or burning. The patient had no recent illnesses, surgeries, thyroid issues, or anemia. She was only taking biotin supplements for hair health.
Upon further discussion, she revealed experiencing a significant emotional stressor — a breakup in December 2024 — followed by a 22-pound weight loss due to decreased appetite. She noted that her hair shedding began soon afterward.
Examination and Diagnosis
A comprehensive scalp and hair examination was performed, including inspection with dermatoscopy. The findings showed diffuse, non-scarring hair loss with a positive hair pull test for telogen hairs, particularly over the mid-frontal scalp — consistent with telogen effluvium (TE). However, the pattern of thinning along the central scalp with preservation of the frontal hairline also suggested an underlying component of female pattern hair loss (androgenetic alopecia).
Given this overlap, Dr. Jogi explained that telogen effluvium often acts as a trigger or masking factor for androgenetic alopecia, temporarily increasing shedding and making chronic thinning more noticeable.
Treatment Discussion
The patient was counseled on both TE and AGA management, with a focus on the fact that telogen effluvium is self-limited, often resolving within months once the triggering event (such as stress or rapid weight loss) is addressed.
Dr. Jogi outlined a comprehensive treatment plan that included both topical and oral options, tailored to her comfort and readiness:
Topical Therapies
Rogaine® (Minoxidil 5%) foam or solution applied twice daily to all areas of the scalp.
Education provided that initial shedding is normal and temporary as follicles transition into active growth.
Oral and Adjunctive Options
Oral Minoxidil — discussed as a potential next step for long-term maintenance, with counseling on side effects such as mild swelling, lightheadedness, or increased hair growth on other areas.
Spironolactone — discussed as a hormonal treatment for female pattern hair loss, with information on potential side effects like menstrual irregularities, fatigue, and breast tenderness.
Nutritional Supplements — recommended Nutrafol®, Xtress®, or Viviscal® to support healthy hair growth.
Low-Level Laser Therapy (LLLT) — options such as laser caps or helmets to help stimulate hair follicles.
Platelet-Rich Plasma (PRP) Therapy — discussed as a regenerative option, with pricing provided ($800 per session or $3,200 for a package of four).
The patient chose to begin with topical minoxidil and supplements, preferring to review her oral treatment options before starting any prescription medications.
Counseling and Expectations
Dr. Jogi provided counseling on both telogen effluvium and androgenetic alopecia, emphasizing the following key points:
Telogen Effluvium is often temporary, but recovery can take 3–6 months after the trigger resolves.
Androgenetic Alopecia is chronic and genetically influenced, requiring ongoing maintenance therapy to preserve hair density.
Early intervention significantly improves outcomes for long-term hair preservation.
Follow-up in 3 months was scheduled to assess response and discuss possible escalation to oral or procedural therapies such as PRP or AlmaTED®.
Discussion
This case highlights the complex interplay between stress-related telogen effluvium and underlying female pattern hair loss — a scenario commonly seen in women in their 30s. At Reena Jogi MD Dermatology, our approach combines medical, nutritional, and procedural therapies to address both the root cause and visible thinning, restoring both hair health and confidence.
Whether the trigger is stress, hormonal shifts, or genetics, early evaluation by a dermatologist is essential for effective and lasting results. Call the office now at 7134874061 to schedule your consultation!
