what is CTE?

Chronic telogen effluvium (CTE) - the most common type of hair loss

CTE is hair loss which is evenly distributed (diffuse) across the scalp, as opposed to hair loss just at the top of the head. Often it is only the sufferer who notices that their hair is shedding more than it used to.

Women affected by this type of hair loss are usually between the ages of 18-50, and they generally show one of the following signs:

  • An increase in the number of hairs lost when shampooing, brushing or combing.
  • Less hair to clip or tie back than before.

Tests often show that women with CTE suffer from low iron stores in the body. The amount of iron stored by the body can be simply measured by your doctor. He/she will take a small blood sample from you and then have it analysed for its serum ferritin level.

However the more common measurement to be taken from a blood test is the haemoglobin level but this simply helps your doctor see if you are anaemic. Research has not established a link between haemoglobin levels and hair loss as it has with hair loss and serum ferritin values.

In fact it is not unusual to find you have a normal haemoglobin level with lowered storage iron (serum ferritin).

Low dietary iron intakes has been known for some time to be a potential problem for millions of women, but it is only now that it is becoming recognised as an important factor that can contribute to increased hair shedding, and that this condition is really quite common.

What causes low iron stores?

Low serum ferritin levels usually result from the loss of blood during menstruation, which is just enough to cause a gradual depletion of iron stores in the body. Additionally eating a diet containing little or no red meat is likely to give rise to a lower amount of available iron.

CTE linked to low body iron stores

Research has shown that if the iron deficiency is corrected and the serum ferritin level is raised to a certain "trigger point" then hair growth will resume. In fact, what actually happens is that the growing stage of the hair follicles is lengthened so, at any one time there are more hairs in the growing stage.

This means that hair volume will start to increase and any excessive shedding will reduce. However, this takes several months because ferritin levels can only be raised slowly. Also once the “trigger point” is reached and hair growth starts, it takes 2 – 3 months for the shedding to reduce and another 3 – 6 months for the new hair to reach a length that contributes outwardly to fuller hair.

Whilst iron is usually the key factor, other nutrients also play an essential role. This was highlighted by research which showed that a significant proportion of women who were given an iron supplement failed to respond, even when given a high dose with additional vitamin C (which is known to help iron absorption).

This problem was overcome when it was realised that intake of the amino acid L-lysine was very low in many people’s diets, particularly those who eat little or no meat.

When L-lysine was added to the other nutrients being given, most women went on to reach the target ferritin level, and their hair volume subsequently increased. When they stopped the hair shedding resumed several months later.

The answer to chronic telogen effluvium (CTE)

Hair loss caused by any nutritional shortfall of iron can take years to develop and so cannot be corrected overnight. In fact without a supplement it may be many years after the menopause before a woman’s iron stores return to the level of a man of the same age.

From starting a supplement regimen, the minimum time before a reduction in hair shedding is noticed is about 16 weeks. It may take considerably longer to see the benefit in terms of hair volume because of the time the hair takes to grow long enough to contribute to the overall hair volume. If you see no benefit in hair volume after 6-9 months then you should seek professional help as there are probably other reasons for your hair loss.

Eating a large portion of red meat every day would certainly raise iron levels but is not an option for most people. An iron supplement will achieve the same results but research has shown that to increase ferritin levels quickly, you will need a high strength iron supplement supplying 72mg of elemental iron a day, for up to 6 months. Thereafter at least 24mg of iron a day will be needed (or double this if you have heavy menstrual bleeding). For a significant number of women this level of iron intake will not have the desired effect unless they also take L-lysine plus vitamin C and vitamin B12 to aid the absorption of the iron. A supplement which has been developed to provide those nutrients at the specific levels is Florisene®.