TE and still shedding after 6 months

Telogen effluvium, alopecia areata, hair shaft disorders, etc.
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samantha303
Posts: 10
Joined: Sun Mar 30, 2014 8:43 am

TE and still shedding after 6 months

Post by samantha303 »

Thank you very much for registering me Tom.

I am a 22 year old female student who has been suffering hair loss problem for the past 6 months. I inherited my dad's hair which is extremely thick and wig-like.
I had my blood test done last month but my doctor didnt think i have any problem and refused to give me any treatment. I have no money for appointments with derms. I know it is normal that people pay 200 pound (im from the UK) for one appointment only to hear the word TE without being given any treatment.

I had really bad diet and worked 18 hrs a day without relaxing much from September till February. I never felt stressed tho to be honest until recently becos of my hair.
I had my first bout of hair shedding 1 month after i first came to the UK for university but it resolved itself very quickly.


My blood test came back normal in my doctor's opinion.

Free androgen index 1.4 (ref. 0 - 5.6)
Serum sex hormne binding glob 64nmol/L (ref. 20 -110)
Testosterone 0.9 nmol/L (0 - 1.8)
Calcium 2.38 mmol/L
Serum free T4 level 15.5 pmol/L (reference 9 - 24)
Serum TSH level 1.6 mu/L (ref. 0.2 -5)
Vitamin B12 502 ng/L (150 - 900)
Folate 13.1 ug/L (3 - 16)
Ferritin 22.2 ug/L (reference 7 - 90)
Vitamin D3 34nmol/L (Optimal Level >75 nmol/L)
HbA1c level - IFCC standardized 30 mmol/mol (Tight Glycaemic control <48 mmol/mol)


I spotted my low ferritin and Vitamin D level and started to take high strength iron and vitamin D tablets and changed my diet completely since last week.
Since December, I shed around 10 - 30 a day and around another 50 after shower. I wash my hair once every the other day.
I know it doesnt sound like a lot but my hairline and part line are still thinning imo. My scalp is showing on my hairline and my sides are suffering also.
I have short, thick and healthy hair sticking up all over my scalp but no where near to cover my thinning hair line.
I also shed a few intermediate hair also. I have no problem with my scalp, no itch/burning sensation whatsoever.

Yesterday I got so upset I almost called a private derm and booked an appointment. Now im really torn. I dont want my hair loss problem gets worse but on the other hand i really cant afford it. My doctor still refused to refer me to a derm.

I had almost all of the bad symptoms of anemia since December. I got so much better now after a week of taking high strength iron tablets

Now I am taking fish oil capsule 1x, vitamin E 1x, Vitamin C 1x, ferrous fumurate 1x (69 mg of elemental iron, prescribed by my doctor), l-lysine 1,000mg 1x, biotin 5000mcg, vitamin B complex 1x, vitamin D 20,000 IU 1x a day.

My diet:
Breakfast: milk and cereal with five dates, 1 spoon of blackstrap molasses, a handful of raisins and five walnuts.
Lunch and dinner: veggies with at least 100g of meat per meal. I also eat lots of fruits

My problem is,
1. Is it possible that my hair loss problem is TE/CTE due to diet and low iron?
2. Am I in a stage where my shedding is not severe or even considered normal but the regrowth is so slow that it can't keep up with my previous shedding?
In terms of diet, Im not vegetarian, I just hate my cooking and had no appetite before February. I also consider eating pig's liver once a week. My dad has problem of high cholesterol and doesnt recommend eating liver twice a week. And I also wonder whether it's ok to eat red meat every meal? Im considering eating red meat for lunch and white meat for dinner.
3. Do i have to see a derm at this stage? I really hope it's not AGA but i can't think of a reason why it would be. Apart from diet, I can't think of any other triggers. If it's better to see another doctor, should i go for a private family doctor or nutritionist as they are way cheaper.


Thank you so much for reading Tom! I really appreciate your input!
Tom Hagerty
Site Admin
Posts: 629
Joined: Mon Dec 06, 2010 9:21 am

Re: TE and still shedding after 6 months

Post by Tom Hagerty »

After reading your message, my opinion is that you don't need to see a dermatologist. You had many lab tests done and the results are mostly within the normal range except for vitamin D and serum ferritin. A dermatologist might want to do a small punch biopsy of your scalp to determine what kind of hair loss you have. It's a tough problem in the early stages of hair loss to make a deferential diagnosis. And you probably don't need this diagnosis anyway. And you certainly can use the 200 pounds in a more creative way - like a trip to Paris.
I had really bad diet and worked 18 hrs a day without relaxing much from September till February.


For many years I was around people who had your same life style - bad diet, long hours of work, and incredible levels of psychological stress. These people, almost without exception, had various kinds of hair problems. (All these people were men though.) Prolonged physical and psychological stress have a negative effect on the hair follicles. Hair follicles are small organs that are extremely sensitive to sustained stress of any kind. The growing stage of the hair cycle (anagen) can close down and transition into the resting stage (telogen). The result is thinning hair.


I spotted my low ferritin and Vitamin D level and started to take high strength iron and vitamin D tablets...
Vitamin D3, 2000 IU, is one of the few supplements I take, but I don't take any iron supplement. Perhaps the iron supplement you're taking is OK for the short term in order to bring up your serum ferritin number. You should not take an iron supplement for an extended period of time though. This might be dangerous for your general health. Do some research on this topic.

