Telogen Effluvium- What You Need To Know

female hair

Telogen effluvium is a form of hair loss. It is commonly associated with hair loss in a female but actually the diagnosis can affect males too. In most cases the condition self-resolves. However, it can be concerning to lose so much hair quickly. This blog helps to explain what Telogen Effluvium is and what treatments are available to you.

What does “Telogen Effluvium” mean?

Your hair goes through different stages of growth. Telogen effluvium is caused by a disturbance in the normal hair lifecycle. Hair initially grows from the hair root (anagen phase, lasting 2-6 years), then it stops growing and rests (catagen phase, lasting 2-3 weeks). Eventually this resting hair shortens and falls out (telogen phase, lasting 3 months). In the scalp 85% of your hairs are in the active growth phase (anagen) and about 15% of your hairs are being shed (telogen phase).

Telogen– this is the shedding phase of a hair follicle and it comes after two other phases (Anagen- growth phase, Catagen- end of growth phase)

Effluvium- the active shedding of hair

So in a nutshell, telogen effluvium, means you are suffering from hair loss and you are primarily shedding hair that is at the end of its lifecycle. If more of your hair switches into the telogen phase you will notice more hair being shed than is actually grown (less anagen hairs and more telogen hairs). This imbalance and hair loss is called telogen effluvium.

What does telogen effluvium look like?

Telogen effluvium causes hair loss and thinning all over the scalp and differs from Female Pattern Hair Loss where hair is only lost on the top of the scalp. There are two main types of Telogen Effluvium- Acute Telogen Effluvium and Chronic Telogen Effluvium.

Acute- lasting for a short period of time (up to 6 months)

Chronic– lasting for more than 6 months

Acute Telogen Effluvium

In Acute Telogen Effluvium, you will notice you lose hair all over your head. A particularly sudden stressful event normally triggers acute telogen effluvium and it causes more of your hairs to switch from a growing (anagen) phase to a resting (telogen) phase. These hairs will remain in this phase for 3 months and will eventually shed. The process usually resolves after 6 months and you should recover well.

Many different triggers have been found and you may realise you have experienced the following events that are now triggering your hair loss:

  • Going through a severe illness
  • Giving birth or going through an abortion
  • Psychological stress (e.g. death of a loved one)
  • Drastic changes in diet
  • Large blood loss
  • Surgical operation including hair transplant surgery
  • Traumatic accident (e.g. car crash)
  • Medications like Birth Control Pills

Chronic Telogen Effluvium

Although in most cases acute telogen effluvium self resolves after the initial stress event has passed, in some cases hair loss can persist past 6 months. This is called Chronic Telogen Effluvium- a condition where hair thinning and loss continues after 6 months.

How Do You Know If You Are Suffering From Telogen Effluvium?

If you are worried about a diagnosis of telogen effluvium then you should seek immediate advice from a hair loss specialist. If you wanted to book a consultation with the hair loss doctors at The Treatment Rooms London, then please click (here).

For both diagnoses it is important you are seen in person so you hair loss can be examined in detail. In most cases of acute telogen effluvium you should notice your hair grows back as the hair loss is temporary.

For those who may be suffering from chronic telogen effluvium it is important to exclude any common long term causes of hair thinning and hair loss such as:

  • Iron deficiency
  • Zinc deficiency
  • Thyroid disease
  • Kidney or Liver disease
  • Stomach or pancreatic disease
  • Systemic lupus erythematosus
  • Long term viral infections
  • Medications that can cause hair loss

In some cases of chronic telogen effluvium there are no specific triggers and this is called primary chronic telogen effluvium whereby there is diffuse (all over the scalp) hair loss. Mostly women are affected by telogen effluvium (both acute and chronic) as they go through childbirth and can often have iron deficiency.

Can You Treat Telogen Effluvium?

In most cases of acute telogen effluvium you will notice your hair starts to grow back after 3-6 months. However, you can take the licensed medication, Minoxidil, to help treat your hair loss.

In chronic telogen effluvium, you will first need to exclude other causes of hair loss before undergoing treatment. If you are found to have primary chronic telogen effluvium (no specific trigger) then you may notice you benefit from Minoxidil too.

