Hair loss

Understanding hair loss — types and facts

Hair loss (alopecia) is extremely common and one of the most searched health concerns online — especially among men worried about receding hairlines and women noticing widening partings. Most hair loss is not a sign of serious disease, but the pattern and speed of loss help determine cause and treatment.

Normal hair cycling: each follicle grows for years (anagen), rests (telogen), then sheds — 50 to 100 hairs daily is normal. Loss becomes visible when shedding exceeds regrowth or follicles miniaturise.

Male pattern baldness (androgenetic alopecia)

The most common cause of hair loss in men — affects roughly 30% of men under 30 and about half by age 50.

Cause: Genetic sensitivity of scalp follicles to dihydrotestosterone (DHT), derived from testosterone. DHT shrinks follicles over time — hairs become finer and shorter until follicles stop producing visible hair.

Pattern:

• receding temples and hairline
• thinning at the crown (vertex)
• may progress to join — Hippocratic wreath pattern leaving hair at sides and back

Key facts:

• Not caused by poor circulation, clogged pores, or shampoo frequency
• Inherited — look at family history on both sides
• Not harmful to physical health — but affects confidence and mental wellbeing
• Progressive — rate varies person to person

Treatments — see our hair loss treatments guide: finasteride, minoxidil, hair transplant (private). No NHS cure — management slows progression.

Female pattern hair loss

Affects many women — especially after menopause when oestrogen declines and relative androgen effect increases. Also seen in PCOS (higher androgens).

Pattern:

• widening parting at top of scalp
• diffuse thinning over crown — preserves frontal hairline (unlike men)
• rarely progresses to complete baldness

Other causes more common in women:

• telogen effluvium (see below)
• iron deficiency — especially with heavy periods
• thyroid disease
• tight hairstyles — traction alopecia

See a GP to exclude treatable causes before assuming pattern loss alone.

Telogen effluvium — stress and shedding

Widespread shedding — often 2 to 3 months after a trigger:

• severe illness, surgery, high fever (including COVID)
• significant emotional stress
• childbirth (postpartum telogen effluvium)
• crash dieting or rapid weight loss
• stopping oral contraceptive pill
• some medicines

What happens: More follicles enter telogen (rest) phase simultaneously — then shed together. Can feel alarming — handfuls in the brush or shower.

Prognosis: Usually self-limiting — regrowth over 6 to 12 months once trigger resolves. Does not cause permanent baldness unless another condition coexists.

What to do: Identify and address trigger if possible; gentle hair care; reassurance. See GP if shedding persists beyond a year or scalp is inflamed.

Alopecia areata — patchy autoimmune loss

Immune system attacks hair follicles — smooth, round bald patches, sometimes several. Can affect beard, eyebrows, eyelashes. Nail pitting may occur.

Course unpredictable:

• may regrow spontaneously within months
• may spread — alopecia totalis (whole scalp) or universalis (whole body) — rare
• may recur in cycles

Not contagious. Associated with other autoimmune conditions (thyroid disease, vitiligo) — slightly higher risk.

Treatments:

• wait and watch for small patches — many regrow
• steroid injections into patches (dermatology)
• topical steroids
• contact immunotherapy (DPCP) for extensive loss — specialist centres
• JAK inhibitors (e.g. baricitinib) — newer licensed options for severe cases — specialist only

Wigs and psychological support matter — sudden visible loss affects quality of life significantly.

Other important causes

Iron deficiency anaemia

Low ferritin (iron stores) linked to shedding — especially women with heavy periods. GP blood tests check ferritin, full blood count, thyroid.

Thyroid disorders

Both underactive and overactive thyroid cause diffuse thinning — treatable when thyroid corrected.

Medicines

Chemotherapy causes predictable temporary loss. Other medicines occasionally linked — anticoagulants, some antihypertensives, retinoids, mood stabilisers. Do not stop prescribed medicines without medical advice.

Scalp conditions

Ringworm (tinea capitis) — patchy loss with scaling, more common in children — needs antifungals.

Scarring (cicatricial) alopecia — inflammation destroys follicles permanently. Redness, scaling, pain, or smooth shiny patches without visible pores — urgent dermatology referral.

