You cannot go bald without first losing your hair: telogen effluvium is a precursor to, prerequisite for and potentially an incitant to common baldness in men

Abstract

Background Telogen effluvium (TE) is defined by an increased ratio of hairs in telogen to hairs in anagen. Diagnosis is not contingent on a self-reported quantum of telogen shedding. Androgenetic alopecia (AGA) is diagnosed histologically by follicular miniaturization. TE and AGA can both produce balding; however, their relative contributions and the sequence of these events are unknown. Objectives To correlate individual fibre diameter (a proxy for follicular miniaturization) with anagen and telogen duration to determine whether TE precedes or follows AGA. Methods Healthy men aged 18–55 years with stage 3–5 vertex balding had serial tattoo-directed phototrichograms on days 1, 84 and 112. In..