Alopecia: recognise which form is yours before you look for a treatment

Summary

Alopecia simply means hair falling out faster than the scalp can replace it. That is the whole definition. Behind that single word sit a dozen or so quite distinct medical situations, with different causes, different outlooks and different treatments. A crop of round bald patches appearing over a fortnight and a temple line creeping slowly backwards over fifteen years carry the same label, and almost nothing else in common.

Which is why treatment picked at random so often disappoints. The useful question is not what to take, it is which alopecia you actually have. This page is the starting point: each form gets a short description, the signs that identify it, and a link to its own article. If you are not yet sure whether any of this applies to you, the first signs of baldness give you a few things you can check at home.

Normal shedding or alopecia: where the line falls

Losing hair every day is exactly what a healthy scalp does. Each follicle, the small pocket in the skin that manufactures one hair, works on its own schedule. That schedule runs through a growth phase (anagen) lasting two to five years, a very brief transition phase (catagen) of two to three weeks, then a resting phase (telogen) of two to four months at the end of which the hair drops out. A new one starts up in the same follicle.

Infographic titled the hair cycle takes place in three phases, showing anagen phase with hair growth over a 2 to 5 years phase, catagen phase with stop of hair growth over a 2 to 3 weeks phase, telogen phase with hair loss over a 2 to 4 months phase, then a new anagen phase

Because those schedules are staggered, 50 to 100 hairs a day reach the end of the line and let go. That is the normal figure, and it drifts with the seasons and with age.

Alopecia begins when the balance stays negative, when regrowth no longer keeps pace with shedding. Three clues matter far more than counting what you find on the pillow: a centre parting getting wider, a hairline sitting higher than it did, scalp showing through under a bright overhead light. And a photograph taken a year ago is still the best comparison tool you own.

The distinction that governs everything: scarring or not

Before sorting by cause, dermatologists sort by the state of the follicle. This is the single most important division in the whole subject.

Infographic titled scalp structure, an illustrated cross-section labelling the epidermis, dermis and subcutaneous layer around a hair follicle, along with the hair shaft, the sebaceous gland, the hair bulb and the blood vessels that feed it

In non-scarring alopecia the follicle is still alive. It may be producing a thinner, shorter hair, or it may have gone quiet, but the structure survives. Regrowth remains possible, on its own or with treatment, and a transplant stays on the table once the loss has stabilised. The large majority of cases sit here.

In scarring alopecia the follicle has been destroyed and replaced by fibrous tissue, a scar you cannot see. Nothing will bring it back: on the affected patch the loss is permanent. The only remaining goal is to stop the inflammation before it claims more ground.

That border is not always obvious to the naked eye, and some conditions start out non-scarring and then cross over. A close look at the scalp with a dermatoscope, sometimes a small biopsy, settles it. This is where serious care really begins, before any conversation about alopecia treatment.

The non-scarring alopecias

Androgenetic alopecia in men

This is the most common form by a wide margin: roughly four men in five show some degree of balding before the age of 70. The mechanism is well mapped. Under the influence of DHT, a hormone derived from testosterone, genetically sensitive follicles shorten their cycles. The hair grows back finer and shorter each time round, until it is little more than invisible down. That process is called miniaturisation.

Dark-haired man facing a mirror, lifting the hair off his forehead to reveal a clearly receded temple

It is easy to identify. The retreat starts at the temples and the crown, while the band running from the nape round to the ears stays untouched. That spared band lacks receptors sensitive to DHT and hair loss, and that is precisely what makes a transplant possible.

Progression is read off a seven-stage scale, the Norwood-Hamilton scale, which gives patient and surgeon a shared vocabulary. The full account of diagnosis and options sits on the page devoted to androgenetic alopecia.

Androgenetic alopecia in women

Same hormonal mechanism, completely different pattern. In women the frontal hairline is usually preserved and the loss concentrates on top of the head: the centre parting widens, the ponytail feels thinner in the hand, the scalp starts to show through. Close to 40 per cent of women at 50 have signs of this kind.

Blonde young woman lifting her hair back: her centre parting has widened and the scalp shows through on top of the head

The trigger is rarely a single thing. Childbirth, coming off the pill, a thyroid disorder or low iron can bring out a predisposition that had been sitting quietly. Hence the value of blood work before any treatment, since a correctable cause changes the whole outlook.

