Receding temples
The hairline at the forehead gradually recedes backward, more often in men.
CONDITION / HAIR
Androgenic alopecia.
Androgenetic alopecia — hereditary baldness: hair gradually thins and becomes sparse — in men on the temples and crown, in women along the part line. It is treated with medications, and hair transplantation is considered when baldness has stabilized.
CONCEPTUAL VISUALIZATION- What it is
- Hereditary baldness, where hair gradually thins and becomes sparse in a typical pattern.
- How common
- According to the European guideline — up to 80% of men of European descent and 42% of women; the frequency increases with age.
- Main medications
- Minoxidil — for men and women; finasteride — only for men.
- Who treats it
- Dermatologist; hair transplantation is performed by a surgeon.
01 / WHAT IS ITWhat is
What is
androgenetic alopecia.
Androgenetic alopecia — the most common type of baldness in men and women. The first signs usually appear in adolescence, and then hair gradually thins following a typical pattern.
The cause lies in the sensitivity of hair follicles to the hormone dihydrotestosterone (DHT). Under its influence, follicles shrink, and the hair growth phase shortens with each cycle: thick long hair turns into thin, short, downy-like hair.
In men, bald spots usually appear at the temples and the crown thins. In women, hair thins diffusely, most noticeably along the parting, while the hairline above the forehead often remains.
This is not scarring baldness: the scalp is healthy, follicles shrink but are not replaced by scar tissue. Baldness can significantly affect well-being and quality of life — and this is a reason to consult a doctor, even if there is no medical threat.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
presents.
Baldness develops over years. The typical pattern in men and women is different.
The crown becomes thinner
On the top of the head, hair becomes thinner, skin shows through.
Parting widens
In women, hair thins over the entire top of the head, most noticeably along the part.
Thinner hair
Hair becomes thinner, shorter, and softer; ponytail or braid becomes thinner.
Gradualness
Changes accumulate slowly; baldness occurs more often with age.
Without scars
The scalp looks healthy. If hair is missing at the scar site, that is a different condition.
Scarring alopecia03 / REASONSWhy
Why
hair thinning.
Androgenetic alopecia is an inherited condition. But hair thinning has other causes as well, so they are ruled out first.
Heredity
According to the NHS, male- and female-pattern baldness usually runs in families and is permanent.
Hormone DHT
The enzyme 5-alpha-reductase converts testosterone into dihydrotestosterone, which shrinks hair follicles.
age
The first signs can appear in teenagers, and baldness becomes more common with age.
Other causes of thinning
Hair can temporarily thin due to illness, stress, cancer treatment, weight loss, or iron deficiency. Such conditions are treated differently.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Androgenetic alopecia develops over years, it does not require urgent medical attention. Urgent doctor visits may only be necessary due to side effects of medications.
103 immediately if:
- thoughts of harming yourself;
- sudden swelling of the lips, mouth, throat, or tongue;
- very rapid breathing or difficulty breathing;
- throat tightness or difficulty swallowing;
- skin, lips, or tongue turning blue, gray, or pale;
- sudden severe confusion or drowsiness;
- person has fainted and does not regain consciousness.
When to see a doctor:
On the same day, to the doctor who prescribed the medicine: depressed mood on finasteride (according to NHS, the medication should be stopped immediately), lumps, pain, or swelling in the breast area or nipple discharge; rapid heartbeat, dizziness, swelling in the legs or eyelids on minoxidil tablets. In the near future: erection problems, lower libido, less semen on finasteride; strong hair growth on the face and body from minoxidil tablets. Planned: actual baldness — when it bothers you; women should see a doctor to find out the cause of thinning.
05 / DIAGNOSTICSHow we make the
How we make the
diagnosis
- Conversation
Since the hair is thinning, whether shedding continues, if there is baldness in the family, what medications you take, whether baldness was treated previously.
- Hair examination
A doctor can often determine the cause by examining the hair and scalp; if needed — under magnification.
- Examination for women
The European guideline advises different diagnostic steps for men and women. For women, hormone levels, iron levels, and thyroid function are usually checked.
- Donor area assessment
If a transplant is being discussed, the doctor assesses the hair density on the back of the head.
06 / TREATMENTHow we treat
How we treat
androgenetic alopecia.
First — medication: it slows down hair loss and in some people restores part of the hair. According to the NHS, medications do not help everyone and work only as long as they are used. Most remedies offered for hair loss do not have evidence from clinical studies.
01
Minoxidil
For men and women.
- What is known
- In a meta-analysis of randomized studies, minoxidil 5% and 2% in men and 2% in women worked better than placebo; studies varied significantly from each other.
- In women
- According to the Cochrane review, moderate or significant hair regrowth was observed in 157 out of 593 women on minoxidil compared to 77 out of 555 on placebo; 2% and 5% solutions did not differ in effect.