Traction alopecia

Tight braids, ponytails, extensions, religious headwear friction — loss at hairline. Early stopping allows regrowth; long-term traction causes scarring.

Trichotillomania

Compulsive hair pulling — irregular broken hairs, often psychological component. CBT and habit reversal help.

Diagnosis — what a GP does

1. History — pattern, speed, triggers, family history, medicines, diet, periods, stress
2. Scalp examination — patches vs diffuse, scaling, inflammation, scarring
3. Pull test — gentle traction; many hairs coming out suggests active telogen effluvium
4. Blood tests if indicated — ferritin, thyroid function, androgens (if PCOS suspected)
5. Referral to dermatology for unclear diagnosis, scarring, or alopecia areata needing specialist treatment

Hair does not need to be washed before appointment — contrary to popular myth.

Treatments for pattern baldness

Minoxidil (Regaine)

Topical — 2% or 5% solution or foam applied to scalp once or twice daily.

Works for: men and women with pattern loss.

Mechanism: Widens small vessels, extends anagen phase — exact mechanism not fully understood.

Timeline: 4 to 6 months minimum before visible improvement. Initial shedding in first weeks is common — old hairs pushed out as new growth starts.

Side effects: Scalp irritation, unwanted facial hair if drips onto face. Stop if pregnant — not for use in pregnancy.

Availability: Over the counter and pharmacy. NHS prescribing possible in some areas.

Important: Benefits reverse within months of stopping — treatment is ongoing.

Finasteride (Propecia)

Oral — 1mg daily for men only.

Mechanism: Blocks 5-alpha reductase, reducing DHT by ~60%. Slows loss and regrows hair in ~90% of men (stops worsening) with visible regrowth in ~65% over 2 years in trials.

Side effects (uncommon):

• reduced libido, erectile dysfunction — usually reversible on stopping
• depression reported rarely
• must not be handled by pregnant women — crushed tablets risk to male foetus

Availability: Private prescription common; NHS GP may prescribe off-label in some cases. Not for women.

Higher dose finasteride (5mg — Proscar) treats enlarged prostate — do not split tablets for hair loss without medical guidance.

Dutasteride

Blocks both type 1 and 2 5-alpha reductase — stronger DHT suppression. Used off-label for hair loss — not first-line on NHS. Similar side effect profile to finasteride.

Hair transplant (FUE/FUT)

Private procedure — follicles from permanent zone (back/sides) moved to thinning areas. Costs thousands of pounds. Results depend on surgeon skill and ongoing medical therapy to protect remaining native hair. Not available on NHS for cosmetic reasons.

Low-level laser therapy, PRP, microneedling

Mixed evidence — some small studies show modest benefit. Not standard NHS treatments. Expensive private options.

Wigs and camouflage

NHS wig provision on prescription for alopecia areata and some medical hair loss — synthetic or partial human hair depending on criteria. Real hair wigs may have patient contribution.

Cosmetic fibres, scalp micropigmentation — cosmetic options without medical treatment.

What does not work (evidence)

• Regular shampoo brand changes — does not cause or cure baldness
• Scalp massage alone — pleasant but no proven regrowth
• Biotin megadoses — unless deficient
• Caffeine shampoos — minimal evidence vs minoxidil
• “Block DHT” herbal supplements — unregulated, unproven
• Shaving head to thicken hair — cut hair feels coarser at the tip but does not change follicle

Hair loss and mental health

Visible hair loss affects self-esteem, social confidence, and body image — for men and women. Alopecia areata in particular causes significant distress.

Support:

• Alopecia UK — peer support and information
• GP can refer for counselling if anxiety or depression develop
• realistic expectations about treatments — improvement, not perfection

Children and hair loss

Not normal for children to have significant thinning. Causes include:

• tinea capitis — needs antifungal treatment
• alopecia areata
• trichotillomania
• telogen effluvium after illness

Always see a GP for childhood hair loss.

Practical summary

Pattern	Likely cause	Action
Gradual receding/thinning crown (men)	Male pattern	Minoxidil, finasteride, or accept; GP to discuss
Widening part, top thinning (women)	Female pattern or telogen	GP — check ferritin, thyroid
Round smooth patches	Alopecia areata	GP — may need dermatology
Diffuse shedding after illness/stress	Telogen effluvium	Usually wait; treat trigger
Patches with scaling in child	Ringworm	GP — antifungals
Painful/red/scarring scalp	Scarring alopecia	Urgent dermatology

Hair loss is common, often treatable, and rarely dangerous — but the right diagnosis matters because treatment depends entirely on cause. A GP visit for proper assessment is worthwhile before spending on unproven products.

