Male pattern baldness (also known as androgenetic alopecia) is usually characterised by hair loss around the temples and the development of a bald spot on the crown. But in rare cases of aggressive androgenetic alopecia, men may see hair loss at the back of the head, around the ears, and around the nape. This is known as retrograde alopecia.
Retrograde alopecia (RA) typically happens in men who have extensive hair loss at stages 6-7 of the Norwood Scale. As well as causing obvious signs of hair loss, retrograde alopecia can also impact the success of a hair transplant.
Learn more here about how to recognise the symptoms of retrograde alopecia, treatment for the condition, and how retrograde alopecia affects surgical hair restoration.
The main symptom of retrograde alopecia is hair loss at the back or side of the head that doesn’t have another underlying cause. Conditions like alopecia areata and certain types of scarring alopecia can cause hair loss at the back of the head, but this is unrelated to retrograde hair loss.
Retrograde alopecia can start at the nape and travel upwards, or develop downwards from the crown. In both cases, hair loss starts to encroach on the safe donor area for a hair transplant.
Men with RA are more likely to lose hair beneath the occipital protuberance — the knobbly bit on the back of the head — so hair transplant surgeons aim to extract grafts from higher than this point on the skull .
The Norwood Scale, which is used to measure male pattern baldness, doesn’t account for retrograde alopecia, despite evidence suggesting it’s a form of extensive male pattern hair loss .
Ahmad’s NPRT system accounts for hair loss across the back of the head, as well as along the temples and crown :
The reverse thinning number represents the extent of RA. Here are 4 examples of what retrograde hair loss looks like according to the NPRT scale:
It’s almost exclusively men who are affected by retrograde alopecia. Women are at much lower risk of developing female pattern hair loss along the nape .
Because the hair follicles around the nape are shorter, softer, and finer than elsewhere on the scalp, it’s often used for female eyebrow transplants.
Hair transplant eligibility depends on the amount of donor hair you have available. Retrograde alopecia is usually seen in men with advanced hair loss, which may make them ineligible for hair transplant surgery. Research suggests that hair transplants can be difficult to perform on patients with hair loss at Norwood stages 5-7, due to a mismatch between the donor hair available and the large recipient area .
Surgeons should only take hair grafts from the safe donor area. Retrograde alopecia can compromise the safe donor area. If surgeons transplant hair from an area that is later affected by RA, this hair will eventually thin and fall out.
If you’re unable to take grafts from the scalp donor area, hair grafts can be taken from elsewhere on the body, such as the beard or chest . Most surgeons prefer to use donor hair from the scalp, as the texture and colour tends to match the recipient area more closely. But in cases where this isn’t possible, body hair transplantation can be very successful.
FUE surgery is more popular than the older hair transplant strip method . But when retrograde alopecia is a factor, FUT tends to be the preferred choice. FUT allows you to get the best grafts from your donor area .
Learn more about the difference between FUT and FUE.
Due to retrograde alopecia being an aggressive type of male pattern baldness, symptoms can be improved with Finasteride. Learn about the safety of Finasteride as a hair loss treatment.
Yes. Other treatments can help improve hair density around the back and sides of your head. Non-surgical hair loss treatments include:
Find out more about alternatives to a hair transplant.
Most people notice other symptoms of hair loss before they see retrograde alopecia. As the photos above show, it’s much more likely that you’ll get RA if you already have a receding hairline and/or crown hair loss.
As a result, the best way to prevent retrograde alopecia is to tackle it at the earliest signs of hair loss. If you catch your hair loss early enough, you may be able to manage it with non-surgical treatments alone.
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