- Inconveniences
- The solution is applied twice a day; some people stop treatment due to changes in hair texture and scalp irritation.
- Low-dose tablets
- According to a meta-analysis of 4 studies (279 patients), hair density did not differ from placebo, but excessive hair growth on the body and face occurred more frequently. In a retrospective study of 1,404 patients without a control group, excessive hair growth was observed in 15.1%, dizziness in 1.7%, fluid retention in 1.3%, and rapid heartbeat in 0.9%. Minoxidil tablets are prescribed by a doctor: inform them in advance about heart disease, blood pressure, pregnancy, or breastfeeding.
02
Finasteride
For men only.
- How it works
- The tablet blocks the conversion of testosterone to DHT. According to the NHS, improvement can be expected in 3–6 months. In a network meta-analysis of 33 studies in men, among treatments approved in the US, the most effective topical was 5% minoxidil, and among tablets, 1 mg finasteride. Finasteride is not recommended for women; in the Cochrane review, it was no more effective than placebo (low-quality evidence).
- Sexual side effects
- According to the NHS, erectile problems, decreased libido, and reduced semen occur in more than 1 in 100 people; sometimes they continue even after discontinuation. In a meta-analysis of 15 studies (4495 participants), sexual disorders on finasteride occurred 1.66 times more often than on placebo.
- mood
- Serious side effects are rare — less than 1 in 1000 people. Low mood is a reason to immediately stop the medication and consult a doctor. In a systematic review, depressive symptoms occurred in 3.33% of those taking finasteride, compared to 2.54% of those not taking it. In the WHO reporting database, a signal regarding suicidal thoughts and depression was detected in people under 45 who took finasteride for hair loss; the authors explain this by the fact that such effects have started to be reported more often, and/or that younger patients are more vulnerable to the side effects of finasteride.
- Before starting
- Tell your doctor if you have had depression, thoughts of self-harm, or liver problems, and inform your relatives that you are taking finasteride.
03
Other methods
The decision is up to the doctor.
- What the consensus recommends
- The 2025 Canadian consensus, besides minoxidil and finasteride, recommends topical finasteride, oral dutasteride, platelet-rich plasma, and microneedling.
- What is not recommended
- The same consensus does not recommend, in particular, rosemary oil, caffeine, and herbal remedies for the scalp.
- Laser
- In a meta-analysis of randomized trials, low-level laser light in men was more effective than placebo; in women, studies of laser devices gave contradictory results.
04
Hair transplantation
- Who
- According to the NHS, a transplant is suitable for permanent hereditary baldness and is usually not suitable for patchy alopecia. It is done when the baldness has stabilized and there is enough hair at the back of the head.
- After
- New hair appears in about 4 months, with full results visible in 10–18 months. The natural hair around the transplanted area may continue to thin, so medication treatment is often continued.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Androgenetic alopecia at the Dr. Valikhnovskyi Surgery Institute is treated in the direction of "Robotic Hair Transplantation." A transplant is offered when the baldness has stabilized, the cause of thinning is identified, and the donor area is sufficient.
CLINIC SERVICE
Robotic hair transplantation
Own hair in baldness — with the ARTAS robot and manually, as well as after burns, injuries, and surgeries.
View service
What we do for this condition
- Medication treatment — the doctor can prescribe it together with a transplant to preserve own hair.
- Determining the cause in women — before transplant, hormonal and other causes are ruled out — hormones, iron, thyroid gland.
- Robotic FUE (ARTAS) — the robot selects follicular units by camera images and excises them according to given parameters; the surgeon controls the process and forms the hairline.
- Manual FUE — follicles are extracted individually using a fine tool; small dot-like scars remain, barely noticeable under the hair.
- FUT — strip method — a strip of skin is removed from the back of the head and divided into grafts; a linear scar remains, hidden by hair.
- BHT — body hair — if donor hair on the back of the head is insufficient, follicles are additionally taken from the beard or body.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend photos of your head from several angles and, if available, test results and a list of medications you have already tried.
- ConsultationExamination of the hair and donor area, identification of the cause of thinning; if necessary — further examination.
- PlanWhether medication is needed now, whether a transplant is appropriate and when; how many grafts can be taken considering future hair loss.
- TreatmentMedication treatment or hair transplant — using the ARTAS robot, manual FUE, or FUT.
- Follow-upThe growth of transplanted hair is assessed after several months; medications, if prescribed, are continued.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Can androgenetic alopecia be cured?
It can be slowed down, and in some people, part of the hair can be restored. According to the NHS, medicines do not help everyone and only work as long as they are used: after stopping, the hair loss continues.
When will the results from the medicine be visible?
