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Elevated Donor Telogen Ratio

This is a graft from a donor area taken recently. The patient relayed a story that a month after beginning Propecia he noted shedding in his donor area. He stated that each morning when he awoke, he began seeing 12 or more hairs on his pillow. He also stated that he began seeing more hair come out when he ran his hands through the back of his scalp. He clearly stated that the shed hairs were from his donor area.

Examination of the grafts revealed a 17% telogen ratio. This is high for a donor area, but not beyond the normal limits. According to Kligman, one can have up to 25% telogen hairs on the scalp.

The history was very suggestive of an increased telogen ratio and this is what we found. Typically there is no more than 8 to 12% telogen hairs. Propecia stimulates anagen. When a new anagen cycle begins, the old resting hair is pushed out of the scalp and onto the pillow. The shift to anagen suddenly by propecia was evidenced by increased shedding.

This patient averaged 2.88 hairs per graft. This means he averaged 2.39 anagen hairs per graft. This compares to 2.0 hairs per graft from strip surgery.

Strip surgery might have lost these exogen telogen hairs because there is no evidence when dissecting them. This is clearly an advantage of the Cole FIT process.

Incidentally, each hair has only so many hair cycles. This is why you want to load up on anagen stimulators designed to prolong or promote anagen. These include Propecia, Avodart, Minoxidil, Nizoral, and Hair Cycle Shampoo. Multiple products used concurrently probably work better than one product at a time.

The grafts depicted here show an large percentage of telogen or resting hair. Some hairs are also in catagen.

Dr. Cole:

This is very interesting. On a related, but different subject, do you believe in the so-called “loose anagen” syndrome?

» Dr. Cole:
» This is very interesting. On a related, but different subject, do you
» believe in the so-called “loose anagen” syndrome?

What does loose anagen mean? Also how can I tell from the pic that a large percentage of telogen or resting hair exists like Dr. Cole said? Thanks.

Loose Anagen is thought to be where hairs in the anagen (growth) phase are not very securely attached and easily come out when showering, combing, etc.

I would think that there is no way to tell if you have a lot of hairs in telogen unless you were to look at a cross section of your scalp under a microscope.

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