Retrograde Alopecia: Causes, Symptoms, & Treatment Options

Knox Beasley, MD

Reviewed by Knox Beasley, MD

Written by Rachel Sacks

Updated 05/13/2024

Hair loss can happen in many different ways. Some natural hair loss occurs with the hair growth cycle, but you might notice more hairs going down the shower drain. Or you may wake up one day and see your forehead has magically gotten larger (in reality, a receding hairline happens slowly over time).

But what if you’re experiencing hair loss at the nape of your neck or around your ears? Known as retrograde alopecia, this type of hair loss happens to men at a 6 or 7 on the Norwood scale, a hair loss guide.

What is retrograde alopecia exactly, and how does it differ from other types of alopecia? We explain retrograde hair loss and retrograde alopecia treatments to get your hair growing again.

While there’s not much research about it, retrograde alopecia is a unique condition associated with androgenetic alopecia, the most common form of male pattern baldness. Specifically, retrograde hair loss is characterized by hair loss at the back of the head and along the nape of the neck.

Retrograde hair loss can typically happen to men at a 6 or 7 on the Norwood scale, a hair loss guide. These are the two most severe steps of hair loss on the Norwood scale.

Hair loss in retrograde alopecia can appear very similar to androgenetic alopecia (also known as androgenic alopecia or AGA) and is even thought to be a subtype of AGA.

However, while the Norwood scale outlines typical hairs men lose hair from, including in male pattern baldness, this type of hair loss usually affects different areas not highlighted on the Norwood scale.

One study found that out of 1,000 patients with AGA, approximately five percent of those showed different patterns and severity of retrograde alopecia.

While retrograde hair loss can be very similar to androgenetic alopecia, the hair loss pattern differs slightly.

Androgenetic alopecia follows a typical hair loss pattern that affects the temples, crown of the head, and mid-frontal scalp.

In retrograde alopecia, the hair loss pattern occurs on the back of the head, behind the ears, and at the base of the neck. So, if you’ve noticed hair loss at the top of the back of your neck, you may be experiencing retrograde alopecia at the nape of the neck.

In both types of hair loss, however, you’ll see similar growth of fine, short hair and decreased normal hair.

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How do you determine if you have retrograde alopecia versus other types of hair loss?

As mentioned above, retrograde alopecia is linked to androgenetic alopecia, a severe yet common form of hair loss in men. This type of hair loss is characterized by a receding hairline, a bald patch around your crown, or a horseshoe-shaped pattern of hair loss.

AGA is caused by a hormone called dihydrotestosterone, or DHT, that causes hair follicles to shrink and stop new hair growth.

But if you’re experiencing sudden extreme stress or nutritional deficiencies along with hair shedding, you may have a temporary form of hair loss called telogen effluvium. While telogen effluvium stops when the cause is gone, AGA and retrograde alopecia may continue to worsen.

Another type of hair loss, alopecia areata, is patchy hair loss that develops when your immune system targets and attacks your hair follicles. Unlike male pattern hair loss, alopecia areata is usually caused by autoimmune diseases.

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Since this type of hair loss is similar to androgenetic alopecia, retrograde alopecia treatment is also similar.

There are currently three treatment options approved by the Food and Drug Administration (FDA) for androgenetic alopecia: topical minoxidil, oral finasteride, and low-level laser therapy, or LLLT.

Minoxidil encourages new hair growth by increasing blood flow to your hair follicles and pushing hairs into the growth phase of the hair growth cycle. Depending on your application preference, this medication is available as a topical solution and a minoxidil foam.

Oral finasteride (sold under the brand name Propecia®) reduces your body’s DHT production, which slows or stops the DHT-related damage that causes hair loss.

Research of over 530 Japanese men with AGA found that 91 percent experienced hair regrowth while taking finasteride. A 2021 study found that topical finasteride also improved hair growth.

Low-level laser therapy or laser hair growth treatments may sound scary, but they can be effective and are safe for most people. These newer methods of treatment increase blood circulation and stimulate new hair growth.

Another option to treat retrograde alopecia is hair transplant surgery. It involves taking donor hair grafts from the sides and back of your scalp and implanting them in areas with hair loss or hair thinning.

There are generally two types of hair restoration procedures: follicular unit extraction (FUE hair transplant) and follicular unit transplantation (FUT).

If you’re not ready for medical hair loss treatments yet or just want an extra boost, you can try using a hair loss prevention shampoo containing ingredients such as saw palmetto and ketoconazole to slow down retrograde alopecia.

