1. What is it?
  2. Symptoms
  3. Is it reversible?
  4. Treatment
  5. Can you get a hair transplant?

Retrograde alopecia is the lesser-known cause of thinning hair, which remains a perplexing condition for many experiencing unexplained hair loss.

Unlike male pattern hair loss, the regions affected by retrograde alopecia include the nape of the neck, above the ears, and in some cases it can also extend to the sides of the scalp.

This article will explore the latest findings, and offer an expert opinion on the nature and treatment of retrograde alopecia.

Understanding it is not just about recognizing the patterns, but also about uncovering the underlying mechanisms.

From hormonal influences to genetic predispositions, the triggers of retrograde alopecia are as complex as they are varied.

Let’s find out more about this complex disease.

What is Retrograde Alopecia?

Retrograde alopecia is where thinning occurs in the areas that are typically resistant to androgenetic alopecia. These inlcude the nape of the neck and the area above the ears.

Unlike common male pattern baldness, retrograde alopecia primarily affects these more uncommon areas leading to eventual follicular death.

The exact cause of retrograde alopecia is not fully understood. Scientists believe it’s related to hormonal factors similar to those involved in androgenetic alopecia.

retrogade alopecia

What are the symptoms of retrograde alopecia?

The symptoms of retrograde alopecia include:

  • Thinning of hair or hair loss in the areas typically resistant to common balding patterns. Specifically around the nape of the neck, above the ears, and sometimes the sides of the scalp.
  • The hairline itself may remain intact, while the area of the scalp affected suffers from vertical alopecia.
  • Individuals may experience weakened hair follicles and subsequent hair thinning in the frontal hairline similar to androgenetic alopecia. The difference is the atypical nature of the pattern of hair loss in these areas.
  • Retrograde alopecia often comes with gradual thinning which can make it difficult to notice in the early stages.

To properly diagnose vertical thinning it’s best to seek advice from a dermatologist or hair restoration specialist who can advise on both surgical hair restoration options and non-surgical treatments.

How to measure retrograde alopecia?

how to measure retrogade alopecia

Measuring retrograde alopecia involves a combination of clinical evaluation and diagnostic tools.

Here are the common methods used to evaluate and measure retrograde alopecia:

  1. Clinical Examination: A dermatologist or trichologist will perform a detailed scalp examination to identify the pattern of hair loss.
  2. Photographic Documentation: Taking standardized, consistent photographs of the affected areas over time can help in assessing the progression of hair loss.
  3. Dermoscopy: A handheld device called a dermatoscope can be used to magnify the scalp and hair follicles. This helps to identify subtle thinning and healthy hair count in the traditional donor area.
  4. Hair Pull Test: This involves gently pulling on a small section of hair to see how many hairs are easily removed.
  5. Trichoscopy: A form of dermoscopy specialized for hair and scalp conditions. It can be useful to assess lower-density hair closer and get a better idea about the state of finer hairs.
  6. Biopsy: A small scalp biopsy from the affected area may be taken and examined under a microscope to assess the hair follicles’ structure and any signs of scarring or inflammation.
  7. Hair Density Measurements: Tools and software can measure hair density and the percentage of miniaturized hairs in specific scalp regions, providing a quantitative assessment of hair loss.

Is retrograde alopecia reversible?

Retrograde alopecia, like other forms of hair loss linked to genetic factors (such as androgenetic alopecia), is generally considered to be a progressive condition that is not fully reversible.

However, the progression of hair loss may be slowed, and complete hair loss can be prevented with appropriate treatment.

Retrograde alopecia treatment

Treatment for retrograde alopecia focuses on managing the symptoms and attempting to slow the progression of hair loss.

Since retrograde alopecia shares characteristics with androgenetic alopecia, treatments often overlap. Here are some common approaches to treating retrograde alopecia:


Minoxodil treatment for hair loss

This topical treatment is applied directly to the scalp and can lead to higher-density hair by increasing blood flow to the hair follicles.

It’s one of the most accessible and first-line treatments for various types of hair loss, including retrograde alopecia, androgenetic alopecia, and even alopecia areata in certain cases.

Finasteride (Men Only)

An oral medication that reduces the production of dihydrotestosterone (DHT), a hormone implicated in hair loss.

It’s primarily used for treating male pattern baldness but may also be effective in managing this condition by slowing the progression of hair loss.

It’s solely a medication for men, as it can lead to hormonal imbalances, birth defects, and other serious complications in women.


Similar to finasteride, dutasteride is another medication that inhibits the production of DHT.

Although not FDA-approved specifically for hair loss treatment, it’s sometimes used off-label for its potential benefits in hair regrowth.

Platelet-Rich Plasma (PRP) Therapy

prp is a hair loss treatment

This involves withdrawing a patient’s blood, processing it to enrich for platelets, and then re-injecting it into the scalp.

The growth factors in PRP can stimulate hair follicle activity and promote new hair growth in patients with retrograde alopecia or male pattern hair loss.

Low-Level Laser Therapy (LLLT)

Devices that emit specific wavelengths of light are used to stimulate cellular activity in the hair follicles, potentially leading to improved hair growth. LLLT can be used at home or in clinical settings.

Hair Transplant Surgery

In cases where medical treatments do not yield the desired results, hair transplant surgery may be considered.

This involves transplanting hair follicles from denser areas of the scalp (or other body parts) to the thinning areas.

Scalp Micropigmentation (SMP)

Scalp Micropigmentation Benefits

For individuals looking for a cosmetic solution rather than hair regrowth, SMP involves tattooing the scalp with tiny dots that resemble the appearance of short hair follicles.

This doesn’t treat the hair loss caused by retrograde alopecia but can help camouflage the thinning areas.

Lifestyle Changes and Supplements

While these are no direct treatments for retrograde alopecia, maintaining a healthy diet, managing stress, and ensuring adequate intake of vitamins and minerals can support overall scalp and hair health.

Is a retrograde alopecia hair transplant possible?

advantages of hair transplantation

Hair transplantation can be an option for those suffering from retrograde alopecia but the treatment’s effectiveness and long-term results depend on certain factors.

Hair transplant surgery involves moving hair follicles from a donor area to the thinning or balding areas.

The transplanted hair follicles will behave how they would in their original location, which is why a hair restoration procedure is the best way to address male pattern baldness.

The traditional donor area is located in the back and sides of the head. Both of these areas are resistant to the effects of the DHT hormone that leads to male hair loss.

However, there are key considerations for those with retrograde alopecia contemplating a hair transplant:

The success of a hair transplant largely depends on the availability of healthy donor hair follicles.

If the nape of the neck (which is a common donor site) is affected by retrograde alopecia, it may prevent you from being eligible for a hair transplant

A hair transplant procedure is often not feasible for those suffering from retrograde alopecia. This is due to the limited amount of healthy donor hair.

Lastly, if the hair loss is ongoing, it might affect the results of the transplant, as newly transplanted areas could become surrounded by areas of thinning hair over time.


Does retrograde alopecia get worse?

Yes, retrograde alopecia can progressively worsen over time without treatment.