Unlicensed treatments for Telogen Effluvium include PRP injections to help stimulate hair growth and increase hair thickness.

References

What You Need To Know About Finasteride For Hair Loss

finasteride tablet

Propecia® is its brand name. Finasteride is the generic name and it is a medication widely used for the treatment and prevention of hair loss. But how do you, as a patient, decide whether to take it or not? This blog will help you in your decision making process.

Male Hair Loss

Finasteride is primarily a medication for male pattern hair loss. It is not a commonly used medication in females- mainly because there hasn’t been any consistent beneficial effects. The use of finasteride in females may only be limited to conditions like hirsuitism and polycystic ovary syndrome (1).

For the majority of males, the main cause of hair loss occurs in a predictable pattern called male pattern baldness. Male pattern baldness is a type of alopecia caused by dihydrotestosterone (DHT), (2). DHT is a hormone converted from testosterone and it works in your scalp to thin your hair and make it fall out. In most men it is the primary driver for hair thinning and hair loss.

By stopping the action of DHT at hair follicles, we can stop and reverse the hair loss process. This is how Finasteride works. But should you take it?

Taking Finasteride

Firstly- Finasteride is a medication that should be prescribed by your Doctor. Some patients buy it online- at The Treatment Rooms, London we recommend you see a hair loss specialist. The main reasons for this are:

  • Sometimes Finasteride is NOT the correct medication for you as you might be suffering another type of hair loss
  • You should therefore have a hair loss DIAGNOSIS by a specialist before deciding on the best treatment for you
  • Finasteride, like all medications, has SIDE EFFECTS that need to be monitored for
  • You need to check how EFFECTIVE finasteride is- so having an objective analysis of your hair growth whilst on the medication is important. This should be done by a hair loss specialist
  • If you are planning on having CHILDREN then Finasteride should be stopped before & during pregnancy as well as when your partner is breast feeding. This requires meticulous planning on behalf of you and your hair loss Doctor to make sure you limit hair loss during the time when you are not taking the medication

Does Finasteride Work?

At a dose of 1mg taken once a day, Finasteride has been shown to reduce the levels of DHT in the scalp by 60%. In clinical trials this has had the following effects:

  1. Stops hair loss in 86% of males
  2. 65% of men report a significant increase in hair growth

These positive effects can be see in the first year or two when starting treatment. Interestingly, for those who haven’t noticed a change after a year of taking the medication, you should still continue it. Hair growth in clincial trials have been shown to improve even in those with no or little change after 1 year, with great results in growth after 5 years (2).

crown hair transplant with finasteride before and after
Hair regrowth following 5 months of treatment

What are the side effects of Finasteride?

As with all medications there are of course some side effects of Finasteride (3). The two main side effects you ought to know about are:

  1. Low mood
  2. Sexual Dysfunction (2.1-3.8% of males)

For patients who do unfortunately suffer from these side effects- rest assured most patients recover well if they stop the medication. Interestingly, some patients recover despite continuing the medication- this suggests that the medication did not cause the side effect in the first place.

If you are worried about these side effects it is important you discuss them with your hair loss doctor as there are other treatment options available to you. This includes the option of taking the medication on alternate days.

When should you take finasteride?

Finasteride is a medication you usually take once a day. The decision to start finasteride really depends on you. If you are concerned about your hair loss and you have been diagnosed with androgenic alopecia (male pattern baldness) then finasteride is a medication that can prevent further hair loss and help you grow thicker hair.

If you are planning on having a family soon then Finasteride might not be the medication you choose to have. Other treatment options like Minoxidil could be your first line treatment. After you have finished having children you can then think about adding in or swapping to Finasteride.

Some patients may also benefit from having Finasteride to stabilise their existing hair loss before choosing to have a hair transplant. By stopping the progression of hair loss and helping to thicken hair in previously thin areas many patients are able to achieve a very good aesthetic outcome. If they then wanted to have a hair transplant the total number of grafts required for a desirable outcome is less. Overall, the combination of finasteride and a hair transplant to reverse and treat hair loss is the most effective treatment.

