What To Do About Hair Loss: An Honest Guide With a 4-Step Plan

More hair in your brush, a widening parting, bald patches on top: anyone who notices this mainly wants to know one thing: what to actually do now. This guide walks you honestly through the decision. It shows you how to recognise your type of hair loss, where to get help and which treatment is genuinely proven for which cause.

One thing up front: the most common form, hereditary hair loss, already affects 58% of men between 30 and 50, according to a population-based study of 1,005 men (Yeo et al., PMC2938575). It responds differently from diffuse, nutrition-related hair loss. It is precisely this distinction that determines the right help.

When does hair loss need treatment?

Hair loss does not become a matter for treatment at a fixed number, but when your usual appearance changes: when you consistently lose noticeably more hair than usual, or your hair visibly thins over a period of weeks. As a rough guide, a daily loss of around 50 to 100 hairs is considered normal (a dermatological rule of thumb, including from NHS inform Scotland).

This rule of thumb is not a medical cut-off. How many hairs you lose each day depends heavily on hair density, hair length and how often you wash, and naturally more come out on wash days. More telling than counting is therefore the change over time, which you can best document with photos of your parting taken in the same light over several weeks.

A simple self-check is the pull test: take about 50 to 60 hairs between your thumb, index and middle finger and pull gently from the root to the tip. As a classic rule of thumb, the result is considered notable if more than 10% come away (with 60 hairs, roughly 5 to 6). A more recent reference (McDonald et al. 2017) sets the threshold more strictly at around 2 hairs. The test only shows active hair loss, not a diagnosis.

First step: which type of hair loss do I have?

The most important step with hair loss is to identify the type, because treatment, prognosis and the question of a possible hair transplant all depend on it. There are three main forms: hereditary (androgenetic), diffuse (telogen effluvium) and patchy (alopecia areata). The classification follows the American Academy of Dermatology (AAD).

Hereditary hair loss shows a typical pattern: in men, a receding hairline at the temples and a bald spot at the crown (Norwood scale); in women, a diffuse widening of the parting without a receding hairline (Ludwig scale). It is the most common cause worldwide and does not grow back on its own without treatment, because the affected follicles progressively shrink.

Diffuse hair loss thins the whole head evenly, without a sharp pattern. It is usually a response to a trigger such as iron deficiency, a thyroid disorder, stress or an illness, and in most cases it is reversible once the cause is addressed. Patchy hair loss shows sharply defined bald patches and is an autoimmune reaction.

If you suspect a hereditary pattern, the established scales help you place it: the Norwood scale for men, the Ludwig scale for women. They describe how far pattern hair loss has progressed and give a first sense of which options make sense. The table below will help you place yourself roughly.

This is the crucial fork in the road: only hereditary pattern hair loss responds to hair-growth products or a hair transplant. Diffuse hair loss needs treatment of the underlying cause. The two often occur at the same time. Both the causes of hair loss and androgenetic alopecia are broad topics worth understanding in more detail in our related articles.

Which doctor helps with hair loss?

The first port of call for help with hair loss is a dermatologist. They identify the type using trichoscopy, a non-invasive examination of the scalp with a dermatoscope, order the relevant blood tests and, if needed, carry out a scalp biopsy. In the specialist literature (PMC8719967), trichoscopy is regarded as a quick, painless standard tool for distinguishing between the forms of alopecia.

Additional specialist help can be useful: an endocrinologist if a hormonal or thyroid cause is suspected, and, for women with cycle- or hormone-related questions, a gynaecologist. In the UK, “trichologist” is not a protected medical title and does not replace medical diagnostics. For the actual work-up, the dermatologist remains responsible.

It pays to arrive well prepared for the appointment. It saves time and makes the diagnosis more accurate. Bring your photo record, a list of all your medicines and details about your family (does hereditary hair loss run in the family?). The checklist below sums up what to bring and which values to raise.

Which blood values should I have checked?

For diffuse hair loss, a targeted blood test is worthwhile, because many triggers are correctable. The most important are ferritin (iron stores), TSH (thyroid), vitamin D, zinc and vitamin B12, plus a hormone panel in women. These values are part of standard dermatological diagnostics. You can read the details in our article on the blood test for hair loss.

For ferritin, a value below 30 ng/ml is regarded as manifest iron deficiency, which often goes hand in hand with hair loss. Some trichologists cite target values above 70 ng/ml for optimal hair growth. Important: this is a practical rule of thumb debated within trichology, not a general lab standard (the usual reference range is mostly 15 to 150 ng/ml). More on this in our article on iron deficiency and hair loss.

The TSH value reveals an over- or underactive thyroid, both of which can trigger diffuse hair loss (see our article on hair loss and the thyroid). For vitamin D, zinc and B12, intake is guided by the DGE reference values (vitamin D 20 µg/day, B12 4.0 µg/day, zinc 7 to 16 mg/day depending on phytate intake). Our article on vitamins against hair loss offers further background.

A word on safety: these values are diagnostic goals, not an invitation to self-supplement. Without a proven deficiency, overdosing can do harm; too much zinc, for example, triggers a copper deficiency, and too much vitamin D causes hypercalcaemia. Have your levels measured first, then correct them in a targeted way and under medical supervision.

What really helps against hair loss? An overview of the treatment options

What really helps against hair loss depends on the cause: correctable diffuse hair loss usually disappears once the trigger is addressed; hereditary hair loss needs ongoing treatment (minoxidil, and finasteride in men) or a hair transplant; and patchy hair loss is treated dermatologically. The recommendations for the hereditary type are backed by the European EDF S3 guideline (Kanti et al. 2018, JEADV).

