1. What you should do now
Quick help with hair loss
- Do the pull test yourself: take 50–60 hairs between thumb and index finger and pull gently – more than 5–6 hairs come loose = hair loss.
- Classify the type: diffuse thinning, a receding hairline, round bald patches or scarring areas?
- Request basic blood tests: ferritin, TSH, zinc, vitamin D – common treatable causes.
- Check medications: chemotherapy, retinoids, beta-blockers, lithium and antiepileptics can trigger hair loss.
- Gentle care: a mild shampoo, do not blow-dry too hot, no aggressive styling products.
Caution: scarring alopecia is irreversible
With redness, scaling, itching or scarring on the scalp, a dermatological assessment should be carried out quickly. With scarring alopecia the hair follicles are permanently destroyed – once lost, the hair does not grow back.
2. Understanding hair loss – what happens in the body?
Everyone loses hair every day – up to about 100 a day is usually normal. We speak of pathological hair loss (alopecia, effluvium) when considerably more hair falls out than grows back, the hair becomes visibly thinner or bald patches develop.
Hair loss can occur at any age, affects men and women and has many different causes. In many cases it is reversible – provided the cause is recognised and treated. The work-up begins with the question of which type it is: hereditary hair loss, diffuse thinning, round bald patches or scarring alopecia.
A simple self-test: the pull test
Take 50–60 hairs between thumb and index finger and pull gently through. If more than 5–6 hairs come loose, the test is positive – this suggests increased hair loss. Repeat the test several times at different spots. Important: do not wash for at least 24 hours before the test.
3. Types and common causes
3.1 Androgenetic alopecia (hereditary)
By far the most common type. In men: a receding hairline, a thinning parting, balding. In women: diffuse thinning in the parting area, the frontal hairline is usually preserved. Genetically and hormonally determined – the hair follicles react over-sensitively to the hormone dihydrotestosterone (DHT).
3.2 Diffuse hair loss (telogen effluvium)
Even thinning of all the scalp hair. Usually occurs two to three months after the trigger. Common causes:
- Iron deficiency – the most common treatable cause, especially in women. Have the ferritin value determined.
- Underactive thyroid (Hashimoto's) or overactive thyroid – both can cause hair loss.
- Stress (physical and psychological) – after surgery, a severe infection, a psychological crisis or a crash diet.
- Medications – chemotherapy, retinoids, certain blood thinners, beta-blockers, lithium, antiepileptics.
- Nutritional deficiency – zinc, biotin, vitamin D, protein deficiency.
- After infections – post-COVID hair loss is common and usually reversible.
- Hormonal changes – after birth (postpartum effluvium), the menopause, PCOS, stopping the pill.
3.3 Patchy hair loss (alopecia areata)
Suddenly occurring, sharply defined, round, bald patches – usually on the head, more rarely in the beard area or on other parts of the body. An autoimmune disease: the immune system attacks the body's own hair follicles. In many cases the hair grows back spontaneously within months.
3.4 Scarring alopecia
Rare but important: the hair follicles are permanently destroyed through inflammation or scarring. Recognisable by redness, scaling or visible scarring. It requires an early dermatological assessment because the hair loss is irreversible.
4. Hair loss in women vs. men
Hair loss in men
The most common type is androgenetic alopecia – typical are a receding hairline, a thinning crown (tonsure) and finally balding. It often begins as early as between the ages of 20 and 40. First treatment option: topical minoxidil or finasteride (a tablet, on prescription). The high level of psychological distress is often underestimated in men.
Hair loss in women
Androgenetic alopecia is also common in women but shows a different pattern: diffuse thinning in the parting area, the frontal hairline is preserved. Iron deficiency is particularly common – women of childbearing age are often affected through menstruation, even without visible anaemia. Hormonal triggers: after birth (postpartum effluvium, usually between the 2nd and 4th month after delivery), on stopping the pill, during the menopause, with PCOS. Thyroid diseases are more common in women and often occur together with hair loss.
In women, topical minoxidil is approved – finasteride usually is not, as it is teratogenic. Antiandrogens or hormonal therapies can be sensible in certain constellations.
5. What really helps
Treatment for hereditary hair loss
Minoxidil (topical): the most commonly used agent. Available over the counter as a solution or foam. It must be used long-term – on stopping, the regrown hair usually falls out again. The effect only sets in after a few months.
Finasteride (men): a prescription 5-alpha-reductase inhibitor in tablet form. It inhibits the conversion of testosterone to DHT. Effective, but possible side effects (reduced libido, erectile dysfunction) must be discussed with the practice.
Hair transplant: a surgical option with a stable finding (at least one year). Your own hair is transplanted from the back of the head into the bald areas. Reputable points of contact are experienced dermatology practices or university dermatology clinics.
Treatment for diffuse hair loss
The treatment depends on the cause: treat iron deficiency with iron substitution (a ferritin target well above the lower normal value), control hypothyroidism with levothyroxine, switch or stop triggering medications in consultation with the practice. Plus: a balanced diet with protein, zinc, iron, vitamin D – and stress management. Patience: after the cause is removed, regrowth takes three to six months.
Treatment for patchy hair loss (alopecia areata)
Waiting: with small, single patches the hair often grows back spontaneously.
Topical corticosteroids: cortisone-containing solutions or creams can promote regrowth.
Intralesional cortisone injections: with limited involvement, injected directly into the bald patches.
JAK inhibitors (e.g. baricitinib): approved in the EU since 2022 for severe alopecia areata. They act on the misdirected immune system. For severe courses in adults.
Everyday life and care
A mild shampoo, do not blow-dry too hot, no aggressive styling products. Do not constantly tie the hair up (traction alopecia). Food supplements (biotin, zinc, iron) only help with a proven deficiency – be wary of overpriced hair-vitamin products without evidence. With more severe or permanent hair loss, wigs are an option – with alopecia areata totalis the costs are usually covered by health insurance.
With redness, scaling or scarring of the scalp, have it assessed by a dermatologist promptly – scarring alopecia is irreversible!
