Telogen Effluvium in a 36-Year-Old Female After Birth Control Change
Hair shedding can be alarming, especially when it begins abruptly. Telogen effluvium (TE) is one of the most common causes of sudden, diffuse hair shedding in women—and it is often triggered by hormonal changes, stress, or internal shifts within the body. At Reena Jogi MD in Katy and Houston, Texas, we frequently evaluate patients with similar symptoms and help them navigate recovery through education, targeted treatments, and close follow-up.
This case highlights a 36-year-old woman experiencing diffuse hair thinning after a recent birth control change, demonstrating the importance of proper diagnosis and a tailored treatment plan.
Patient Background
A 36-year-old female presented as a new patient with a chief complaint of diffuse hair loss that began 4 months ago. She described the hair shedding as:
Moderate in severity
Gradual in onset
Diffuse across the scalp
She also noted a history of noticeable hair thinning approximately 1 month after switching birth control pills, suggesting a hormonal trigger. She denied meaningful scalp pain, burning, or irritation.
Family History
The patient reported hair loss in her mother, which can contribute to baseline hair density patterns or underlying genetic hair thinning.
Physical Examination
A thorough examination included:
Scalp and hair inspection
Head and face evaluation
Dermatoscopic exam for follicular assessment
Exam Findings
Patient appeared well-developed and well-nourished
Alert and oriented ×3
No acute distress
Positive hair pull test—consistent with active telogen shedding
Diffuse shedding noted on the posterior mid-parietal, right central frontal, and left central frontal scalp
No scarring or inflammatory signs were present.
Diagnosis: Telogen Effluvium (TE)
Based on her clinical history, timing of symptoms, and exam findings, the patient was diagnosed with telogen effluvium, a temporary shedding cycle in which hair prematurely enters the telogen (resting) phase.
In this case, the most likely trigger was her recent birth control change, a common hormonal cause of TE.
To further confirm the diagnosis, a punch biopsy was offered.
Treatment Discussion
A full counseling session was provided, covering the nature of telogen effluvium and its typical recovery timeline.
Key Education Points
TE is self-limited, usually resolving within several months
Common triggers include illness, stress, nutritional deficiencies, thyroid abnormalities, and medications
Regrowth can be gradual and may lag several months behind the initial trigger
Underlying organic causes should be identified and addressed
Treatment Options Reviewed
The following therapies were discussed in detail, including side effects:
Finasteride
Spironolactone
Topical 5% minoxidil solution
Low-level laser therapy (Theradome, others)
Nutrafol, Viviscal, and other supplements
Hair transplantation (not appropriate for active TE but discussed for completeness)
After discussing all options, the patient elected to begin spironolactone.
Final Treatment Plan
1. Spironolactone 50 mg
Prescription:
50 mg tablets
Take 1 tablet daily for 1 week
Then increase to 1 tablet in the morning + 1 tablet at bedtime
If well tolerated, may take both tablets at once
Side Effects Reviewed:
Breast tenderness
Menstrual irregularities
Dizziness
Fatigue
Elevated potassium levels
Not safe in pregnancy
2. Begin Topical Minoxidil 5% Solution
Recommended to support regrowth and reduce prolonged shedding.
3. Optional Future Treatments
PRP therapy
AlmaTED
Laser therapy
4. Follow-Up
Return in 3 months to reassess shedding, scalp health, and response to spironolactone.
Conclusion
This case illustrates a classic presentation of telogen effluvium triggered by a hormonal change. With appropriate counseling, targeted therapy, and close monitoring, most patients experience significant recovery as hair follicles naturally re-enter the growth phase. At Reena Jogi MD, we focus on patient-specific evaluation to determine triggers and curate individualized hair restoration plans.
Women in Katy and Houston, Texas seeking evaluation for sudden or diffuse hair thinning can benefit from early diagnosis and supportive care—often preventing unnecessary worry and promoting faster recovery.
