About hair loss
Hair loss is common and has many causes. The most frequent pattern — affecting around 50% of men and 25% of women in Ireland to some degree by their 50s — is androgenetic alopecia (male- or female-pattern hair loss). Other patterns include telogen effluvium (diffuse shedding after a stressor), alopecia areata (patchy autoimmune loss), and scarring alopecias. Identifying the type guides treatment.
Symptoms and signs by type
Per NICE CKS:
- Male-pattern (androgenetic): gradual receding hairline at the temples and crown thinning
- Female-pattern: gradual diffuse thinning across the top of the scalp; frontal hairline usually preserved
- Telogen effluvium: sudden diffuse shedding 2–3 months after a trigger (stress, illness, surgery, postpartum, weight loss, iron deficiency, thyroid imbalance, certain medications)
- Alopecia areata: smooth round patches of complete hair loss; can affect any body site; often autoimmune
- Scarring alopecia: hair loss with visible scalp inflammation, redness, scaling, or scarring — needs specialist review
When to seek help — and when specialist review is needed
An Online Doctor consultation is appropriate for: typical androgenetic alopecia, telogen effluvium after a clear trigger, and discussing treatment options. Seek in-person or dermatology review for: patchy hair loss (alopecia areata or other causes); any sign of scalp scarring, redness, scaling, or inflammation; sudden severe hair loss; hair loss with systemic symptoms (rash, joint pain, fatigue); rapid onset hair loss in a young woman; or significant psychological distress that warrants in-person support.
Investigation
For diffuse hair loss the Online Doctor may recommend blood tests including: full blood count, ferritin (iron stores), thyroid function, and sometimes vitamin D. Low ferritin (especially below 30 ng/mL) and hypothyroidism are common reversible contributors. Hormonal investigation (testosterone, DHEAS) may be relevant in women with signs of androgen excess.
Treatment options
Per NICE and dermatology guidance:
- Topical minoxidil — applied to the scalp once or twice daily. Slows progression and modestly regrows hair in many men and women. Effects appear over 3–6 months; needs continued use to maintain
- Oral finasteride — for men with androgenetic alopecia. Blocks DHT (the hormone driving hair loss). Slows progression and may modestly regrow hair in around two-thirds of men. Side effects (rare but include sexual side effects) require informed discussion
- Oral dutasteride — selected cases under specialist guidance
- Address reversible causes — iron supplementation if low ferritin; thyroid treatment if abnormal; medication review
- Specialist referral for alopecia areata (intralesional steroids, JAK inhibitors), scarring alopecias, or extensive hair loss
- Cosmetic options — wigs, hair systems, hair transplantation — discussed alongside medical treatment
Self-care and lifestyle
Be gentle with your hair — avoid tight styles that pull at the hairline (traction alopecia), excessive heat or chemical treatments. Eat a balanced diet adequate in iron, protein, and zinc. Manage stress where possible. Most over-the-counter "hair growth" supplements lack strong evidence — beware of marketing claims. Most importantly: have realistic expectations. Medical treatment slows progression and modestly improves hair density — it doesn't typically restore a full head of hair.
Frequently asked questions
Can I get finasteride from an Online Doctor?
Yes — for adult men with androgenetic alopecia who have been informed of the benefits, side-effect profile, and need for ongoing use. The Online Doctor will discuss the rare but important sexual side effects and other considerations. Finasteride is not appropriate for women of reproductive age.
Does stress cause hair loss?
Significant stress can trigger telogen effluvium — diffuse shedding starting 2–3 months after the stressor. The good news: it's usually reversible. Hair regrowth typically begins within 6 months of the trigger being resolved.
Will my hair loss be permanent?
Depends on the type. Androgenetic alopecia is progressive without treatment but slows or improves with minoxidil/finasteride. Telogen effluvium is usually reversible. Alopecia areata often regrows but may recur. Scarring alopecias may cause permanent loss without prompt treatment — hence early specialist review matters.
What about hair transplants?
Hair transplantation (FUE, FUT) can be very effective for stable androgenetic alopecia, particularly in men. Most reputable clinicians recommend stabilising hair loss with medical treatment (minoxidil ± finasteride) first, then transplantation for definitive results. Cost is significant and it's not covered by HSE.
Sources: HSE.ie, NICE CKS Scalp and Hair Disorders, British Association of Dermatologists, Irish Skin Foundation. General information only.