Hair loss (alopecia) in Australian adults: causes, tests, treatment

What hair loss actually is

Hair loss — clinically called alopecia — is one of the most common reasons adults see a GP about their skin. It is a normal part of life that hair sheds and regrows on a cycle, but several conditions can disrupt that cycle and produce noticeable thinning, patches, or diffuse shedding. Around half of men and about 40 per cent of women have some degree of patterned hair loss by age 50, and roughly 1.7 per cent of people experience at least one episode of alopecia areata in their lifetime.

The emotional weight of hair loss often does not match how clinicians talk about it. For many people — particularly women, and people losing eyebrows or eyelashes — it affects self-image, work confidence, and relationships in ways that deserve to be taken seriously. The mental health side of hair loss is part of good care, not an optional extra.

This page explains the four broad patterns of adult hair loss, how Australian GPs investigate, what treatment involves, and when to seek prompt help. For background reading, HealthDirect, Better Health Channel, and DermNet provide good consumer-friendly overviews.

The four main patterns

Androgenetic alopecia (genetic patterned hair loss)

Androgenetic alopecia is the most common form. It runs in families and is driven by hair follicles being genetically sensitive to a hormone called dihydrotestosterone (DHT), which gradually shrinks the follicles over years. In men it produces the classic Hamilton-Norwood pattern — receding temples and a thinning crown that can progress to a bald vertex. In women it usually shows up as a widening centre part with diffuse thinning across the top of the scalp (the Ludwig or Sinclair patterns), often described as a “Christmas tree” pattern when viewed from above. Both sexes can be affected from their twenties onwards.

Alopecia areata (autoimmune patchy loss)

Alopecia areata is an autoimmune condition in which the immune system attacks growing hair follicles. It typically appears as one or more smooth, round, coin-sized patches with no redness, scaling, or scarring. In some cases it progresses to alopecia totalis (loss of all scalp hair) or alopecia universalis (loss of all body hair, including eyebrows and eyelashes). About 10 to 25 per cent of people with alopecia areata have a family history, and around 15 per cent have another autoimmune condition such as thyroid disease, vitiligo, or type 1 diabetes. Onset can be sudden. Spontaneous regrowth occurs in about half of people with limited disease within a year, though relapses are common. The Australia Alopecia Areata Foundation provides peer support and patient information.

Telogen effluvium (diffuse shedding after a trigger)

Telogen effluvium is a temporary, diffuse shedding two to four months after a trigger. It happens because a large proportion of follicles synchronise into the resting (telogen) phase together and then shed when the next growth cycle begins. Common triggers include serious illness or surgery, childbirth (postpartum hair loss), significant weight loss or crash dieting, severe stress, iron deficiency, thyroid dysfunction, and starting or stopping various medications. Hair loss following a COVID-19 infection has been particularly common over recent years. The reassuring point is that the follicles themselves are healthy — they simply restart their cycle and most people recover within six to twelve months, especially once the underlying cause is addressed.

Scarring (cicatricial) alopecias

Scarring alopecias are a smaller but clinically important group of conditions in which inflammation destroys the follicle and replaces it with scar tissue, so hair will not regrow from those follicles. Examples include lichen planopilaris, frontal fibrosing alopecia (a postmenopausal pattern affecting the front hairline and eyebrows), central centrifugal cicatricial alopecia, and folliculitis decalvans. Warning signs include redness or scaling around the edge of the loss, persistent itch or burning, pustules, and smooth shiny skin where the follicle openings have disappeared. Because the damage is permanent, early specialist treatment matters — and this is the one form of hair loss that needs urgent referral rather than a wait-and-see approach.

What causes it

Hair loss usually has more than one contributor. Common ones to think about include:

• Genetics — strongly familial in androgenetic alopecia and present in many cases of alopecia areata.
• Hormones — DHT in androgenetic patterns; thyroid dysfunction (both under- and overactive thyroid); polycystic ovary syndrome; postpartum hormonal changes; perimenopause and menopause.
• Iron deficiency — low ferritin commonly contributes to diffuse shedding, particularly in women.
• Vitamin and protein status — vitamin D, vitamin B12, and severe protein restriction can all play a role.
• Medications — anticoagulants, retinoids, anticonvulsants, beta-blockers, lithium, allopurinol, certain antidepressants, and chemotherapy are recognised triggers.
• Recent illness or stress — COVID-19, major surgery, hospital admission, severe psychological stress, and significant weight loss are classic precipitants of telogen effluvium.
• Autoimmune disease — alopecia areata, lupus, thyroid disease, vitiligo.
• Hair care practices — tight braids, weaves, chemical relaxers, and prolonged heat or traction can produce a specific pattern of damage.
• Scalp infections — fungal infection (tinea capitis) in children and some adults.

