The Layered guide to hair loss

More than one in five people in the UK experience hair loss in their lifetime, and yet for most, the journey from noticing something is wrong to getting the right diagnosis and treatment is unnecessarily long, confusing and distressing.

Part of the problem is that hair loss is not a single or simple condition—there are 12 different types, each driven by entirely different biology and requiring entirely different treatment. Use the wrong approach for the wrong type and you are at best wasting time and money, at worst making things considerably worse.

Read on to discover the six most common types, how to spot them and what to do next.

Androgenetic alopecia

This is the most common cause of hair loss in both men and women, and one of the most misunderstood. Androgenetic alopecia is driven by a genetic sensitivity of the hair follicle to androgens, specifically DHT, which can shrink hair follicles and shorten the hair growth cycle, eventually causing them to stop producing hair altogether.

In men, it typically follows a predictable pattern: a receding hairline, thinning at the crown and, in more advanced cases, significant baldness across the top of the scalp. In women, it looks quite different. Rather than a receding hairline, women typically notice a widening central parting and a general thinning across the top of the scalp, with the frontal hairline usually remaining intact.

This form of hair loss tends to become noticeable in men from as early as their mid-20s, while women often first notice it from the mid-30s, with significant acceleration around menopause, when oestrogen (which partially counteracts androgenic effects on the follicle) declines.

Treatment options with the strongest evidence base include topical and oral minoxidil, which increases blood flow and encourages growth; finasteride and dutasteride (primarily used in men, though finasteride is used off-label in post-menopausal women), which stop the body from converting testosterone into DHT, and spironolactone (for women) which reduces testosterone levels. PRP and low-level laser therapy are also popular treatments.

As with most hair loss conditions, the earlier you act, the more you preserve, though follicles that have been permanently dormant cannot be regenerated.

Telogen effluvium

When the body experiences some kind of shock to the system, telogen effluvium can ensue. A serious illness, surgery, childbirth, extreme stress, rapid weight loss, any of these can push a large proportion of hairs simultaneously into the resting phase, causing a surge in shedding two to three months later. If you are suddenly finding handfuls of hair in the shower, on your pillow or on your brush, spread evenly across the whole scalp rather than concentrated in one area, this is likely what you are dealing with.

The most important first step is a blood test. Ferritin (stored iron) is the one most consistently missed, and low levels are one of the most common and correctable drivers of diffuse shedding in women. You need your ferritin levels to be at the higher end of the range to support hair growth, as the body prioritises vital organs over hair, skin and nails, meaning a normal result that falls on the lower end of normal will likely not cut it.

Address any deficiencies, support your recovery and be patient. Acute telogen effluvium usually resolves within six to twelve months, once the trigger is identified and corrected.

Traction alopecia

Traction alopecia is caused by repetitive tension on the hair follicle—think tight ponytails, buns, braids, extensions, weaves, even wearing rollers while sleeping. “It presents as thinning or complete loss of hair generally along the hairline and temples, but can affect anywhere on the scalp where pulling occurs,” explains consultant dermatologist Dr Sharon Belmo.

It is particularly prevalent in women with curly and afro-textured hair, as the styling practices common to these hair types tend to create tension, but also because curly hair is naturally drier and more delicate. The hairline is especially vulnerable, because the follicles there are finer and exposed to the greatest tension in many hairstyles.

The good news is that when caught early, traction alopecia is entirely reversible. All it takes is a change in your styling practices to reduce the pulling and subsequent inflammation that tension causes, and your hair will return.

However, "if styling practices remain the same, this chronic inflammation can lead to the destruction of the hair follicle, also known as scarring. At this point, the hair follicle will no longer be able to produce hair, and the hair loss becomes irreversible," warns Belmo.

Alopecia areata

Alopecia areata is an autoimmune condition in which the immune system attacks the hair follicle, producing sudden smooth, circular patches of hair loss. This occurs most commonly on the scalp but can sometimes affect the brows, eyelashes or body hair. The patches are well-defined and the skin within them appears completely normal, with no scaling or scarring.

It can affect anyone at any age and is deeply unpredictable: patches may regrow spontaneously, stabilise, or progress to total scalp hair loss (alopecia totalis) or total body hair loss (alopecia universalis).

Treatment options include corticosteroids, topical immunotherapy, and most significantly in recent years, JAK inhibitors. Topical immunotherapy involves a dermatologist applying a weak chemical allergen directly to the scalp to cause a mild allergic rash. This localised allergic inflammation "distracts" the body's immune cells, stopping them from attacking the hair follicles, giving dormant follicles time to recover and begin growing hair again.

JAK inhibitors also help dormant follicles to grow hair again by blocking specific cellular signalling pathways, which stops the immune system from attacking your hair follicles.

Frontal fibrosing alopecia

Frontal fibrosing alopecia is a scarring alopecia, meaning it permanently destroys hair follicles as it progresses. It presents as a slowly receding frontal and temporal hairline, that leaves a slightly shiny band of skin where the hairline once was. It can often be accompanied by loss of the eyebrows and eyelashes, and predominantly affects post-menopausal women—it is thought to involve an autoimmune process against a background of hormonal change. Incidence has risen sharply in recent decades, and it now affects an estimated 1 in 50 post-menopausal women.

Because follicle destruction is permanent, the goal of treatment is to stop the progression rather than regrow what is already lost, which is why early diagnosis is so critical. A scalp biopsy is needed for a definitive diagnosis, and once confirmed there are a number of treatments that can help stop the condition progressing.

These include anti-inflammatory agents such as corticosteroids and hydroxychloroquine, anti-androgens including dutasteride and finasteride, and topical JAK inhibitors such as ruxolitinib, which has shown promising results in stabilising the condition. It’s also worth rethinking styling practices too, mainly avoiding tight hairstyles that put tension on the hairline.

Other scarring alopecias

Frontal fibrosing alopecia sits within a broader group of scarring alopecias, conditions where inflammation destroys the hair follicle and replaces it with scar tissue, making the loss permanent. Others include lichen planopilaris, which presents with scaling, redness and itching around the follicle typically at the crown, and central centrifugal cicatricial alopecia (CCCA), which predominantly affects Black women and begins at the crown before spreading outward.

Any progressive or patchy hair loss accompanied by persistent scalp symptoms like itching, burning, tenderness, redness or scaling, warrants prompt assessment by a dermatologist or trichologist—for a definitive answer, a biopsy is a must.

Whatever type of hair loss you are dealing with, it’s best to see a specialist, get your blood tested, and do not wait. Hair loss that has been progressing for years is significantly harder to address than hair loss caught early.  So, don’t simply invest in a scalp serum and hope for the best.