Infographic labelled hair loss alopecia, comparing a female cycle and a male cycle in five numbered stages each: on the left the woman's parting widens and the top of the head thins while the frontal line stays, on the right the man recedes from the temples through to complete baldness

Progression is graded on the Ludwig scale, in three stages. The page on androgenetic alopecia in women covers the treatments that suit them, which are not the ones used in men.

Postmenopausal alopecia

After the menopause, oestrogen production collapses while androgen levels hold steady. The hormonal balance shifts, and hair that had been protected until then becomes sensitive to DHT. The loss is diffuse and gradual, and usually comes with a drop in hair diameter: the hair looks flat and volumeless before it looks sparse.

Medical assessment form with the word menopause handwritten on it by a doctor, lying next to a prescription and some capsules

It sometimes begins in perimenopause, several years before periods stop. Many women put it down to ordinary ageing and wait far too long. The details on postmenopausal alopecia and how it is managed are gathered on its own page.

Telogen effluvium

Nothing genetic here. A shock tips a large share of follicles into the resting phase at once, and they release their hairs together. The trigger might be a high fever, surgery, childbirth, rapid weight loss, a medicine, a serious infection.

Two open hands covered in long strands of hair shed all at once

The giveaway is the delay: the shedding arrives two to three months after the event, once you have stopped connecting the two. It is heavy, diffuse, alarming in the shower. The reassuring part is that the follicles themselves are undamaged. Once the cause is dealt with, regrowth usually starts within six months. See the page on telogen effluvium.

Alopecia areata

Alopecia areata is an autoimmune condition: the immune system turns on follicles it has suddenly decided are foreign. It shows up as clean-edged patches of smooth skin, round or oval, appearing over a few weeks on a scalp that is otherwise healthy. It can hit the beard or the eyebrows too.

Three-quarter view of a dark-haired man's head, dotted with several round patches of smooth skin where no hair grows any more

One point admits no exception: alopecia areata is never treated with a transplant. Implanted grafts would be attacked exactly as the original hair was, and the surgery would have achieved nothing. Care is medical and dermatological, and it has moved on considerably with the arrival of JAK inhibitors for alopecia. Spontaneous regrowth also happens, sometimes after many months. Everything is set out on the alopecia areata page.

Localised patchy loss

When hair goes from one clearly bounded area of the head while everything around it carries on as normal, that is described as patchy loss. The term describes an appearance, not a cause: early alopecia areata, a scalp infection, an old scar or repeated mechanical pressure can all produce it.

Back of a dark-haired man's head with thick hair, a finger pointing to a single round hairless patch near the crown

So it is a reason to book an appointment, not a diagnosis. The outlook depends entirely on what turns up, and two patches of identical size can end very differently depending on whether the follicle is alive. Itching or flaking already point the dermatologist somewhere. See the page on patchy hair loss for the leads worth following.

Traction alopecia

This one is inflicted, which is what sets it apart. Hairstyles that pull constantly on the roots eventually tear follicles out: tight braids, extensions, very taut ponytails, weaves. The loss follows the line of tension, so temples and the edge of the forehead go first.

One warning comes before anything is visible: soreness or tenderness of the scalp after styling. Caught early it is reversible, and all it takes is easing off the tension. Caught late it turns scarring, and then it is settled for good. That switch over time is the whole issue, and it explains why the advice is about changing a habit rather than buying a product. See the page on traction alopecia.

Trichotillomania

Trichotillomania is a behavioural disorder: the person pulls their own hair out repeatedly, often without being fully aware of it, to release inner tension. The affected areas look ragged, with hairs snapped off at various lengths, which tells them apart from the smooth patches of alopecia areata.

The answer is not surgical. It is psychological, built around behavioural therapy and sometimes broader support. A transplant performed before the pulling has stopped would be doomed. The trichotillomania page explains the route to take.