How GPs investigate

A careful clinical assessment usually tells your GP a lot before any tests are ordered.

History. Your GP will ask when the loss started, whether it was sudden or gradual, whether it is patchy or diffuse, whether you have noticed scarring or scalp symptoms, what your family history is, what medications you take, what you have been through in the past three to six months (illness, surgery, childbirth, stressful life events), and how it is affecting you emotionally. Diet, weight changes, menstrual cycle in women, and hair care practices are all relevant.

Examination. Inspection of the scalp pattern, a gentle pull test (more than about 10 per cent of hairs coming out with traction suggests active shedding), and increasingly dermoscopy — a magnified view of the scalp that helps distinguish patterns and pick up features like the “exclamation mark hairs” of alopecia areata.

Blood tests. For diffuse or unexplained loss, Therapeutic Guidelines and DermNet support a baseline panel: full blood count, ferritin, thyroid function (TSH), vitamin D, vitamin B12, and fasting glucose. In women with menstrual irregularity, acne, or unwanted facial hair, additional hormonal tests for polycystic ovary syndrome are appropriate. The Cochrane review of female pattern hair loss supports treating iron deficiency where ferritin is below about 30 micrograms per litre.

Scalp biopsy. A small (4 mm) punch biopsy may be arranged where the pattern is unclear or where scarring alopecia is suspected. This is usually done by a dermatologist.

Specialist referral. Any suspicion of scarring alopecia, severe or rapidly progressive alopecia areata, refractory androgenetic alopecia, or diagnostic uncertainty is a reasonable trigger for dermatology referral.

Treatment overview

Treatment depends on the type of hair loss. The summary below is general — the right choice for you involves a conversation with your GP and, in many cases, a dermatologist.

Androgenetic alopecia

The most widely used options in Australia are:

• Topical minoxidil — available over the counter, applied to the scalp twice daily. Effects appear over three to six months; benefits reverse if treatment stops. A short period of increased shedding in the first few weeks is common and not a sign of failure.
• Oral finasteride — for men, a 5-alpha-reductase inhibitor that reduces DHT. Effective in roughly 80 per cent of men for stabilising loss or producing regrowth. Side effects include a small risk of sexual side effects (around 2 to 4 per cent), and it is not used in women of reproductive age because it can harm a developing male foetus. It is not PBS-listed for hair loss in Australia — private prescription only.
• Spironolactone — used off-label in women, particularly when polycystic ovary syndrome contributes to the picture.
• Oral dutasteride — a more potent 5-alpha-reductase inhibitor, used off-label for hair loss under specialist guidance.
• Combined approaches — low-level laser therapy, microneedling with topical minoxidil, platelet-rich plasma (PRP) injections, and oral minoxidil at low dose are all options some clinicians use, generally with specialist input.
• Hair transplantation — a definitive cosmetic option for stable disease, performed by hair restoration surgeons.

Treatment for androgenetic alopecia is generally a long-term commitment because the underlying genetic process continues.

Alopecia areata

• Limited patchy disease — intralesional corticosteroid injections (small injections directly into the bald patches) every four weeks for three to six cycles; superpotent topical corticosteroids; and sometimes topical minoxidil as an adjunct.
• Severe disease (more than half the scalp affected, totalis, or universalis) — Australian dermatologists can now use a newer class of medicines called JAK inhibitors. Baricitinib is TGA-approved and PBS Authority Required for severe alopecia areata in adults; ritlecitinib access is emerging. The NICE TA871 evaluation covers the evidence for baricitinib. Older systemic medicines such as methotrexate or ciclosporin remain options where JAK inhibitors are not suitable.
• Wigs and scalp prosthetics — an important part of care for many people; some health insurance and charity programs help with cost.
• Mental health support — a routine and legitimate part of treatment, including via a Mental Health Treatment Plan with your GP.

