Biopsy to Diagnose Telogen Effluvium or MPB?

Hi Dr. Rassman,
I really need your help. I am a 23 year old male who in the past several months noticed hair shedding. It’s all I can focus on now. Just recently I noticed the left part of my hair line is now thinner then the right side when seen under bright light. I would like to find out if there is a way to diagnose whether or not this is permanent or temporary hair loss. I’ve been to 3 dermatologists all who have done nothing but suggest Propecia. I would almost consider flying out for you to take a look. My question is, is there a definite way for you to say whether its permanent or temporary hair loss?

The shed hairs all appear to be very healthy with a white dot on the end. Is there a way to confirm if this is from telogen effluvium or MPB? What is the best method to diagnose TE or AGA? My dermatologist is recommending a scalp biopsy but I would prefer a miniaturization test since its less invasive. Is one test better then the other?

If three doctors have diagnosed with you with MPB (hence the Propecia suggestions they gave you), I highly doubt I would have any thing more to add.

Statistically, a 23 year old male experiencing frontal hair loss would indicate male pattern baldness (MPB). A scalp biopsy will not tell you anything you do not already know… and in fact, it will leave a scar. We do not perform scalp biopsies for diagnosing standard hair loss. Telogen effluvium (TE) does no occur in patterns or localize only to the front, which male pattern baldness does. TE is diffuse and happens all over the scalp.

Also note that if you do have MPB, Propecia may help slow the progression of the loss, but it is not a cure and it does not work as well at the front of the scalp. As you indicated you are in NY, I’d suggest seeing Dr. Bernstein in Manhattan… or you’re welcome to setup a consultation and fly out to my office in Los Angeles. Unless your loss is more than what you described though, it seems like you’ve got early genetic hair loss and should probably follow one of the three doctors that advised you to start Propecia.