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Hair loss can affect many men in many different ways. If you’re seeing hair loss at the nape of your neck, you may be experiencing retrograde alopecia, an uncommon type of male pattern baldness.

  • There’s very little research on retrograde alopecia. However, it appears to be associated with androgenetic alopecia, which is the most common type of hair loss among men and is caused by genetics and the hormone DHT.

  • While androgenetic alopecia causes hair loss at the temples and crown of the head, retrograde alopecia symptoms include hair loss at the back of the head, behind the ears, and at the base of the neck.

  • Retrograde alopecia treatments are similar to androgenetic alopecia treatments, including oral finasteride, topical minoxidil, laser hair growth treatments, and possible hair restoration surgery.

Dealing with any type of hair loss can be frustrating, but treatments are available. You can discuss your symptoms and explore more hair loss treatments in an online consultation with a healthcare provider or dermatologist.

10 Sources

  1. Mohamed, A., Al khalawany, M., & Abdalkarim, I. (2023). Retrograde alopecia: Prevalence, patterns, dermoscopic features among Egyptian men: A Cross Sectional Study. International Journal of Medical Arts, 5(5), 3286–3290. Retrieved from https://journals.ekb.eg/article_307064_5e79e022004a0ab413bcac4caf668971.pdf
  2. Qi, J., & Garza, L. A. (2014). An overview of alopecias. Cold Spring Harbor perspectives in medicine, 4(3), a013615. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935391/
  3. Ntshingila, S., Oputu, O., Arowolo, A. T., & Khumalo, N. P. (2023). Androgenetic alopecia: An update. JAAD International, 13, 150-158. Retrieved from https://www.sciencedirect.com/science/article/pii/S2666328723001128
  4. Lolli, F., Pallotti, F., Rossi, A., Fortuna, M. C., Caro, G., Lenzi, A., Sansone, A., & Lombardo, F. (2017). Androgenetic alopecia: A Review. Endocrine, 57(1), 9–17. Retrieved from https://art.torvergata.it/bitstream/2108/272636/1/Lolli2017_Article_AndrogeneticAlopeciaAReview.pdf
  5. Nestor, M. S., Ablon, G., Gade, A., Han, H., & Fischer, D. L. (2021). Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethics. Journal of Cosmetic Dermatology, 20(12), 3759-3781. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocd.14537
  6. Suchonwanit, P., Thammarucha, S., & Leerunyakul, K. (2019). Minoxidil and its use in hair disorders: a review. Drug design, development and therapy, 13, 2777–2786. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691938/
  7. HIGHLIGHTS OF PRESCRIBING INFORMATION. (n.d.). accessdata.fda.gov. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/020788s020s021s023lbl.pdf
  8. Yanagisawa, M., Fujimaki, H., Takeda, A., Nemoto, M., Sugimoto, T., & Sato, A. (2019). Long-term (10-year) efficacy of finasteride in 523 Japanese men with Androgenetic Alopecia. Clinical Research and Trials, 5(5). Retrieved from https://www.researchgate.net/publication/337105943_Long-term_10-year_efficacy_of_finasteride_in_523_Japanese_men_with_androgenetic_alopecia
  9. Piraccini, B. M., Blume-Peytavi, U., Scarci, F., Jansat, J. M., Falqués, M., Otero, R., Tamarit, M. L., Galván, J., Tebbs, V., Massana, E., & Topical Finasteride Study Group (2022). Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. Journal of the European Academy of Dermatology and Venereology : JEADV, 36(2), 286–294. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9297965/
  10. Zito, P.M., Raggio, B.S. Hair Transplantation. [Updated 2023 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK547740/
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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references. See a mistake? Let us know at [email protected]!

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Knox Beasley, MD

Dr. Knox Beasley is a board certified dermatologist specializing in hair loss. He completed his undergraduate studies at the United States Military Academy at West Point, NY, and subsequently attended medical school at Tulane University School of Medicine in New Orleans, LA. 

Dr. Beasley first began doing telemedicine during his dermatology residency in 2013 with the military, helping to diagnose dermatologic conditions in soldiers all over the world. 

Dr. Beasley is board certified by the American Board of Dermatology, and is a Fellow of the American Academy of Dermatology.

Originally from Nashville, TN, Dr. Beasley currently lives in North Carolina and enjoys spending time outdoors (with sunscreen of course) with his wife and two children in his spare time. 

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