Telogen effluvium

The mainstay is identifying and addressing the trigger. Replenishing iron stores where ferritin is low, treating thyroid dysfunction, reviewing medications that may be contributing, restoring adequate nutrition (particularly protein) during weight loss, and managing psychological stress all help. Most cases resolve within six to twelve months without specific therapy. Topical minoxidil is sometimes used as an adjunct. Gentle reassurance — that the follicles are healthy and the hair will come back — is often the most important intervention.

Scarring alopecias

These require dermatology specialist care. Treatment aims to control the inflammation and stop progression — early treatment preserves the hair that remains. Because the damage is permanent, time matters.

Lifestyle, mental health, and practical strategies

Whatever the diagnosis, some general points support recovery and wellbeing:

• Address deficiencies — iron, vitamin D, B12, and thyroid where the tests show a problem.
• Avoid crash diets — severe caloric or protein restriction is a common telogen effluvium trigger.
• Gentle hair care — avoid tight braids, weaves, chemical relaxers, and excessive heat that can produce traction or chemical damage.
• Mental health support — alopecia of any cause can affect mood, anxiety, and self-image. Australian Better Access psychology sessions (up to 10 per year) are available via a Mental Health Treatment Plan with your GP.
• Peer support — the Australia Alopecia Areata Foundation and online communities reduce isolation.
• Cosmetic strategies — concealers, hair-thickening fibres, and wig and prosthetic services can substantially improve daily quality of life.
• Avoid “miracle” supplements — vitamins and supplements help only when they correct a measured deficiency. Biotin in particular can interfere with thyroid and cardiac blood tests if taken in high doses.

When to see your GP

Reasonable triggers to book a GP appointment include:

• Diffuse shedding that has lasted more than two to three months
• Patchy hair loss
• Hair loss after illness, surgery, childbirth, or starting a new medication
• A widening part or visible scalp where there used to be coverage
• Loss of eyebrows or eyelashes
• A meaningful effect on mood, confidence, or daily life

When to seek help urgently

The features below warrant a prompt review — and in the case of scarring patterns, urgent referral to a dermatologist:

• Redness, scaling, pustules, or persistent itch or pain in the scalp — possible scarring alopecia
• Smooth, shiny patches where the follicle openings have disappeared — possible scarring alopecia
• Rapidly progressive patchy loss — particularly with loss of eyebrows or eyelashes
• Hair loss with broken hairs and scaling in a child — possible fungal infection (tinea capitis)
• Hair loss alongside systemic features — unexplained weight change, fatigue, palpitations, or fevers
• Significant mental health impact — distress, low mood, or thoughts of self-harm warrant urgent support; Lifeline 13 11 14 and Beyond Blue 1300 22 4636 are available around the clock

What this article is and is not

This is general health information drawn from current Australian clinical sources — Therapeutic Guidelines (eTG complete), the Australasian College of Dermatologists, the RACGP, the Australian Medicines Handbook, HealthDirect, Better Health Channel, and DermNet — alongside the Cochrane review of female pattern hair loss and the NICE TA871 evaluation of baricitinib. It is not personal medical advice and does not create a doctor-patient relationship. Treatment decisions — including whether and how to investigate, which medications are appropriate, and when to seek specialist input — are made together with your own GP and specialist clinicians.

For Australian consumer-friendly information: HealthDirect — Hair loss · Better Health Channel — Hair loss · Australia Alopecia Areata Foundation · DermNet — Hair loss.

For acute mental health crisis: Lifeline 13 11 14 · Beyond Blue 1300 22 4636.

---

Sources cited

1. Therapeutic Guidelines — eTG complete (Dermatology — Alopecia)
2. Australasian College of Dermatologists — Alopecia position statements
3. RACGP — Clinical resources
4. Australian Medicines Handbook
5. HealthDirect — Hair loss
6. Better Health Channel — Hair loss
7. DermNet — Hair loss / alopecia
8. Australia Alopecia Areata Foundation (AAAF)
9. Cochrane — Interventions for female pattern hair loss
10. NICE TA871 — Baricitinib for severe alopecia areata (2023)