Want to know more?

If you would like to find out more about Finasteride then please don’t hesitate to contact our hair loss specialists at The Treatment Rooms London. Our Surgeons and Doctors are happy to take you through a full consultation around hair loss, including a discussion about Finasteride. Feel free to book your consultation today.

References

  1. https://onlinelibrary.wiley.com/doi/abs/10.1111/ijd.14370
  2. https://www.ncbi.nlm.nih.gov/books/NBK278957/
  3. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1529-8019.2011.01441.x
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/
  5. https://link.springer.com/article/10.2165%2F00003495-199957010-00014
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1622749/
  7. https://thriveglobal.com/stories/what-is-the-role-of-the-pharmacological-use-of-finasteride-in-male-patients/

Read more blogs:

British Association of Hair Restoration Surgery

Dr Fernando Hair Restoration Surgeon British Association of Hair Restoration Surgery

Dr Fernando, lead hair transplant surgeon at The Treatment Rooms London, is now a full member of the British Association of Hair Restoration Surgery.

What is the British Association of Hair Restoration Surgery?

The British Association of Hair Restoration Surgery (BAHRS) is a UK non-profit organisation for individuals who have an interest in hair loss, hair transplant surgery and hair research. Its key objectives are to:

  1. Promote the understanding and reputation of hair restoration surgery in the UK and Ireland
  2. Foster the communication of information relating to hair restoration surgery amongst members, other practitioners and other professional bodies
  3. Advance all aspects of the professional practice of hair restoration surgery to high standards of competence, conduct and ethics and to promote education in appropriate skills
  4. Represent members, to assist members to protect their interests, and to offer members support in matters relating to hair restoration surgery practice

BAHRS has a strict code of conduct and standard when it comes to hair transplant surgery. Any member of BAHRS is required to uphold these principles. As a result, if you visit a surgeon who is a BAHRS member, you can expect them to provide you high quality hair transplant surgery as outlined by BAHRS’ professional standards.

Dr Dilan Fernando- Full Member of the British Association of Hair Restoration Surgery

As of January 2019- Dr Fernando is now a full member of the British Association of Hair Restoration Surgery. He continues to work tirelessly to give his patients the highest quality hair transplant surgery. This includes working to BAHRS’ professional standards. It means no corners are cut in delivering hair transplants to patients in London and the wider UK.

Being a full member of BAHRS, Dr Fernando will continue to uphold its code of conduct around the following standards of hair transplant surgery:

  • Consultation process
  • Consent process
  • Transparent transaction processes
  • Record keeping
  • Hair Transplant aftercare
  • Hair Transplant advertising

For more information, you can click the link (here).

References

  1. https://www.bahrs.co.uk/content/large/documents/bahrs_standards/psfhtsv3january19.pdf
  2. https://www.bahrs.co.uk/about-us/bahrs-standards/
  3. https://www.bahrs.co.uk/

Read more blogs:

Embracing Baldness

john travolta baldness

John Travolta recently embraced being fully bald- posting a picture on Instagram of him “rocking the look”. And recently in the news an MP was unfortunately “ridiculed” for wearing a wig in the House of Commons. With an increasing number of gentleman looking for hair loss treatment- at what point do you embrace baldness?

Baldness

Becoming bald is a natural process of ageing. For decades we have looked for the one and ultimate cure for hair loss. With FDA and MHRA-approved treatments like Finasteride and Minoxidil; there are proven hair loss treatments for both men and women.

At what stage would you say you are bald? Baldness has several different stages- as represented by the Norwood Scale for men (picture blow).

norwood scale for hair loss
Norwood scale of balding showing the different stages of hair loss

We would describe complete baldness as stage 5a-7, where you have lost all of your hair on the top of your head (if you are male). However, at each stage you can describe yourself as going bald.

If you decided to start hair loss treatment when you at stages 1-5 there is a good chance of being able to restore your hair on the top and crown. The choice of your treatment will depend on a number of factors. Ideally a combination of finasteride, minoxidil and hair transplantation could be an option for you.

