Shedding - Hair Loss's Four Letter Word

Article by Dr. Kevin McElwee

Why does it happen?


Although we do not know exactly why the shedding occurs, the most likely explanation is due to how the hair follicle "organ" operates. Hair follicles are relatively inflexible in their anagen, "hair producing" state. In response to additional stimuli the growing hairs may be able to increase their growth rate or increase the diameter of the hair fiber produced a little, but it is not possible for a hair follicle to undergo big changes in size while producing hair fiber. What ends up happening, is that when that follicle gets hit with a growth stimulant like Minoxidil, it is given a very strong signal to change size (expand) and increase activity. The rule of the follicle is that it must then stop, and start over. The existing hair is ejected, the follicle goes into dormancy, and begins to restructure its processes to produce a thicker, stronger hair that can produce a bigger (thicker) hair fiber.

Shedding is a sign that the Treatment is Working

Howso??? When Rogaine is applied to stimulate hair follicles, the follicles must regress, shed the old fiber, rearrange themselves into a bigger hair follicle, and start making a new, improved fiber. This would inevitably lead to a temporary shed phase. You're seeing your hairs respond. Its unfortunate that the first sign of new hair growth is seeming hair LOSS, but that's the way it works, quite often.

There is a belief among some dermatologists that an initial shed phase when first starting to use a treatment for hair loss is inevitable regardless of the treatment used. Because of the hair follicle's inflexibility in changing the nature of hair growth mid stream, for any drug to promote hair growth it must involve hair follicles entering telogen to rearrange themselves into a larger follicle under the influence of the drug. However, certainly, the shed phase with minoxidil use can be very apparent in some people.

But "BOB" on xxxx.com told me that the shedding will NEVER STOP!

There are a few who claim that using treatments like Propecia and Minoxidil can cause a persistent shedding that lasts longer than the first three months. While there is no hard research evidence to support these claims, it is always possible that an individual may have an adverse reaction to a drug. We are each unique because of our different genetic make up and the different environments in which we live. This means that there are somewhat different responses to the same drug when used by different people. It is almost inevitable that a very few people will have a bad reaction to a drug. It may be that for a few minoxidil does more harm than good and follicle growth cycles are adversely affected. If this is the case, stopping use of the drug should allow the body to recover. However, it is most likely that many of the claims for persistent shedding actually come from those who are experiencing the expected shedding in the first 3 months, have not been consistent with their dosages, or have been continually adding or taking away from their treatment regimen.

But *I* think I have Telogen Effluvium!


Many hair loss sufferers with traditional male or female pattern baldness want to believe they have Telogen Effluvium (TE), because it provides a glimmer of hope that the whole ordeal is just temporary. Unfortunately, TE by definition is a condition that occurs in response to serious traumatic shock to the system as a whole. It is not a something that will happen without any abnormalities going on in your life. Things like sudden shock, chronic debilitating stress, extreme malnutrition, certain medications, and chronic serious illness are the most common causes. There is no way to know for sure how long shedding will last with telogen effluvium. Increased shedding occurs in response to a trigger factor. If exposure to the trigger is brief and there are no other contributing factors then the shedding may last for around 3 months and then recover so that 6 months later the hair is pretty much back to normal. However, if the trigger factor hangs around, like chronic stress or illness, then the shedding may persist. The hair follicles can get into a habit of short, truncated growth cycles, producing short hair that falls out after a few months. This results in a high shed rate - although the hair loss on the scalp need not progress much.

In Conclusion - Don't Count Hairs

In terms of understanding hair loss, the nature of shed hair and the rate of shedding is not very important, although it may be disturbing to see. Shedding is natural, everyone sheds hair daily whether affected by hair loss or not. You can shed up to 100 scalp hairs a day without having any scalp hair loss. A few people may shed more than this but still not develop baldness. To understand the development of hair loss the main factor to consider is the rate of hair growth and replacement, not so much the rate of shedding. Some people have a high rate of shedding but also a high rate of hair growth. The result is no net loss of hair on the scalp. Some people have a low rate of hair shedding and a low hair regrowth rate. The result is similarly no alopecia development. The problem comes when someone sheds hair at a faster rate than it is replaced. This is the scenario where baldness develops. You can have a normal or even a low shed rate and still develop baldness. If the hair is being shed faster than it regrows then alopecia will develop. So the amount hair shed each day/week/month is a poor diagnostic indicator of hair loss. To define alopecia you must look at what is left on the scalp. That is where it counts.

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