Minoxidil (topical, for women and men) is well supported. A Cochrane review of female hair loss found twice as many women with at least moderate regrowth as on placebo (relative risk 1.86; 95% confidence interval 1.42 to 2.43). The effect only lasts, however, for as long as you use it. Once you stop, the hair loss returns. Details in our article on minoxidil for hair loss.

Finasteride (oral, prescription-only, men only) lowers DHT levels and is effective, but not without risks (see the safety note below). For women of childbearing age it is contraindicated because of the risk to unborn children. PRP (platelet-rich plasma therapy), along with low-level laser therapy and mesotherapy, can play a supporting role, but the evidence for them is limited and inconsistent (high study heterogeneity, risk of bias).

To put the last column in context: the practical difference often lies in the effort involved. Minoxidil and finasteride slow hereditary hair loss but demand daily, ongoing use and continuing costs. A hair transplant is a one-off procedure with a permanent result in the treated area. You should never adjust the dose of these medicines yourself; only use them as prescribed by a doctor.

Safety note on finasteride

On the common question of cost: in the UK, a dermatology work-up (history, trichoscopy, blood tests where medically indicated) is generally available on the NHS. A hair transplant for hereditary hair loss, by contrast, counts as a cosmetic procedure and is not covered as a rule. It is a privately funded treatment.

What can I do myself about hair loss?

There is plenty you can do yourself about hair loss, though you should be realistic about the effect: a balanced diet rich in protein and iron, less chronic stress, gentle hair care without tight braids (which encourage traction alopecia, StatPearls NBK470434) and giving up smoking all support hair health. With hereditary or disease-related hair loss, however, they do not replace treatment.

Let us be honest about home remedies and shampoos: caffeine shampoos and most cosmetic “miracle products” have no solid evidence for significant hair growth in hereditary hair loss. Excessive vitamin regimes do not help healthy people without a deficiency either, and can even do harm. You can read what nutrients can and cannot do in our article on capsules for hair loss.

What helps quickly to cover thinning, for example before an event?

If you want to bridge a thinning spot at short notice, say before a date, a celebration or an important meeting, there are purely cosmetic instant options. They do not treat the hair loss and do not replace a diagnosis, but they visibly conceal the thinning. Important: they are a stopgap, not a treatment, and change nothing about the cause.

What to do about sudden, stress-related or illness-related hair loss?

Sudden, heavy hair loss is usually down to acute telogen effluvium, triggered by an event around 2 to 3 months earlier: a fever, an operation, a serious illness, a crash diet or severe stress. This form is often reversible and, according to the specialist literature (PMC8719967), usually settles within 6 months. If it lasts longer, you should have it assessed by a doctor.

With stress-related hair loss, the body pushes follicles into the resting phase prematurely. Once the trigger falls away, the cycle recovers on its own over a few months, and a specific medicine is usually not needed. After childbirth, hormone-driven shedding affects an estimated 40 to 50% of women. It often starts 2 to 4 months after delivery and usually normalises within 6 to 12 months.

Between women and men, the pattern differs: men usually show a receding hairline and a bald crown, women a widening parting with an intact hairline. In women, correctable causes such as iron deficiency or thyroid problems more often play a part as well, which is why blood values are especially important here. For more depth, see our articles on hair loss in women and hair loss due to hypothyroidism.

With patchy hair loss and sharply defined bald spots, you always belong in dermatological hands, as this is an autoimmune condition with its own treatment (AWMF S3 guideline 013-104). For severe cases, JAK inhibitors such as baricitinib have also been approved since 2022/2023. Do not treat this type yourself.

Hereditary hair loss: what to do when medication is no longer enough?

Hereditary (androgenetic) hair loss is progressive and does not grow back on its own. Medicines such as minoxidil and finasteride can slow it and partly thicken the hair, but they cannot bring back areas that are already bald with fully lost follicles. Where the pattern is stable and there is a sufficient donor area, a hair transplant is the only permanent solution.

On the common question “Do I still have time for minoxidil?” there is a rough guide: as long as fine, short fuzz is still visible on the thinning area, there are usually shrunken but living follicles there that might respond to medical treatment. If the skin looks completely smooth and shiny with no fuzz at all, the follicles there are probably exhausted, and medicines can generally no longer reactivate them. This is only a rough guide and does not replace a specialist’s view through the dermatoscope.

The honest distinction is decisive: only hereditary pattern hair loss is suitable for a hair transplant. Diffuse hair loss across the whole head is a contraindication; here the cause must be treated first. With active patchy hair loss, a transplant is even expressly contraindicated, because the immune system can attack newly transplanted follicles too. Often a hereditary and a diffuse component are present at the same time.

Because the right decision depends on the type, diagnostics always come first, not buying a product. For the medical work-up of the cause and blood values, the dermatologist is and remains the right person. If you already suspect a hereditary pattern and want to know whether it could be treated surgically, Elithair’s free hair analysis is a good second check, focused purely on the aesthetic-surgical side. It is a visual pattern analysis (Norwood/Ludwig) and assesses whether there is a stable donor area and transplantable hair loss. It replaces neither a visit to the dermatologist nor a medical blood test, but complements them.

When does the hair grow back?

With correctable causes such as iron deficiency, a well-managed thyroid or resolved stress, the hair grows back in most cases, realistically around 3 to 6 months after the cause is addressed. The reason lies in the hair cycle: the follicles first have to pass through the resting phase (telogen) before they re-enter the growth phase (anagen). More on this in our article on the hair cycle.

Expert perspective

Frequently asked questions: what to do about hair loss?

Sources

Note: this article is for general information and does not replace medical advice, diagnosis or treatment. If your hair loss is persistent or heavy, please see a dermatologist. Medicines such as minoxidil and finasteride may only be used after medical counselling and on prescription. Last updated: 2026.