Chapter 2 61 androgens and genetics play a partial role as well. For FPHL patients presenting with other signs of hyperandrogenism such as hirsutism, severe acne, and oligo- or amenorrhea, blood tests for sex hormones are required to rule out underlying pathology such as polycystic ovary syndrome. Sudden exacerbation of FPHL in women also warrants surveys for hormones, especially with regard to androgen-producing tumors.80 Topical use of 2% minoxidil is the only approved medication in most of the countries. Off-label use of oral medications that possess anti- androgen effects is an alternative choice. Diffuse Hair Loss Telogen effluvium: Telogen effluvium manifests as sudden and abnormal shedding of telogen hairs, which persists for a few months. The condition is caused by increased proportion of telogen hairs from various etiologies followed by sequential hair shedding of 300 hairs daily on average.81,82 The hair shafts can be pulled out easily from the scalp. Shed hair all over the pillow, floor, and shower drain is the common complaint from the affected individual. Hair thinning diffuses over the whole scalp without predilection of involving areas (Figure 10). The hair shedding usually lasts for 3-6 months before the affected hair follicles enter the anagen stage again. Subsequent regrowth of hair is expected, provided the triggering event is removed, and treatment is not necessary once the Figure 10 Telogen effluvium related to the use of interferon