{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T05:35:22Z","timestamp":1777354522634,"version":"3.51.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Follicum AB"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To correlate individual fibre diameter (a proxy for follicular miniaturization) with anagen and telogen duration to determine whether TE precedes or follows AGA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Healthy men aged 18\u201355\u2005years with stage 3\u20135 vertex balding had serial tattoo-directed phototrichograms on days 1, 84 and 112. Individual hairs were tracked with computer-assisted hair-to-hair matching. Fibre diameter was measured. Anagen and telogen duration were mathematically calculated using the fraction of anagen and telogen hairs that remained in the same cycle phase between follow-up examinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was a linear correlation between fibre diameter and anagen duration. Thin fibres (60\u2005\u00b5m) had a shortened mean (SD) anagen duration of 200 (72) days. In balding scalps, thick anagen fibres (&amp;gt; 80\u2005\u00b5m) also had a shortened mean anagen duration of 580 (150) days. Telogen duration did not vary with fibre diameter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In men, a shortening of anagen duration precedes fibre diameter reduction. The clinical correlate of anagen shortening is TE, while reduction in fibre diameter correlates with follicle miniaturization and AGA. While visible TE occurs years in advance of visible balding in women with long hair, TE may go unnoticed in men with short hair. The observed sequence of events establishes that TE is a precursor to AGA. Failure to observe shedding does not negate a diagnosis of TE. We have developed a new model to describe the pathogenesis of balding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ced\/llaf361","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T11:37:13Z","timestamp":1753961833000},"page":"220-225","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1093","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0049-8377","authenticated-orcid":false,"given":"Leila","family":"Asfour","sequence":"first","affiliation":[{"name":"Sinclair Dermatology , Melbourne, VIC ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3528-3752","authenticated-orcid":false,"given":"Ulrike","family":"Blume-Peytavi","sequence":"additional","affiliation":[{"name":"Charit\u00e9 University Medicine , Berlin ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laita","family":"Bokhari","sequence":"additional","affiliation":[{"name":"Sinclair Dermatology , Melbourne, VIC ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1081-0547","authenticated-orcid":false,"given":"Michal","family":"Kasprzak","sequence":"additional","affiliation":[{"name":"TrichoLAB , Warsaw ,","place":["Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Seise","sequence":"additional","affiliation":[{"name":"SGS proderm GmbH , Schenefeld\/Hamburg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7907-2837","authenticated-orcid":false,"given":"Justyna","family":"Sicinska","sequence":"additional","affiliation":[{"name":"Department of Dermatology, CSK MSWiA\/CMKP , Warsaw ,","place":["Poland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6751-1428","authenticated-orcid":false,"given":"Rodney D","family":"Sinclair","sequence":"additional","affiliation":[{"name":"Sinclair Dermatology , Melbourne, VIC ,","place":["Australia"]},{"name":"University of Melbourne , Melbourne, VIC ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"2026012711323811500_llaf361-B1","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1001\/archderm.1961.01580080005001","article-title":"Pathologic dynamics of human hair loss: I. Telogen effuvium","volume":"83","author":"Kligman","year":"1961","journal-title":"Arch Dermatol"},{"key":"2026012711323811500_llaf361-B2","doi-asserted-by":"crossref","first-page":"150","DOI":"10.2340\/0001555573150153","article-title":"Comparative evaluation of scalp hair by phototrichogram and unit area trichogram analysis within the same subjects","volume":"73","author":"Rushton","year":"1993","journal-title":"Acta Derm Venereol"},{"key":"2026012711323811500_llaf361-B3","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1111\/bjd.13873","article-title":"Hair shedding in women: how much is too much?","volume":"173","author":"Sinclair","year":"2015","journal-title":"Br J Dermatol"},{"key":"2026012711323811500_llaf361-B4","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s13555-017-0171-8","article-title":"The hair shedding visual scale: a quick tool to assess hair loss in women","volume":"7","author":"Mart\u00ednez-Velasco","year":"2017","journal-title":"Dermatol Ther (Heidelb)"},{"key":"2026012711323811500_llaf361-B5","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1046\/j.1523-1747.1999.00797.x","article-title":"Differences in hair follicle dermal papilla volume are due to extracellular matrix volume and cell number: implications for the control of hair follicle size and androgen responses","volume":"113","author":"Elliott","year":"1999","journal-title":"J Invest Dermatol"},{"key":"2026012711323811500_llaf361-B6","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0190-9622(03)00045-8","article-title":"The reliability of horizontally sectioned scalp biopsies in the diagnosis of chronic diffuse telogen hair loss in women","volume":"51","author":"Sinclair","year":"2004","journal-title":"J Am Acad Dermatol"},{"key":"2026012711323811500_llaf361-B7","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/S0190-9622(96)90113-9","article-title":"Chronic telogen effluvium: increased scalp hair shedding in middle-aged women","volume":"35","author":"Whiting","year":"1996","journal-title":"J Am Acad Dermatol"},{"key":"2026012711323811500_llaf361-B8","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1440-0960.2010.00654.x","article-title":"Chronic telogen effluvium is due to a reduction in the variance of anagen duration","volume":"51","author":"Gilmore","year":"2010","journal-title":"Australas