The scarring alopecias

Scars, burns and inflammatory conditions

Here the follicle has been destroyed and replaced by fibrous tissue. The area turns smooth and slightly shiny, without a single visible hair opening, and that detail is what the dermatologist hunts for with the dermatoscope. Secondary causes are mechanical: a burn, a deep wound, radiotherapy. Primary causes are inflammatory, lichen planopilaris or cutaneous lupus for instance, with the inflammation aimed straight at the follicle.

Closely shaved scalp crossed by a band of pale smooth skin, with no hair openings at all, where hair no longer grows back

The point of treatment is never regrowth, which is off the table. It is to put out the inflammation so the patch stops advancing. Once the condition has been quiet for long enough, a transplant can add density to the scarred surface, provided the skin still carries enough blood supply to feed grafts. That judgement is a delicate one and is made case by case. See the page on scarring alopecia.

Frontal fibrosing alopecia

This is a particular scarring form, clearly on the rise, and it mainly affects women after the menopause. The frontal hairline retreats as an even band, symmetrically, and the eyebrows often thin before the forehead changes at all. That early eyebrow sign is the most useful way of catching it in time.

A quick diagnosis counts for a great deal, because every millimetre lost is lost for good. The page on frontal fibrosing alopecia describes the treatments that slow the advance.

What works, and for which alopecia

No treatment suits every form. That is the entire reason for sorting them out first.

Box of finasteride 1 mg film-coated tablets, one of the medicines prescribed for androgenetic hair loss

Topical minoxidil stretches out the growth phase and thickens miniaturised hair. It works on androgenetic alopecia and on some effluviums, without touching the cause. Give it several months before judging, and stopping gives back whatever ground you gained.

Finasteride blocks the enzyme that converts testosterone into DHT. It slows progression in men and often holds the situation steady, but it carries side effects that have to be explained and monitored by a doctor. The prescription is a discussion, not a formality.

A hair transplant answers a problem no medicine can solve: rebuilding density where follicles have gone. The principle is to move follicles from the donor band, which DHT does not reach, into the thinned areas, where they keep that immunity. That is what makes it the most durable treatment for androgenetic alopecia, with graft survival documented at more than ten years. It calls for stabilised loss and a donor area with enough to give, which means an exact diagnosis first: the complete hair transplant guide sets out the conditions.

Top of a patient's head at the end of surgery: the whole thinned frontal area is covered with freshly implanted grafts, being dabbed by a gloved nurse

Finally, a handful of cases respond to none of these levers: alopecia areata, active trichotillomania, or a scarring alopecia that is still inflamed. Sending those towards surgery would be a mistake.

Where to start

An accurate diagnosis beats a quick treatment. Photograph your scalp in the same light every two months, write down what changed in your life in the six months before the shedding started, get iron and thyroid levels checked. Then have your scalp examined properly, by a dermatologist or by a team that deals with this every day.

In the operating room, Dr Cinik and two masked nurses lean over a patient to examine his frontal hairline under the surgical lamp

If the workup points to stabilised androgenetic alopecia, the next step is an assessment of your donor area. That is what we do before proposing any hair transplant Turkey procedure, working from photographs and your own history. And if your case is not a surgical one, we will tell you so.

Sources

Workman, K., & Piliang, M. (2023). Approach to the patient with hair loss. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2023.05.040

Pinedo-Moraleda, F., Tristán-Martín, B., & Dradi, G. G. (2023). Alopecias: practical tips for the management of biopsies and main diagnostic clues for general pathologists and dermatopathologists. Journal of Clinical Medicine. https://doi.org/10.3390/jcm12155004

Guo, R.-X., Zhao, Y.-K., Hu, K.-J., Jia, K.-M., Shi, W., & Yi, Y.-X. (2025). Research progress in the treatment of non-scarring alopecia: mechanism and treatment. Frontiers in Pharmacology. https://doi.org/10.3389/fphar.2025.1544068

Singh, R., Kumar, P., Kumar, D., Aggarwal, N., Chopra, H., & Kumar, V. (2024). Alopecia areata: review of epidemiology, pathophysiology, current treatments and nanoparticulate delivery system. Therapeutic Delivery. https://doi.org/10.4155/tde-2023-0071

Pathomvanich, D., & Mella, C. A. (2023). A ten-year retrospective analysis on the long-term survival of hair transplants. Hair Transplant Forum International. https://doi.org/10.33589/33.5.157