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Pattern hair loss

Also called androgenetic alopecia. A gradual change in the kind of hair being produced, in a recognisable distribution. Common, slow, and frequently noticed years before anyone else can see it.

01 What it is

In pattern hair loss the follicle does not disappear; it changes what it makes. Over successive growth cycles, hairs in affected areas are produced progressively finer, shorter and lighter, a process called miniaturisation. The count may barely change. The volume does.

It follows a distribution rather than appearing at random: in women most often a widening of the central parting with the frontal hairline largely preserved; in men most often the temples and crown. It is gradual, it is common, and it can begin far earlier than people expect.

02 Recognition

What people usually notice

  • A parting that has widened, often noticed in a photograph rather than a mirror.
  • A ponytail that feels thinner to hold, even though shedding seems normal.
  • More scalp visible under bright or overhead light.
  • Hairs that are noticeably finer and shorter than the rest, especially at the front.
  • Nothing dramatic, which is exactly why it is often dismissed.

03 Contributors

What may contribute

Grouped by how well supported each one is. That distinction matters more than the list itself.

Well established

  • Genetic susceptibility, inherited from either side of the family.
  • Androgen sensitivity of the follicle: the follicle's response matters more than the level circulating in the blood, which is why hormone tests are often normal.
  • Age. Prevalence rises steadily across the decades in both men and women.

Commonly associated

  • Menopause and other significant hormonal transitions, which often coincide with it becoming noticeable.
  • Polycystic ovary syndrome and other conditions involving androgen excess, in some women.
  • A period of shedding from another cause, which can unmask a pattern that was already developing.

Debated or unsupported

  • Shampoo, hard water, hats, and most of the things people blame first.
  • “DHT-blocking” topicals sold without evidence. Some prescription treatments do have good evidence; most over-the-counter products claiming the same mechanism do not.
  • Scalp massage as a primary treatment. Pleasant, low-risk, not a substitute for anything.

04 Uncertainty

What we don’t know

  • Why the same genetic predisposition produces very different rates of change in different people.
  • Why some people respond well to available treatments and others do not.
  • How much of the female pattern seen after menopause is androgen-related and how much reflects other age-related changes in the follicle.

Worth doing first

When to bring a doctor in

  • If loss is rapid rather than gradual, or came on over weeks.
  • If it is accompanied by irregular periods, acne, unusual hair growth on the face or body, or other signs of hormonal change.
  • If you want to consider prescription treatment: that conversation belongs with a doctor.
  • If the scalp is sore, scarred or inflamed, or the hairline looks like it is being replaced by smooth skin rather than fine hair.

If any of this applies, see a doctor first. It’s the quickest way to an answer. Bring what they tell you back to me and we’ll work out what it means for you.

05 Consultation

What a consultation can explore

  • Whether the pattern is consistent with androgenetic change, or whether something else is also happening. The two very often overlap.
  • The timeline, and what else was going on when you first noticed.
  • Family history on both sides.
  • What you have already tried, for how long, and whether it was given a fair test.
  • What the realistic options are, including the ones that require a doctor.
  • Hair handling, styling and scalp care that will not accelerate the visible effect.
  • How to measure change over time so you are not judging it by how you feel on a given morning.

Pattern hair loss is usually managed rather than reversed, and honest management starts with knowing whether it is actually what you have.

What happens next

  1. Book

    Online, wherever you are. You’ll receive a questionnaire and a prep sheet, and I read both before we meet.

  2. We look at it properly

    History, assessment, findings, and time for the questions you came with.

  3. You get it in writing

    A summary you can act on, sit with, or hand to your doctor.

This page describes what people commonly experience. Reading it isn’t the same as having someone look at your situation properly, and it can’t tell you which of these you have. That’s what the consultation is for.

Book a consultation

Related reading

Sources and further reading

  • DermNet Androgenetic alopecia
  • British Association of Dermatologists Female pattern hair loss: patient information leaflet
  • British Association of Dermatologists Male pattern hair loss: patient information leaflet
  • American Academy of Dermatology Hair loss: who gets and causes

Written by Brigita Deveikaite, certified trichologist (VTCT Skills (ITEC) Level 4 Certificate in Trichology for Hairdressers, Trichocare). Last reviewed . This page is educational and is not a diagnosis.