One of the main topics I hear from women experiencing hair loss is questions about how a person can determine what type of loss they have. This can be very important because it can tell you how long you will have to deal with this and how best to treat it so that you get some relief sooner rather than later. And I find that women are often more concerned with whether they have androgenic alopecia (AGA) or TE (telogen effluvium). At first, most women expect telogen effluvium because, optimally, this condition should resolve on its own. AGA, on the other hand, often requires early treatment to get a good result.
However, sometimes, as ET persists and seemingly lasts forever without real treatment, some women tell me that they would actually rather have AGA because at least then they would know what they are dealing with and they know there are treatments for that instead. of having to adopt the “wait and see” approach that is often recommended with shedding. The truth is, there are many similarities and differences to these two conditions, and sometimes the recommended treatments overlap so that you can at least try something, even if you have a molt. I will discuss more about this matter in the next article.
Causes of telogen effluvium vs. AGA causes: Generally speaking, temporary shedding is caused by some disruption in your system or some kind of stressor on your body. Often times, for women, this can mean hormones, illness, or medications. And what can sometimes make the two overlap or difficult to diagnose is the fact that hormones (and androgens) are often to blame for androgenic alopecia as well.
Now, medical problems and changes in your medication are pretty easy to identify. Anything that could have caused changes in your body or could have been a trigger apparently points to temporary shedding rather than genetic thinning. And, in the case of shedding, this is usually things like giving birth, stopping birth control, or the fluctuation of hormones that comes with aging and changes in your body. (These things are also usually pretty easy to notice.)
However, hormonal changes that occur with aging or body changes can also lead to more androgens taking hold because there are not as many protective sex hormones as estrogen that offer resistance to androgens. And this in turn leads to androgenic alopecia, even if you don’t have family members you know who have this same condition. And to make things even more confusing, in some cases for people who already had genetic inclinations, hormonal TE can eventually give way to AGA.
Some key differences between shedding and thinning: So with all these similarities, how can you tell the differences? It used to be that you were told that if you were losing a lot of hair (more than 100 or more per day) you were more likely to have TE. And this is true sometimes. But it is also possible to have a less severe shedding episode. And it is possible to have a very aggressive episode of AGA in which more than 100 hairs are lost per day as well. As you can see, while the number of stray hairs is one way to differentiate them and this should definitely be taken into account, this cannot always be counted on as there are not always textbook cases of either.
One of the best ways to differentiate between the two is to look at the regrowth. Because if you see miniaturization (hair that is getting thinner and thinner), it can be a good indication that you are looking at AGA. This condition shrinks and compromises the follicles (due to androgens) so regrown hair will likely start to look different. It is often lighter in color and noticeably finer in texture.
Regrowth that appears after temporary shedding (TE) should look like the rest of your hair without miniaturization. In fact, while this is happening, you may have to play around with different styles to match this as your hair grows back and new strands can pop. This new growth is usually as dark and healthy as the rest of your hair.
Similarities in treatments for both: People often ask me if there are things they can do in terms of treatment if they are not sure which one is to blame for hair loss. Well, one thing these two conditions share is inflammation. You will often see an angry looking scalp (or even feel a tight and painful scalp) no matter which of these you have. So anything you can do to calm your skin and decrease inflammation (without clogging) will offer some relief and help it grow back. There are many topical treatments that work for this, but until you are sure you have AGA, you should avoid treatments that affect your hormone levels because this can sometimes only make the process worse as your body gets out of control again, you develop another trigger, and usher in a new round of detachment.
Additionally, both conditions can benefit from scalp stimulation aimed at making regrowth healthier and more vigorous. Again, you want to focus on the things that you can do internally and through the scalp rather than the things that are internal and can cause more triggers.