I read through the list of supplements you're taking. It probably makes you feel better psychologically that you are doing something for your condition - popping a few pills - but I doubt if all that pill popping is actually going to improve your hair. Eating real food, nutritious food, is much better for you than taking a dozen pills. I know that is hard to believe because we live in a pill culture - and if you actually do see a dermatologist, he's most likely will prescribe another couple of pills. That's what most doctors do because they know that their patients expect it. But after saying all this, I believe some vitamin pills actually are modestly effective if your diet is poor.
Breakfast: milk and cereal with five dates, 1 spoon of blackstrap molasses, a handful of raisins and five walnuts.
A good breakfast - a lot of nutrition - but after eating dates and raisins please brush your teeth and use dental floss right after you eat. The sugars from dates and raisins stick between your teeth and cause dramatic problems. I much rather see a woman with horrible hair than one with horrible teeth. Do some research on this teeth topic too.

To answer all your questions (1, 2, &3) in one paragraph: If you change into a healthy life style - good nutrition from real food, and that includes some red meat, a relatively stress-free day and night, and maybe even some exercise thrown in, your hair problem should take care of itself. Give it a sufficient time frame though - six months to a year to see results. Hair takes a while to deteriorate and it takes a while to bounce back.
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samantha303
Posts: 10
Joined: Sun Mar 30, 2014 8:43 am

Re: TE and still shedding after 6 months

Post by samantha303 »

Hello Tom,


Thank you so much for your help!

One follow-up question, I JUST remember that I have taken Accutane for two weeks back in August. I didn't have any side effects when taking Accutane apart from mild dryness on my lips. My hair didnt start to fall out until September or October when i started to mess up my diet.
I did some research and found out that Accutane-induced hair loss is mainly because of high testosterone. As my testosterone level is within normal range, I suppose I can rule this trigger out? Or should I get my other hormone tests done such as DHT level?

I had a very stressful 2013 and missed my period for a whole month once. From that on I started to get spots all over my face. I suppose that was when my hormone level was abnormal. I didnt have any hair loss problem back then tho. And I had no idea what my testosterone level was before the first bloodwork I have done in this February. I guess it could be possible that Accutane did mess up my hormone and my hormone is back to normal now.


I'm going to see a trichologist soon as it's way cheaper and the appointment will last for around 45 mins to 1 hour. I'm not going to use products like Rogaine tho and will stick with healthy diet.

Thank you so much!
Tom Hagerty
Site Admin
Posts: 629
Joined: Mon Dec 06, 2010 9:21 am

Re: TE and still shedding after 6 months

Post by Tom Hagerty »

I...found out that Accutane-induced hair loss is mainly because of high testosterone.
Accutane reduces sebaceous gland activity and that's why it's often helpful for people with severe acne. But this slowing down of cell growth in the sebaceous glands might also slow down cell growth in the hair follicles. The hair follicles and the sebaceous glands have basically the same cell types. So if your hair follicles are sensitive to the drug and the dose of the drug is strong enough, telogen effluvium may be the result. Of course there might be some other chemical process at work here too. Accutane is a complex drug with many side effects, some long term.

Accutane does reduce DHT local production. If testosterone is not being converted to DHT via the enzyme 5-alpha reductase, then there will be more circulating testosterone. But this is all too complicated for a non-chemist to have an opinion about. :D And, anyway, I'm sure that by now all the Accutane is out of your system.
samantha303
Posts: 10
Joined: Sun Mar 30, 2014 8:43 am

Re: TE and still shedding after 6 months

Post by samantha303 »

I have read some posts on Keratin.net and read that Accutane-induced TE can be very long lasting.
Although I have only taken this pills for two weeks and have not experienced hair loss during treatment, I still worry that I might be the one who is unlucky.


I still shed around 30 a day without a shower and plus another 40 - 60 with a shower. I see healthy regrowth of around an inch along my hairline after taking high-strength iron tablet for around 3 weeks. I do know that it can take up to 6 months to up my ferritin level so now I think it might not be a good idea to visit a trichologist.

After reading all the Accutane-induced hair loss related posts, I wonder if people can cure these type of TE with anything other than minox/rogaine?
Just in case I'm one of the suffers who happens to have low ferritin.
I also read that Accutane can cause biotin deficiency so I might be on the right route (started to take biotin 5mg a day 2 weeks ago).


Thank you!
Tom Hagerty
Site Admin
Posts: 629
Joined: Mon Dec 06, 2010 9:21 am

Re: TE and still shedding after 6 months

Post by Tom Hagerty »

I have read some posts on Keratin.net
Kevin McElwee on this website has given some of the best advice on all hair-related problems. I don't think he is associated with the site anymore though. If you ask a question on the forum it will probably not be responded to. The information on Accutane and its hair problem side effects is important to read through. This is a drug that you don't fool around with - even if a doctor might prescribe it. The negative effects can be long lasting. You've taken Accutane for only two weeks though.
I also read that Accutane can cause biotin deficiency
Perhaps it causes a biotin deficiency. But even if it does, taking mega doses of any one member of the B-complex can throw out of balance all of these water soluble vitamins. I get a nice mix of the entire B-complex from brewer's yeast (a real food) blended in juice. There are many posts on the Internet similar to this one though: "Be sure to take biotin. Accutane causes biotin deficiency. Biotin is very important for hair growth. Do not take any vitamin supplements that have Vitamin A. Accutane increases Vitamin A levels. Vitamin A toxicity causes hair loss. Limiting foods high in Vitamin A may also be helpful while you're on this medication." A complex topic.

If you have read through many of the posts on keratin.net, you have a lot of information about Accutane. I can add nothing to this. As you can see, occasionally it takes a long time for hair problems to resolve themselves. If you are doing everything right now, your hair should bounce back. But no one can give you a credible time frame for improvement. You just have to be patient and get on with your life as best as you can.
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