For finasteride, according to the NHS, improvement can be expected in 3–6 months. Whether the treatment works for you is assessed by the doctor at a follow-up appointment.
Is finasteride safe?
Many people take it for months or years without problems, but in more than 1 in 100 there are sexual side effects, sometimes even after stopping. Rarely, there is depressed mood — in that case, the drug is stopped immediately and a doctor is consulted.
Can women take finasteride?
According to the NHS, finasteride is not recommended for women. For women, the main treatment is minoxidil.
Which is better — minoxidil solution or tablets?
In a meta-analysis of 4 studies, hair density did not differ, but pills more often caused excess hair growth on the face and body. What suits you is decided by a doctor taking into account blood pressure, heart, and other medications.
When should one think about a transplant?
When hair loss has stabilized, the cause has been determined, and there is enough hair on the back of the head. The natural hair around the transplanted area may continue to thin, so medication is often continued.
Do shampoos or rosemary oil help?
The Canadian consensus does not recommend rosemary oil, caffeine, or herbal remedies; shampoo with ketoconazole is recommended with almost unanimous expert agreement — as part of treatment, not instead of medication.
Sources
19 sources · European guidelines, consensuses, Cochrane review, meta-analyses, and NHSshowCollapse
- Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men - short versionJournal of the European Academy of Dermatology and Venereology, 2018doi:10.1111/jdv.14624 ↗
- S1 guideline for diagnostic evaluation in androgenetic alopecia in men, women and adolescentsBritish Journal of Dermatology, 2011doi:10.1111/j.1365-2133.2010.10011.x ↗
- A Canadian Consensus on Androgenetic Alopecia: Approach and ManagementJournal of Cutaneous Medicine and Surgery, 2025doi:10.1177/12034754251368849 ↗
- [Translated article] Recommendations on the Clinical Management of Androgenetic Alopecia: A Consensus Statement From the Spanish Hair Disorders Group of the Spanish Academy of Dermatology and Venererology (AEDV)Actas Dermo-Sifiliográficas, 2024doi:10.1016/j.ad.2023.10.043 ↗
- Interventions for female pattern hair lossCochrane Database of Systematic Reviews, 2016doi:10.1002/14651858.CD007628.pub4 ↗
- The effectiveness of treatments for androgenetic alopecia: A systematic review and meta-analysisJournal of the American Academy of Dermatology, 2017doi:10.1016/j.jaad.2017.02.054 ↗
- Comparative Efficacy of Minoxidil and 5-Alpha Reductase Inhibitors Monotherapy for Male Pattern Hair Loss: Network Meta-Analysis Study of Current Empirical EvidenceJournal of Cosmetic Dermatology, 2025doi:10.1111/jocd.70320 ↗
- Efficacy and safety of oral minoxidil versus topical solution in androgenetic alopecia: a meta-analysis of randomized clinical trialsInternational Journal of Dermatology, 2025doi:10.1111/ijd.17524 ↗
- Safety of low-dose oral minoxidil for hair loss: A multicenter study of 1404 patientsJournal of the American Academy of Dermatology, 2021doi:10.1016/j.jaad.2021.02.054 ↗
- Oral minoxidil treatment for hair loss: A review of efficacy and safetyJournal of the American Academy of Dermatology, 2021doi:10.1016/j.jaad.2020.06.1009 ↗
- Adverse Sexual Effects of Treatment with Finasteride or Dutasteride for Male Androgenetic Alopecia: A Systematic Review and Meta-analysisActa Dermato-Venereologica, 2019doi:10.2340/00015555-3035 ↗
- Investigation of Suicidality and Psychological Adverse Events in Patients Treated With FinasterideJAMA Dermatology, 2021doi:10.1001/jamadermatol.2020.3385 ↗
- Risk of Depression Associated With Finasteride TreatmentJournal of Clinical Psychopharmacology, 2021doi:10.1097/JCP.0000000000001379 ↗
- Treatment options for androgenetic alopecia: Efficacy, side effects, compliance, financial considerations, and ethicsJournal of Cosmetic Dermatology, 2021doi:10.1111/jocd.14537 ↗
- Hair lossNHS, 2024nhs.uk/symptoms/hair-loss ↗
- Side effects of finasterideNHS, 2023nhs.uk/medicines/finasteride/side-effects-of-finasteride ↗
- Common questions about finasterideNHS, 2023nhs.uk/medicines/finasteride/common-questions-about-finasteride ↗
- Who can and cannot take finasterideNHS, 2023nhs.uk/medicines/finasteride/who-can-and-cannot-take-finasteride ↗
- Hair transplantNHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/hair-transplant ↗
The figures on the page are from these sources.
Hair thinning —
where to start?
Send photos of the head from multiple angles. The doctor will advise on how to start treatment and whether a transplant is appropriate.