If you are stage 5a-7 you have three main options:

1- Have a hair transplant- this is dependant on how much hair you have left on the back and sides

2- Have scalp micropigmentation that will give you the illusion of dense short hair

3- Embrace baldness!

Embracing baldness- what does this mean?

Some gentlemen who we find coming to The Treatment Rooms London are content with not undergoing treatment for their hair loss. They would prefer to style out their baldness. At The Treatment Rooms we have always been led by our patients on their preference for treatment or not. If you prefer being bald and it suits you then why would you bother choosing to have treatment?

Embracing baldness is more a paradigm shift in thinking and perception than it is acceptance. Acceptance suggests that becoming bald wasn’t a choice but it just happened without giving you the chance to do something about it. In reality, there are so many treatments now available that in the 21st century you now have a choice about whether to embrace baldness or not.

Finasteride

A medication that helps to stop any more hair loss and freeze-frame your existing hair loss pattern. Who is on this treatment?

Donald Trump’s famous hair has always caught the media headlines. It is widely rumoured that Donald Trump takes Finasteride. Not convinced of his results? Check out some of the hair regrowth results we have managed to achieve at The Treatment Rooms London in our gallery (click here).

Minoxidil

This a solution, shampoo or spray you apply to your hair. It helps to promote the blood supply to your hair and makes your hair thicker.

Hair Transplantation

The Treatment Rooms London is one of the UK’s premier hair transplant centres, specialising in hair restoration surgery. Thousands of gentlemen choose to have the procedure including rumours about well known celebrities having undergone the treatment too:

References

  1. https://www.telegraph.co.uk/health-fitness/body/like-john-travolta-know-liberation-embracing-bald/
  2. https://www.stuff.co.nz/sport/rugby/all-blacks/110118631/former-all-blacks-fullback-israel-dagg-reveals-effects-of-hair-transplant-surgery
  3. https://www.celebsnow.co.uk/celebrity-news/exclusive-peter-andre-speaks-hair-transplants-775987
  4. https://www.telegraph.co.uk/health-fitness/body/finasteride-does-donald-trumps-favourite-hair-loss-treatment/
  5. https://www.dazeddigital.com/beauty/head/article/43007/1/why-are-more-men-getting-hair-transplants
  6. https://www.thesun.co.uk/sport/8257041/ben-stokes-hair-transplant-steve-bruce-england-first-test-west-indies/
  7. https://www.treatmentroomslondon.com/male-hair-loss-blog/
  8. https://www.treatmentroomslondon.com/male-hair-loss-blog/
  9. https://www.itv.com/news/central/2019-01-25/its-a-wig-tory-mp-michael-fabricant-mocked-by-colleague-during-pmqs/

Read more blogs:

Unregulated Hair Transplant Clinics

skin necrosis after attending unregulated hair transplant clinic

An increasing number of patients are coming in to see us to correct hair transplants that have been performed poorly. It is disheartening to see these patients. Their suffering affects all our staff from our nurses to our surgeons as we take pride in being able to provide high quality hair transplants. As a result we wanted to write something to increase awareness about going to an unregulated hair transplant clinic.

A Disastrous Case

In the above the picture, the gentleman had his hair transplant two months prior to presenting to The Treatment Rooms’ Doctors. He complained of having the following:

1. A wound on the top of his head.
2. Worried that his transplanted hairs would NOT have thick enough coverage.
3. Soreness at the back of his head and poor skin healing at his extraction site.

One look and our Doctors knew he was in trouble. He was suffering because:

1. The black areas on the top of his head were dead skin. This is skin necrosis and is possibly the worst complication of hair transplant surgery. It occurs when surgery is performed poorly. These areas will eventually scar and no hair will grow there. The chance of hair ever growing there is very slim (1). He may even need a further operation to cut away the dead skin.

2. The transplanted hairs are far too spread out and his eventual result will likely be thin coverage. This did not meet his expectations of a full thick set of hair following a hair transplant. The issue here is likely at the consultation stage of the treatment process.

3. The area at the back of his head, where hair was extracted, is suffering from widespread hair loss (also called shock loss). There is also poor healing where the surgeon has over-extracted hairs from the donor site. This may result in large areas of scarring at the back of the head which will be noticeable.