Common questions

Why is my hair falling out?

Common causes include male or female pattern baldness (gradual thinning), telogen effluvium (shedding after stress, illness, surgery, or childbirth), alopecia areata (immune patches), thyroid disorders, iron deficiency, and some medicines. Less common — scalp infections, scarring alopecia, and traction from tight hairstyles.

Can hair loss be reversed?

Pattern baldness can be slowed and partially reversed with treatment (finasteride, minoxidil) — but not cured. Telogen effluvium usually resolves when the trigger passes — regrowth in 6 to 12 months. Alopecia areata may regrow on its own or with steroids/immunotherapy. Scarring alopecia causes permanent loss if not treated early.

Does stress cause hair loss?

Yes — significant physical or emotional stress can trigger telogen effluvium, pushing more hairs into the shedding phase 2 to 3 months later. Stress does not cause male pattern baldness directly but may unmask it or worsen shedding. Chronic stress affects overall health including hair.

Is finasteride safe for hair loss?

Finasteride 1mg daily is licensed for male pattern baldness. It blocks DHT, slowing loss and promoting regrowth in many men. Side effects are uncommon but can include reduced libido and erectile difficulties — usually reversible on stopping. Not for women who could become pregnant (risk to male foetus). Available on private prescription; NHS prescribing varies.

Does minoxidil work for women?

Yes — minoxidil 2% or 5% solution/foam is used for female pattern hair loss as well as male. Apply to scalp daily; initial increased shedding can occur before improvement. Results take 4 to 6 months minimum. Available over the counter (Regaine) and on NHS in some cases.

What is alopecia areata?

An autoimmune condition where the immune system attacks hair follicles, causing round bald patches — sometimes total scalp (alopecia totalis) or body hair loss (alopecia universalis). Nails may pit. May regrow spontaneously; treatments include steroid injections, topical steroids, or immunotherapy. Not contagious.

Can wearing hats cause baldness?

No — hats do not cause pattern baldness. Traction alopecia from tight ponytails, braids, extensions, or trichotillomania (hair pulling) can cause localised loss. Poor scalp hygiene does not cause pattern baldness either.

Does biotin or vitamin supplements stop hair loss?

Only if deficiency exists — biotin deficiency is rare. Iron deficiency (common in heavy periods) can contribute to shedding; correcting it helps. Routine supplements without deficiency show little evidence for pattern baldness. Excess vitamin A can cause hair loss.

When does postpartum hair loss stop?

Telogen effluvium after childbirth typically peaks around 3 to 4 months postpartum and resolves by 6 to 12 months as hormones stabilise. It is normal and temporary — not true baldness. See a GP if loss is severe or persists beyond a year.

How long does minoxidil take to work?

Visible improvement usually takes at least 4 to 6 months of daily use — some men notice change at 3 months. Initial increased shedding in the first few weeks is common and does not mean it is failing. You must continue long term — benefits reverse within months of stopping.

Can you use finasteride and minoxidil together?

Yes — combining oral finasteride with topical minoxidil is common and often more effective than either alone for male pattern baldness. They work differently — finasteride reduces DHT, minoxidil improves follicle blood supply. Discuss with a GP or pharmacist; use only licensed doses.

What is a receding hairline or balding crown?

A receding hairline — temples and frontal hairline moving back — and thinning at the crown (vertex) are classic male pattern baldness patterns. Hair miniaturises — finer and shorter — before disappearing. Female pattern loss usually widens the central parting rather than receding the front.

How do you apply minoxidil correctly?

Apply to dry scalp on thinning areas — not the hair strands — once or twice daily as directed. Use the dropper or foam; wash hands after. Allow to dry before bed or wearing a hat. Do not apply to broken or inflamed skin. Missing once is fine — do not double the dose.

Sources

• NHS — Hair loss
• NHS — Alopecia areata
• BAD — Male pattern hair loss