ENHair loss is not one disease but several, caused by a hormone, an immune attack or a problem elsewhere in the body. So hair loss treatment in Germany starts with naming the form, not with a prescription: what helps one form is useless for another, and without a diagnosis any course is a lottery.
Below: how the forms are told apart, which tests and treatments fit each, where transplantation comes in and what to bring. Overview: Dermatology in Germany.
The forms of hair loss
Alopecia treatment in Germany depends on which of four groups the loss falls into: androgenetic, patchy (alopecia areata), diffuse or scarring. The commonest in both sexes is androgenetic: an inherited sensitivity to the hormone dihydrotestosterone shrinks follicles until no full hair grows. Men lose hair at the temples and crown, women along the parting, a pattern a dermatologist sees at a glance.
In alopecia areata, an autoimmune condition, the immune system attacks the body’s own follicles: hair falls out in round patches, sometimes also from beard, brows or body, often first in childhood or adolescence, and may regrow on its own and fall out again, unpredictably.
Diffuse (telogen) shedding, an even thinning, follows childbirth, severe illness, surgery, rapid weight loss, some medicines, iron deficiency or thyroid disease; the cause is treated, not the hair. Scarring alopecias destroy follicles for good, so suspected scarring needs a dermatologist urgently: time works against the patient.
How it is investigated in Germany
The work-up has three steps: examination, blood tests, and a biopsy if needed. The dermatologist asks how and when the loss began and what was tried, checks scalp, brows and nails and performs trichoscopy, a magnified camera examination. Photographs are kept for comparison; a gentle tug (the pull test) shows how many hairs come loose.
Usual tests: ferritin and other iron values, thyroid hormones, vitamin D, where indicated zinc and a blood count, and for women with a suspected endocrine cause a hormone profile (see hormone tests in Germany). Have them done at home first, from the clinic’s list, or the first visit goes on ordering them.
A scalp biopsy, a small procedure under local anaesthesia whose sample a pathologist examines, is taken if scarring is suspected or the picture is atypical. The current German guideline sets out how alopecia areata is diagnosed and treated.
What is used for each form
Treatment depends on the form. In androgenetic alopecia the European guideline recommends scalp minoxidil for adults of both sexes and, for men, finasteride, whose 1 mg tablets and spray are authorised in various EU countries for men aged 18 to 41 years with early-stage hair loss. The European Medicines Agency has confirmed that finasteride tablets can cause suicidal thoughts: mood changes mean stopping them and seeing a doctor. Women do not take finasteride, but excess male hormones may call for an anti-androgen. Low-level laser is an accepted add-on; platelet-rich plasma and micro-injections lack good evidence. Effects take months, and the loss resumes once medicines stop.
In alopecia areata, small patches get corticosteroid creams, solutions or, in adults, injections; extensive disease, oral corticosteroids or other systemic drugs. Topical immunotherapy is an option, though its agent is no longer made in Germany. For severe disease the EU has authorised two JAK inhibitors, baricitinib and ritlecitinib, both for patients aged 12 and over. They need an experienced prescriber, blood checks, tuberculosis and hepatitis screening and a prior talk on contraindications, vaccinations and follow-up. People aged 65 or over, smokers and those at high risk of heart attack, stroke or cancer get them only if no suitable alternative exists.
Diffuse shedding means correcting deficiencies, treating thyroid disease and reviewing medication with the doctor, never stopping it alone; scarring forms need inflammation halted before more follicles die, as scarred skin grows no hair.
Is there a best treatment, and when transplantation comes up
There is no single best hair loss treatment, in Germany or anywhere: it depends on form, sex, age, duration and other illnesses. What helps androgenetic alopecia does nothing for alopecia areata and vice versa, so distrust any course promising results without a diagnosis.
Transplantation comes up once the loss has stabilised and there is enough donor hair; it does not replace treating the cause, and the European guideline suggests men combine it with finasteride. See hair transplant clinics in Germany and hair transplant: which country to choose.
What to bring and where it is treated
Bring scalp photographs from recent months, earlier results, a list of medicines and supplements, notes on past treatment and its duration and, for women, pregnancies, births and hormonal contraception: without a timeline and photographs a doctor cannot judge the pace of loss.
One example, not a ranking: the Department of Dermatology, Venereology and Allergology at the Charité in Berlin, whose deputy director Professor Ulrike Blume-Peytavi also co-leads its centre for hair diseases. The centre takes severe alopecia areata, scarring forms, chemotherapy-related hair loss and children, and refers androgenetic alopecia to private-practice dermatologists. University dermatology departments and their specialist clinics handle complex forms; what each offers is confirmed by enquiry.
Frequently asked questions
Can alopecia be cured completely?
It depends on the form. Diffuse shedding usually stops once its trigger is removed; androgenetic alopecia slows under treatment but resumes without it; alopecia areata can recede and return; and in scarring forms destroyed follicles never recover, so treatment only halts the process.
How soon does treatment show results?
Only after several months. Androgenetic alopecia is usually reassessed after about six months, and finasteride often shows a visible effect only after 6 to 12 months. Minoxidil can briefly increase shedding at the start, so compare photographs rather than hairs on a brush.
Do vitamins help with hair loss?
Only if a blood test has shown a deficiency. Germany’s Federal Institute for Risk Assessment does not currently recommend supplements in androgenetic alopecia without a proven deficiency, and the German alopecia areata guideline finds no grounds to recommend them. A doctor then sets the dose.
How AlenMed organises treatment
After the first contact, a medical interpreter translates results and reports, which go with the photographs to a dermatology department; its reply says if an in-person visit is needed and which tests are missing. Medical visa papers are prepared alongside.
AlenMed has 86 partner hospitals in 38 cities and 345 doctors, with its office in Munich. A coordinator books appointments, interprets at consultations, helps with prescriptions and arranges a remote photo review months later.
This material is for information only and is not an offer. Treatment is decided by a doctor at a face-to-face examination.