What happened?

This patient went to a hair transplant clinic that is unregistered and unregulated by the CQC and other professional bodies (e.g. GMC).  He tried to contact his surgeon repeatedly but was refused a consultation and started to have his calls ignored. Upon inspection of the clinic’s website, there was no information on the team or surgeon and their experiences in hair transplant surgery. In addition the clinic itself was not registered under any professional regulatory body so the surgeons could not be held to account if they provided low quality surgical care.

At The Treatment Rooms London, we make it clear, the lines of communication with our surgeons are always open. Doctors and Surgeons ignoring patients can never happen and we were sad to hear this is happening.

The patient was made to pay a certain amount of money up front and then a second amount on top of this as the clinic provided an extra treatment that was not agreed upon. The patient in his own words explained the clinic had “killed my hair”. The clinic that he visited clearly did not answer all his questions prior to having surgery, did not explore his expectations of what could be achieved with a hair transplant and failed to take clear consent for the treatments that were going to be provided.

With this gentleman’s balding pattern it would be very difficult to attain a high density of hair all over the scalp as this would essentially require the surgeon to remove all of his hair at the back of the head. Overpromising results is common in unregulated hair transplant clinics who then go on to perform dangerous transplants that ultimately cause harm to patients as seen in this case.

Be careful of those clinics that are out for the “quick sell” and over promise the result they can achieve for you.

Why is a regulated clinic so important?

Going to a hair transplant clinic that has a Surgeon who is GMC registered and operates in a CQC approved location is incredibly important.

By being GMC-registered, the Surgeon is held to the institution’s high codes of conduct and expectations when it comes to patient care. This means that as a patient, you can feel safe that you are being treated by a Surgeon who is regulated by a larger organisation. Secondly, a hair transplant surgeon can be a member of the British Association of Hair Restoration Surgeons or International Society of Hair Restoration Surgeons– both organisations ensure their members operate and treat under their strict codes of conduct. Check your surgeon is a member of these institutions- you can be assured that you are being seen by someone who values good quality care and practices ethically.

The CQC (Care Quality Commission) is the UK’s independent regulator of all health and social services. They ensure all clinics and hospitals run health services safely and provide patients high quality care. If you visit a clinic that is not regulated by the CQC, be mindful that they may not hold in high regard the same level of precision, safety and quality as would be expected of a CQC-registered clinic.

close up hair transplant doctor

So what next for the patient?

With skin necrosis you need to have it treated immediately. We advised him to go and see his original Surgeon straight away and if they refused to see him then he will need to be admitted to hospital. He will need a further operation to cut out the dead skin and repair the scalp.

His area of skin damage will scar and will not grow any transplanted hair. After it heals he will need to consider how he can conceal the area, for example by combing hair over it. In some cases fat grafting may be considered to make that area amenable to a future hair transplant. However despite this option, the likelihood of permanent scarring and balding is high. This is undoubtedly not what the patient was expecting after agreeing to have treatment for baldness.

Our message to all patients looking to have a hair transplant is:

A hair transplant is not a simple decision and you must think carefully about who will be performing the procedure. The results of a transplant are permanent so you shouldn’t cut corners when choosing a clinic and surgeon. Make sure you have a read of our blog on the 5 considerations you should take before having hair transplant surgery.

Secondly, there are many other treatments apart from hair transplant surgery. Explore all of them so you can be sure you have chosen the best treatment suited to your needs.

If you have been affected by a poorly performed hair transplant and you need advice please don’t hesitate to contact our Doctors. Simply click here and our Doctors will give you a call as soon as they can.

References

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536882/

(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212293/

(3) https://www.nhs.uk/conditions/gangrene/

(4) https://www.khaleejtimes.com/news/uae-health/Cheap-hair-transplants-abroad-are-risky-warn-UAE-health-experts

(5) https://www.menshealth.com/uk/style/grooming/a25734373/hair-transplants-complete-guide/

(6) https://www.aa.com.tr/en/health/turkey-top-choice-for-hair-transplants-in-europe/1361995

Read more blogs: