TE vs Male Pattern Hair Loss

Telogen effluvium vs male pattern hair loss (TE vs MPHL)

Telogen effluvium and male pattern hair loss are two of the most common causes of hair loss, but they differ in their triggers, appearance, and prognosis. TE is a temporary condition where a significant number of hair follicles enter the shedding phase after a stressor. This leads to noticeable, diffuse hair shedding across the scalp, often occurring two to three months after the trigger event.

Male pattern hair loss, or androgenetic alopecia, is a chronic, progressive condition driven by genetic and hormonal factors. It typically presents as gradual thinning at the temples, hairline, or crown, and is characterized by miniaturization of hair follicles. While TE often resolves on its own, MPHL requires ongoing management to slow progression and maintain hair density. Understanding these distinctions is essential for accurate diagnosis and appropriate treatment.

What each condition is

Telogen effluvium (TE)

Telogen effluvium is a form of temporary hair loss that occurs when a large number of hair follicles prematurely shift from the growth phase (anagen) to the resting and shedding phase (telogen). This shift is usually triggered by a significant physical or psychological stressor, such as illness, surgery, major life events, or nutritional deficiencies. TE can affect anyone but is particularly common in women between 30 and 60 years old.

In TE, hair loss is typically diffuse, meaning it affects the entire scalp rather than specific areas. Most people with TE notice increased hair shedding, often up to 300 hairs per day, compared to the usual 100. The condition is usually self-limiting, with acute TE resolving in about 95% of cases. Chronic TE may persist longer than six months and sometimes lacks a clear trigger.

Male pattern hair loss (MPHL, androgenetic alopecia)

Male pattern hair loss, also known as androgenetic alopecia, is a hereditary condition influenced by genetic and hormonal factors, particularly dihydrotestosterone (DHT). MPHL typically begins with gradual thinning at the temples, hairline, or crown and progresses over years. The hallmark of MPHL is the miniaturization of hair follicles, resulting in finer, shorter hairs and eventual baldness in affected areas.

Unlike TE, MPHL follows a predictable pattern, often starting with a receding hairline or thinning at the crown. The process is slow and progressive, and while it does not usually cause rapid shedding, the overall density of hair decreases over time. MPHL is the most common cause of hair loss in men and can also affect women in a different pattern.

How the hair loss looks and feels

Diffuse shedding vs receding hairline

One of the most noticeable differences between TE and MPHL is the pattern of hair loss. In TE, shedding is diffuse, meaning hair falls out from all over the scalp rather than specific regions. People often notice more hair on their pillow, in the shower, or when brushing. The hairline typically remains intact, and there are no obvious bald patches.

In contrast, MPHL is characterized by a receding hairline, especially at the temples, and thinning at the crown. The process is gradual, and individuals may first notice a change in their hairline shape or a widening of the forehead. Unlike TE, the shedding is not usually dramatic, but the affected areas slowly lose density over time.

Crown thinning patterns

Crown thinning is a classic feature of MPHL. The hair at the crown (top rear of the scalp) becomes progressively thinner, sometimes forming a bald spot that expands over time. This pattern is rarely seen in TE, where hair loss is more evenly distributed.

In TE, while the top of the head may be more noticeably affected, the crown does not typically develop a distinct bald spot. Instead, the overall density decreases without clear borders between affected and unaffected areas.

Hair part width and overall density changes

Changes in the width of the hair part can be a clue to the type of hair loss. In TE, the part may appear wider due to overall thinning, but the change is uniform across the scalp. The scalp may become more visible, but there is no distinct pattern.

In MPHL, the part may widen in specific areas, such as the crown or along the hairline, reflecting the patterned nature of the condition. Over time, the density decreases most noticeably in these regions, and the contrast between affected and unaffected areas becomes more pronounced.

What is happening in the scalp (biology)

Hair cycle shift in telogen effluvium

The hair growth cycle consists of three main phases: anagen (growth), catagen (transition), and telogen (resting/shedding). In healthy scalps, about 80% to 90% of hair follicles are in the anagen phase, with only 5% in telogen. In TE, a stressor causes up to 70% of anagen hairs to prematurely enter the telogen phase, leading to increased shedding.

This sudden shift results in a noticeable increase in hair loss, often seen two to three months after the triggering event. The follicles remain healthy and capable of regrowing hair once the underlying cause is addressed and the normal cycle resumes.

Miniaturization in male pattern hair loss

In MPHL, the primary biological process is miniaturization. This means that hair follicles gradually shrink under the influence of androgens, particularly DHT. As follicles miniaturize, they produce thinner, shorter, and less pigmented hairs, eventually leading to visible thinning and baldness in characteristic patterns.

Over time, miniaturized follicles may stop producing visible hair altogether. This process is progressive and, without intervention, can lead to permanent hair loss in affected areas. The presence of miniaturization is a key diagnostic clue distinguishing MPHL from TE.

Common triggers and risk factors

TE triggers (stressors, illness, medications, nutrition)

TE is typically triggered by a significant change or stressor affecting the body. Common causes include severe illness, surgery, childbirth, rapid weight loss, major psychological stress, and certain medications. Nutritional deficiencies, such as low iron or protein intake, can also precipitate TE.

The shedding usually begins two to three months after the trigger, reflecting the time it takes for hairs to transition from the growth to the shedding phase. Identifying and addressing the underlying cause is crucial for recovery.

MPHL risk factors (family history, age, hormones)

The main risk factors for MPHL are genetic predisposition and hormonal influences. A family history of androgenetic alopecia significantly increases the likelihood of developing MPHL. The condition often begins after puberty, when androgen levels rise.

Age is another important factor, as MPHL tends to progress with advancing years. Hormonal changes, particularly increased sensitivity to DHT, drive the miniaturization process that characterizes MPHL.

Timing and progression

Sudden shedding and “lag time” in TE

TE is marked by a sudden onset of shedding, typically occurring two to three months after a triggering event. This lag time reflects the hair cycle’s natural progression from the growth to the shedding phase.

The shedding can be dramatic, with handfuls of hair lost daily. In most cases, acute TE resolves within six months, and normal hair growth resumes as the follicles return to the anagen phase.

Gradual thinning over years in MPHL

MPHL progresses slowly over years or even decades. The initial signs may be subtle, such as a slightly receding hairline or mild thinning at the crown.

As the condition advances, the affected areas become more pronounced, and the density continues to decrease. Without treatment, the process is typically irreversible in the affected regions.

How doctors tell them apart (diagnosis)

History and exam: shedding amount, pattern, family history

Diagnosis begins with a thorough history and physical examination. Doctors ask about the amount and pattern of shedding, timing of onset, recent stressors, and family history of hair loss. Diffuse, sudden shedding suggests TE, while gradual, patterned thinning with a family history points toward MPHL.

The distribution of hair loss, presence of miniaturized hairs, and scalp health are all evaluated to help distinguish between the two conditions.

Hair pull test and wash test (what they can and cannot show)

The hair pull test involves gently tugging on a small section of hair to see how many strands come out. In TE, more than a few hairs may be easily pulled, reflecting active shedding. The wash test, where hair is counted after washing, can also indicate increased shedding.

However, these tests do not reveal the underlying cause or pattern of hair loss. They are most useful for confirming active shedding but must be interpreted alongside other clinical findings.

Trichoscopy: signs of miniaturization vs uniform hairs

Trichoscopy, a form of scalp dermoscopy, allows doctors to examine hair shafts and follicles up close. In TE, hairs appear uniform in diameter, with no evidence of miniaturization. In MPHL, trichoscopy reveals a diversity of hair shaft diameters and miniaturized hairs, which are key diagnostic features.

This tool is especially helpful when the diagnosis is unclear or when both conditions may be present.

When lab tests may be considered (to look for TE triggers)

Laboratory tests are sometimes ordered to identify potential triggers for TE. These may include blood tests for iron levels, thyroid function, and other nutritional markers. Identifying and correcting deficiencies or underlying illnesses can help resolve TE.

Lab tests are less useful for diagnosing MPHL, which is primarily based on clinical features and family history.

Can you have both TE and MPHL at the same time?

How TE can reveal underlying MPHL

It is possible to experience both TE and MPHL simultaneously. TE can unmask or accelerate the appearance of MPHL by causing rapid shedding in areas already predisposed to thinning. After the acute shedding of TE resolves, the underlying pattern of MPHL may become more apparent.

This overlap can make diagnosis challenging, as the diffuse shedding of TE may temporarily obscure the patterned thinning of MPHL.

What to do when diagnosis is mixed

When both TE and MPHL are suspected, a comprehensive approach is needed. Addressing potential TE triggers and supporting overall scalp health is important, while also considering long-term treatment options for MPHL if patterned thinning persists.

Consulting a dermatologist or hair loss specialist can help clarify the diagnosis and guide appropriate management strategies.

Treatment options compared

TE: address trigger, gentle hair care, realistic timelines

The primary treatment for TE is identifying and removing or resolving the underlying trigger. This may involve managing stress, correcting nutritional deficiencies, or adjusting medications. Gentle hair care practices, such as avoiding harsh treatments and minimizing heat styling, can help protect regrowing hair.

Most cases of acute TE resolve within six months, with hair regrowth following the restoration of the normal hair cycle. Patience is key, as full recovery may take several months.

MPHL: evidence-based options and expectations

MPHL is managed with evidence-based medical therapies aimed at slowing progression and promoting regrowth. Topical minoxidil and oral finasteride are the most widely used and studied treatments. These medications can help maintain hair density and, in some cases, stimulate regrowth, but results vary between individuals.

Treatment is ongoing, as stopping therapy often leads to resumed progression. Realistic expectations are important, as complete restoration of lost hair is unlikely.

What to avoid: unproven claims and harsh practices

Many products and treatments claim to cure hair loss but lack scientific support. Avoid harsh chemical treatments, aggressive styling, and unproven supplements or procedures. These can worsen hair loss or damage the scalp.

Always consult a healthcare professional before starting or stopping any treatment. Evidence-based therapies and a gentle approach to hair care offer the best chance for healthy regrowth and maintenance.

FAQ

How can I tell if my shedding is TE or MPHL at home?

TE usually causes sudden, diffuse shedding across the entire scalp, often noticed as increased hair in the shower or brush. MPHL typically presents as gradual thinning at the hairline or crown. If the hairline remains intact and shedding is widespread, TE is more likely. Patterned thinning or a family history suggests MPHL.

Does a widening part mean TE or male pattern hair loss?

A widening part can occur in both TE and MPHL. In TE, the widening is usually uniform across the scalp. In MPHL, the part may widen in specific areas, such as the crown or temples, reflecting the patterned nature of the condition.

Can TE cause a receding hairline?

TE rarely causes a receding hairline. It typically leads to diffuse thinning without affecting the hairline. However, if MPHL is also present, TE can make a receding hairline more noticeable.

What does miniaturization mean, and why does it matter?

Miniaturization refers to the gradual shrinking of hair follicles, resulting in thinner, shorter hairs. It is a hallmark of MPHL and helps distinguish it from TE, where hairs remain uniform in diameter.

Can stress cause male pattern hair loss, or only TE?

Stress is a common trigger for TE but does not directly cause MPHL. However, stress-related shedding can reveal underlying MPHL by accelerating hair loss in predisposed areas.

Will hair grow back after telogen effluvium?

In most cases, hair regrows after TE once the underlying trigger is resolved. Acute TE resolves in about 95% of cases, with hair returning to its normal density over several months.

Is crown thinning always male pattern hair loss?

Crown thinning is a classic feature of MPHL, but diffuse thinning from TE can also make the crown appear less dense. Distinct bald spots at the crown are more typical of MPHL.

Should I start minoxidil if I’m not sure which one I have?

It is best to consult a healthcare professional before starting minoxidil or any hair loss treatment. A clear diagnosis ensures the most effective and appropriate therapy for your condition.