biopsy

Discussions about the diffuse thinning experienced by women, usually after menopause
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charie
Posts: 2
Joined: Tue Jan 07, 2014 4:18 pm

biopsy

Post by charie »

Hello Tom,

Thank you for registering me, I have been a stalker on this forum for many months and finally feel like I have a question to ask, other than "Can someone please HELP ME???" I am 38, female, and dealing with massive hair shedding for over a year now. I have had many tests done, all of which appear to be normal, except for my ferritin level was 9. It took a while, but it has since raised to 92. I had high hopes pinned on the low ferritin being the cause of my hairloss, but it has not slowed down at all.
I had a mid scalp biopsy done in June by a dermatologist who supposedly specializes in hair loss. She diagnosed me with Telogen Effluvium, recurring or chronic, and said I should notice the shedding easing up. Well, I have not, so I went back to my GP to see how I should proceed and he referred me to endocrinologist and also recommended I get the report from the scalp biopsy, which I did.

The reults are as follows: Diagnosis: "Nonscarring Alopecia with increased number of telogen follicles." Microscopic description: "Microscopic sections yield an adequate biopsy containing a decreased number of terminal follicles. Multiple deeper sections reveal one anagen hair and two telogen hairs. There are no vellus follicles. There is no perifillicular scarring and only sparse perifollicular inflammation."

My question is, does this seem to indicate TE vs. AGA? What does a decreased number of terminal follicles indicate? And even though there are no vellus hairs, I have noticed the diameter of my hair strands seems much thinner and less pigmented. Any input you have would be GREATLY appreciated!!

Thanks

Tom Hagerty
Site Admin
Posts: 628
Joined: Mon Dec 06, 2010 9:21 am

Re: biopsy

Post by Tom Hagerty »

It took a while, but it [serum ferritin] has since raised to 92.
How did you get your number from 9 to 92? How long did it take? The normal range for women is between 12 and 150 ng/ml but some researchers say that between 40 and 60 is optimal. Above 80 ng/ml might be an indication of an iron surplus. If you're taking an iron supplement you might consider cutting back.
Multiple deeper sections reveal one anagen hair and two telogen hairs. There are no vellus follicles.
In telogen effluvium there are many telogen hairs that fall out. There is also a lack of vellus hairs. With AGA there are many vellus hairs intermingled among the terminal hairs. You can see these in all areas of the scalp, especially in the frontal hairline. TE might be the proper diagnosis based on these findings in the biopsy.
I have noticed the diameter of my hair strands seems much thinner and less pigmented.
Vellus hairs are thin in diameter and lack pigmentation - and are short. Intermediate hairs have the same characteristics but are longer - several inches.

Differential diagnosis is often difficult - and impossible over the Internet. But even though getting the right diagnosis (label) might be psychologically comforting, what really counts is getting the right advice about getting your hair healthy again. At age 38 I'm sure you want to look good. Sparse hair won't win you any prize in this department. I wish I could suggest the scalp exercise program as a treatment option. The scalp exercise, though, doesn't do much for people with TE. Good diet is important as is keeping your stress level manageable.

I wish I knew what your diet is like as well as what kind of life you have. Something must be triggering your TE. One thing surprises me is the lack of perifollicular inflammation. There is often an inflammatory infiltrate in the follicles of people with TE.

Do you have any allergies - gluten, for example? I just read Wheat Belly by Dr. William Davis. Check out this video for some of his ideas. In his book he suggests that gluten sensitivity may cause hair problems similar to yours.

charie
Posts: 2
Joined: Tue Jan 07, 2014 4:18 pm

Re: biopsy

Post by charie »

Thank you so much for your reply. My lifestyle is extremely active....I teach bootcamp, do kickboxing, train for duathlons, etc.
I thought my diet was pretty good until watching the video you recommended! I eat mostly unprocessed foods, clean of sugar and white anything, for the most part. I had not eaten red meat for years (still got plenty of protein), but started adding some to try to raise my ferritin. I was also taking carbonyl iron, Proferrin, L-lysine and Vitamin C for about 9 months or so to get my ferritin up, expecting for the shedding to stop once it reached 40, and to see regrowth once it hit 70 (as per what I read on the internet). I was tested for Celiacs way back in the beginning, but I do understand Gluten Sensitivity is also a real thing, so that is a change I have been trying to make.

The thinner, lighter hairs I'm seeing are extremely long and almost seem less dense (more fly-away). My hair comes down to about mid-back, so the majority of the shedding hairs are long. Some actually seem thicker at the ends, which is scaring me! I'm thinking my ferritin level was probably very low for a long time before I realized it, so hoping that might be the reason?

I do seem to be experiencing quite a bit of stress, but it's hard for me to believe it could be strictly that. I am seeing an endocrinologist next week, do you know of any specific questions/tests I should be focusing on? Thanks in advance!!

Tom Hagerty
Site Admin
Posts: 628
Joined: Mon Dec 06, 2010 9:21 am

Re: biopsy

Post by Tom Hagerty »

I teach bootcamp, do kickboxing, train for duathlons, etc.
Find out what you body fat percentage is. There is a dramatic change in a woman's hormone balance when body fat drops below 18 percent. I know women who are in running clubs, who participate in marathons, who do rigorous training many times a week. These women have hair problems similar to yours. (These women are also ballroom dancers. I'm a ballroom dancer too.)

If you find out what your body fat percentage is, post it in this thread. If your body fat percentage is as low as 10 or 12 percent, this could very well have triggered the hair problems you describe.

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