Understanding Alopecia · Lead Guide
Androgenetic Alopecia (Male & Female Pattern Hair Loss): The UK Patient Guide
The most common cause of hair loss, the best understood, and the only type on our alopecia hub that a transplant reliably treats. Here is the mechanism, the evidence on every treatment, and where surgery is the wrong answer.
Androgenetic alopecia is the medical name for male and female pattern hair loss. It is the most common cause of hair loss by a very large margin, it is progressive, and it is the one type on our alopecia hub that a hair transplant reliably treats.
What androgenetic alopecia is
Hair follicles on the top of the scalp inherit a sensitivity to dihydrotestosterone (DHT), a hormone derived from testosterone. In sensitive follicles, DHT progressively shortens the growth phase and shrinks the follicle itself — a process called miniaturisation. Each cycle produces a finer, shorter, weaker hair, until the follicle stops producing a visible hair at all.
Follicles at the back and sides of the head do not carry this sensitivity. That single fact is what makes a hair transplant possible: move a resistant follicle to the top of the head and it keeps its resistance.
Male pattern baldness and the Norwood stages
In men the loss follows a recognisable pattern: temple recession first, then the crown, then the two merging. That progression is classified on the Norwood scale, and your stage is what determines graft numbers and whether surgery is appropriate yet.
Read the full Norwood scale guide ›
Female pattern hair loss: Ludwig and Sinclair
In women the presentation is different — diffuse thinning through the mid-scalp with the frontal hairline usually preserved, often first noticed as a widening centre parting. This is graded on the Ludwig or Sinclair scales, not Norwood.
How to know if you have it
| Sign | What it points to |
|---|---|
| Gradual onset over years | Consistent with androgenetic; sudden shedding is not |
| Patterned, symmetrical loss | Consistent with androgenetic; patchy round loss is not |
| Family history | Supportive, on either side of the family |
| Miniaturisation on trichoscopy | The definitive finding |
| Follicular openings still visible | Non-scarring — rules out cicatricial alopecia |
Treatments that actually work, ranked by evidence
| Treatment | Who it is for | Evidence |
|---|---|---|
| Finasteride 1mg (oral, prescription) | Men | Strong — first-line |
| Minoxidil 5% (topical, OTC) | Men and women | Strong — first-line |
| Topical finasteride (compounded, prescription) | Men wanting lower systemic exposure | Moderate and growing |
| Low-dose oral minoxidil (off-label, prescription) | Women in particular | Moderate — flagged off-label |
| Dutasteride 0.5mg (off-label, prescription) | High-responder cases | Moderate — flagged off-label |
| PRP / PRF injections | Adjunct, men and women | Moderate as an adjunct |
| Mesotherapy | Adjunct | Limited |
| Low-level laser therapy | Adjunct | Marginal — we will say so |
| Ketoconazole 2% shampoo | Adjunct | Limited, low risk |
When a transplant is the right answer — and when it isn’t
A transplant is appropriate for most stable, medicated patients with a defined pattern and adequate donor density. There are two exclusions we still see people quoted for elsewhere:
- Diffuse unpatterned alopecia (DUPA). The donor area itself is thinning, so there is no genuinely resistant hair to move. A transplant here produces a poor result and permanently depletes the donor.
- Unmedicated or rapidly progressing loss under 25. Operating on a pattern that is still moving means chasing it for years. Medication first, then reassess.
FUE or DHI — which we recommend
Both extract individual follicular units; the difference is in how they are implanted. FUE remains our default for larger sessions because it is faster per graft and allows better planning across a big area. DHI can be preferable for smaller, dense hairline work. The technique matters far less than the surgeon and the plan behind it.
Cost and timeline in the UK
| Stage of loss | Typical grafts | Indicative cost |
|---|---|---|
| Hairline and temples | 1,500–2,000 | Medium FUE — £4,500 |
| Hairline and mid-scalp | 2,000–2,800 | Medium FUE — £4,500 |
| Full restoration | 3,000–4,000+ | Large FUE — £5,250 |
For an indicative range based on your own pattern, use the graft cost estimator at consultation. Growth timeline is roughly: shedding at weeks 2–6, first new growth at months 3–4, and final result at months 12–18.
Real Vinci patients
Every case below is androgenetic alopecia treated at a Vinci clinic. Images are Vinci’s own clinical photography.
Frequently asked questions
Is androgenetic alopecia reversible?
The underlying process is not reversible, but it is treatable. Medication can slow, stall and partially reverse miniaturisation in follicles that are still producing hair. Follicles that have stopped entirely will not come back, which is why starting early makes such a large difference.
Will I need to stay on finasteride after a transplant?
Strongly advised. A transplant redistributes DHT-resistant hair; it does nothing to protect the native hair around the grafts. Without medication that native hair keeps thinning, and the result looks patchy within a few years.
Does androgenetic alopecia come from my mother’s side?
Partly, but the “it comes from your mother’s father” line is a simplification. The inheritance is polygenic, with contributions from both sides. A strong pattern on either side of the family is meaningful.
Can women have a hair transplant?
Yes, where the loss is patterned and the donor area is stable. The important caveat is that a proportion of female thinning is diffuse rather than patterned, and diffuse loss with an unstable donor is not a surgical case. That is what the bloods and trichoscopy at consultation are for.
Not sure which stage you are at?
Book a diagnostic consultation. We will confirm the pattern, tell you whether medication or surgery is the right next step, and give you a graft range based on your own scalp.
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