Hair loss at the nape of your neck? It could be alopecia retrograde

When most people think of hair loss, they picture a receding hairline or a thinning crown. But what about the nape of the neck? If you’re noticing hair thinning or significant hair loss along the lower edge of your scalp, you could be dealing with a less common but equally frustrating condition: alopecia retrograde.

Unlike male pattern baldness, which typically moves from front to back, retrograde alopecia works in reverse, affecting the lower hairline and creeping upward [1].

It’s a slow burn, but over time, it can lead to complete hair loss in the nape area, making it particularly tricky to manage and conceal.

So, why does it happen? Like other forms of alopecia, retrograde alopecia is tied to a complex mix of genetic factors, hormonal imbalances, and chronic scalp stress. But what makes it different is the way it targets the scalp donor area (the very region often used for hair transplant surgery).

This makes the condition especially challenging to treat, as the hair follicles in the nape can become weak, thin, and less reliable as donor sites [2]. Whether you’re dealing with a few stray patches or more widespread hair loss, understanding the signs, causes, and treatment options for alopecia retrograde is key to getting ahead of the shedding.

What is alopecia retrograde?

Alopecia retrograde, also known as retrograde alopecia, is a form of hair loss that primarily affects the nape of the neck.

Unlike the more familiar androgenetic alopecia (commonly called male pattern baldness), which typically starts at the temples and crown, retrograde alopecia progresses from the bottom up. [3] Think of it as the hairline going in reverse — a gradual, creeping thinning that moves from the neck toward the crown.

What sets retrograde alopecia apart from other types of hair loss is its impact on the scalp donor area. This region is typically considered the gold standard for hair transplantation, as it tends to have the most resilient hair follicles.

But when retrograde alopecia strikes, even these supposedly “safe” areas can experience gradual thinning, making them less viable for hair transplant surgery. And because the condition can lead to eventual follicular death, it’s crucial to address it before the hair follicles become permanently damaged.

Retrograde alopecia can also coexist with other forms of alopecia, such as androgenetic alopecia or alopecia areata [2]. This can make diagnosing the condition more complex, as the scalp biopsy may reveal multiple overlapping hair loss patterns.

While male pattern baldness typically follows a predictable trajectory, retrograde alopecia is less predictable and may spread unevenly, affecting the nape, sides, and lower scalp in varying degrees.

What causes alopecia retrograde?

Retrograde alopecia doesn’t just happen overnight. It’s often triggered by a combination of genetic factors, hormonal imbalances, and external stressors that disrupt scalp health.

Unlike the predictable pattern of male pattern baldness, retrograde alopecia likes to mix things up — starting low, working its way up, and leaving you wondering why the scalp donor area suddenly looks more like a barren wasteland than a reliable source of hair follicles [1].

Hormonal imbalances and androgenic alopecia

If your hair follicles are getting thinner by the day, you can probably thank DHT, the hormone behind most cases of androgenic alopecia. It binds to the hair follicles, shrinking them down and slowing down hair growth cycles [4].

And, while most guys notice it first around the frontal hairline and crown, retrograde alopecia likes to sneak up on you from behind (literally). The nape of the neck becomes ground zero, with gradual thinning and eventual follicular death that can turn a once-thick donor area into a patchy zone of significant hair loss.

Scalp tension and chronic irritation

If you’re the kind of guy who lives in a baseball cap or tight hairstyles, listen up. Constant tension on the scalp tissue can restrict blood flow, starving your hair follicles of the oxygen and nutrients they need to stay put.

Over time, that stress can turn into chronic irritation and retrograde hair loss [1]. And unlike male pattern baldness, which has a predictable trajectory, retrograde alopecia can hit in patches, leaving your scalp donor area looking sparse and uneven.

Genetic predisposition and autoimmune factors

If your dad or grandad had that telltale nape thinning, chances are you’re in the running too. Retrograde alopecia often runs in families, thanks to genetic factors that make your hair follicles more sensitive to DHT and other hormones [4].

But it’s not just about what’s in your DNA. Autoimmune disorders can also trigger hair loss at the nape of the neck, as the immune system decides to go rogue and start attacking healthy hair follicles as if they were foreign invaders. The result? Gradual thinning that can look like diffuse alopecia areata, minus the classic round patches.

At what age does retrograde alopecia start?

Unlike male pattern hair loss, which often starts its slow creep in your late 20s or early 30s, retrograde alopecia is less predictable.

It can show up as early as your 20s or wait until your 40s to start thinning out the nape of your neck, and it often begins subtly, just a few thinning patches along the lower hairline that you might mistake for normal shedding.

What makes retrograde alopecia particularly tricky is how it can fly under the radar for years before becoming noticeable. Unlike the classic receding hairline or bald spot at the crown, this form of hair loss doesn’t follow the usual roadmap.

Instead, it slowly eats away at what was once considered a safe zone (the scalp donor area). Over time, that gradual thinning can lead to complete hair loss in the nape, making it tougher to find donor hair for hair transplant surgery if you decide to go that route later on.

If you have a family history of alopecia, especially androgenetic alopecia, you’re more likely to develop retrograde hair loss earlier. But it’s not just about genetics. Chronic scalp irritation, hormonal changes, and even scalp infections can all accelerate the process, pushing hair follicles into the telogen phase sooner than expected.

The bottom line? Keep an eye on the nape, because what starts as a little thinning can turn into a lot of diffuse alopecia if left unchecked.

How to treat retrograde alopecia

When it comes to treating retrograde alopecia, the goal is twofold: slow down the thinning hair and protect the remaining hair density.

The first step? Address any underlying factors that could be accelerating hair loss, like hormonal imbalances or chronic scalp irritation.

If you’re dealing with permanent hair loss at the nape of the neck, surgical hair restoration might be an option, but it’s not always a straightforward fix. Because retrograde alopecia affects the scalp donor area, those hair follicles may not be as robust as other parts of the scalp, making them less suitable for hair transplant procedures.

For those not ready to go under the knife, there are other hair loss treatments worth exploring. Low-level laser therapy can stimulate blood flow to the scalp, promoting healthier hair growth in areas experiencing gradual thinning.

For those experiencing symptoms of retrograde alopecia (such as itchiness, tenderness, or scalp inflammation), a targeted scalp treatment plan can help calm irritation and support hair health.

And then, there's Pilot. If you’re noticing hair loss creeping up from the nape of your neck, Pilot’s hair loss treatment is designed to address it head-on.

Pilot's clinical hair loss treatment is tailored to your individual hair concerns, and with online consults with an Aussie practitioner, you can get to the root cause of your hair loss. From here, your Pilot practitioner will create a customised treatment for you.

Your formula is delivered discreetly to your door, and you can access unlimited practitioner follow-ups if and when you need them. And the results speak for themselves: 90% of men on either kept or regrew their hair when using one of the treatment options Pilot can provide.

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