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Retrograde Alopecia: Symptoms, Causes, Treatments
Dr. Michael May (FRCS)
Medically reviewed by
Dr. Michael May (FRCS)
Updated on January 12, 2023

Male pattern baldness 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.

In this article, you’ll discover:

  • how to recognise the symptoms of retrograde alopecia
  • how RA affects hair transplants
  • how to treat retrograde alopecia.

Symptoms of retrograde alopecia

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 examples

Two patients with retrograde alopecia.

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 [1].

How is retrograde alopecia measured?

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 [2].

Ahmad’s NPRT system accounts for hair loss across the back of the head, as well as along the temples and crown [3]:

ahmads nprt hair loss measurement system

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:

retrograde alopecia scale - 4 men with hair loss at the side of the head

Who can get retrograde alopecia?

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 [4].

Because hair around the nape is shorter, softer, and finer than elsewhere on the scalp, it’s often used for female eyebrow transplants.

Can you have a hair transplant if you have retrograde alopecia?

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 a hair transplant. 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 [5].

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 [6]. 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. Learn more about where donor hair for a hair transplant comes from.

FUE vs FUT for RA

FUE surgery is more popular than the older hair transplant strip method [7]. 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 [1].

Learn more about the difference between FUT and FUE.

Does Finasteride work for retrograde alopecia?

Yes. Because retrograde alopecia is an aggressive type of male pattern baldness, symptoms can be improved with Finasteride. Learn about the safety of Finasteride as a hair loss treatment, and see Finasteride hair growth results.

Do other hair loss treatments work?

Yes. Other treatments can help improve hair density around the back and sides of your head. Non-surgical hair loss treatments include:

  • Minoxidil — a topical solution you apply to the scalp
  • Low-level laser therapy (LLLT) — a light treatment that stimulates blood flow to the scalp
  • Vitamin infusion therapy — vitamins flow into the bloodstream via an IV drip.

Find out more about alternatives to a hair transplant.

How to prevent retrograde alopecia

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.

Book a free consultation to discuss your hair loss with a Wimpole Clinic hair loss expert, and get impartial guidance on the best treatments available to restore your hair loss.

Retrograde Alopecia: Symptoms, Causes, Treatments, Wimpole Clinic

Sources:

  1. Donor Harvesting: Strip Dissection
  2. Retrograde Androgenetic Alopecia
  3. Ahmad’s NPRT System: A New Classification System for Documenting Male Pattern Baldness
  4. The Science and Art of Eyebrow Transplantation by Follicular Unit Extraction
  5. Approach to Hair Transplantation in Advanced Grade Baldness by Follicular Unit Extraction: A Retrospective Analysis of 820 Cases
  6. A Comparative Study on the Rate of Anagen Effluvium and Survival Rates of Scalp, Beard, and Chest Hair in Hair Restoration Procedure of Scalp
  7. ISHRS Practice Census 2022
Dr. Michael May (FRCS)
Medically reviewed by Dr. Michael May (FRCS)Updated on January 12, 2023
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
Talk to a specialist ☎ 020 7935 1861.
Dr. Michael May (FRCS)
Medically reviewed by
Dr. Michael May (FRCS)
Updated on January 12, 2023

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