J Dermatol"},{"key":"2026012711323811500_llaf361-B9","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/j.0909-752X.2006.00202.x","article-title":"Female patients complaining about hair loss: documentation of defective scalp hair dynamics with contrast-enhanced phototrichogram","volume":"12","author":"Van Neste","year":"2006","journal-title":"Skin Res Technol"},{"key":"2026012711323811500_llaf361-B10","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1111\/j.1365-2133.2006.07409.x","article-title":"Follicular miniaturization in female pattern hair loss: clinicopathological correlations","volume":"155","author":"Messenger","year":"2006","journal-title":"Br J Dermatol"},{"key":"2026012711323811500_llaf361-B11","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1684\/ejd.2014.2428","article-title":"Why care about linear hair growth rates (LHGR)? A study using in vivo imaging and computer assisted image analysis after manual processing (CAIAMP) in unaffected male controls and men with male pattern hair loss (MPHL)","volume":"24","author":"Van Neste","year":"2014","journal-title":"Eur J Dermatol"},{"key":"2026012711323811500_llaf361-B12","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1159\/000497193","article-title":"Follicular map: a novel approach to quantitative trichoscopy","volume":"5","author":"Kasprzak","year":"2019","journal-title":"Skin Appendage Disord"},{"key":"2026012711323811500_llaf361-B13","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1159\/000093051","article-title":"Natural scalp hair regression in preclinical stages of male androgenetic alopecia and its reversal by finasteride","volume":"19","author":"Van Neste","year":"2006","journal-title":"Skin Pharmacol Physiol"},{"key":"2026012711323811500_llaf361-B14","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1001\/archderm.1993.01680240096017","article-title":"Telogen effluvium: new concepts and review","volume":"129","author":"Headington","year":"1993","journal-title":"Arch Dermatol"},{"key":"2026012711323811500_llaf361-B15","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/j.1365-2133.1995.tb08630.x","article-title":"Ageing and hair cycles","volume":"132","author":"Courtois","year":"1995","journal-title":"Br J Dermatol"},{"key":"2026012711323811500_llaf361-B16","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1159\/000524345","article-title":"Efficiency of hair detection in hair-to-hair matched trichoscopy","volume":"8","author":"Bokhari","year":"2022","journal-title":"Skin Appendage Disord"},{"key":"2026012711323811500_llaf361-B17","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/ajd.12964","article-title":"The trichoscopy derived Sinclair scale: enhancing visual assessment through quantitative trichoscopy","volume":"60","author":"Kasprzak","year":"2019","journal-title":"Australas J Dermatol"},{"key":"2026012711323811500_llaf361-B18","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1111\/j.1365-2133.2003.05565.x","article-title":"Androgenetic alopecia in men aged 40\u201369\u2005years: prevalence and risk factors","volume":"149","author":"Severi","year":"2003","journal-title":"Br J Dermatol"},{"key":"2026012711323811500_llaf361-B19","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1046\/j.0007-0963.2003.05809.x","article-title":"Women who present with female pattern hair loss tend to underestimate the severity of their hair loss","volume":"150","author":"Biondo","year":"2004","journal-title":"Br J Dermatol"},{"key":"2026012711323811500_llaf361-B20","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1038\/jid.1958.121","article-title":"Geometric relationships between the matrix of the hair bulb and its dermal papilla in normal and alopecic scalp","volume":"31","author":"Van Scott","year":"1958","journal-title":"J Invest Dermatol"},{"key":"2026012711323811500_llaf361-B21","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.stem.2021.09.009","article-title":"Hair shaft miniaturization causes stem cell depletion through mechanosensory signals mediated by a Piezo1-calcium-TNF-\u03b1 axis","volume":"29","author":"Xie","year":"2022","journal-title":"Cell Stem Cell"},{"key":"2026012711323811500_llaf361-B22","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1111\/exd.12945","article-title":"Hair regrowth in male and female pattern hair loss does not involve conversion of vellus to terminal hair","volume":"25","author":"Rushton","year":"2016","journal-title":"Exp Dermatol"},{"key":"2026012711323811500_llaf361-B23","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/srt.12827","article-title":"Placebo-controlled dose-effect studies with topical minoxidil 2% or 5% in male-patterned hair loss treated with oral finasteride employing an analytical and exhaustive study protocol","volume":"26","author":"Van Neste","year":"2020","journal-title":"Skin Res Technol"},{"key":"2026012711323811500_llaf361-B24","doi-asserted-by":"crossref","first-page":"1362","DOI":"10.1093\/ced\/llaf012","article-title":"Sublingual minoxidil increases fibre diameter in male androgenetic alopecia: a proxy for reversal of hair follicle miniaturization","volume":"50","author":"Sinclair","year":"2025","journal-title":"Clin Exp Dermatol"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ced\/advance-article-pdf\/doi\/10.1093\/ced\/llaf361\/63906392\/llaf361.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/51\/2\/220\/63906392\/llaf361.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/51\/2\/220\/63906392\/llaf361.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T16:32:45Z","timestamp":1769531565000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/article\/51\/2\/220\/8220667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":24,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,8,1]]},"published-print":{"date-parts":[[2026,1,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ced\/llaf361","relation":{},"ISSN":["0307-6938","1365-2230"],"issn-type":[{"value":"0307-6938","type":"print"},{"value":"1365-2230","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2]]},"published":{"date-parts":[[2025,8,1]]}}}