Because the cause is autoimmune rather than hormonal, the treatments that work for pattern hair loss (such as finasteride or minoxidil) do not automatically apply here. The doctor’s review is what determines whether they, or something else, are relevant to your case.
Your path to treatment
1
Start your online visit
Answer a short questionnaire about your health and goal. No in-person appointment, no travel. You’ll know within 24 hours if you’re a candidate.
2
A doctor reviews your case
A licensed doctor reviews your answers personally. If they need clarifications, they message you in the private chat on your account. If treatment is appropriate, they sign an electronic prescription.
3
Review and payment
If the doctor does not approve treatment, the consultation fee is refunded in full.
4
Ongoing support
Private chat with your doctor for questions, a check-in, and renewal before your prescription expires.
How Hi-Doctor handles it
Hi-Doctor’s hair growth consultation is available as an ongoing plan with doctor-reviewed renewals — see pricing for how the plan and refund work. The doctor decides, case by case, whether a treatment is appropriate; nothing is prescribed automatically. See how it works for the full consultation flow.When an in-person specialist matters more
Some presentations of alopecia areata need assessment that an online consultation cannot provide. Where that is the case, the reviewing doctor will say so directly rather than force a fit — declining, or referring you onward, is a normal and expected outcome of the review.Eligibility from anywhere in the EU
The same consultation, doctor-review standard and eligibility checks apply wherever you are in the EU — there is no separate process for a particular country. See how it works for the full flow from questionnaire to doctor decision.Related reading
Alopecia areata is distinct from pattern hair loss, where the cause is hormonal rather than autoimmune — see androgenetic alopecia for that condition and the medicines used for it, such as finasteride. For Hi-Doctor’s safeguards on who decides treatment and what happens when a case isn’t suitable, see safety.Pathophysiology
Alopecia areata is a T-cell-mediated autoimmune condition in which the hair follicle’s immune-privileged state is disrupted (PMID 35492401). In the healthy anagen follicle, immune privilege is maintained by low expression of MHC class I molecules, local production of immunosuppressive factors (TGF-β1, α-MSH, IL-10), and the absence of MHC class II expression on follicular epithelium. In alopecia areata, this protection collapses. Interferon-γ (IFN-γ) upregulates MHC class I and class II on follicular keratinocytes and, via the JAK-STAT pathway, induces IL-15 and chemokines such as CXCL9, CXCL10 and CXCL11. IL-15 acts on CD8+ T cells to promote perforin and granzyme B release, which drives follicular apoptosis. CD8+NKG2D+ T cells are considered the primary effector population; their activation relies on stress-induced ligands (MICA, ULBP3/ULBP6) on the follicle surface (PMID 29791718). The result is premature catagen entry, dystrophic anagen arrest, and non-scarring hair shedding. Why immune privilege breaks in the first place remains debated — proposed triggers include genetic susceptibility (AIRE gene variants), viral infection, and psychological stress — but the final common pathway is a collapse of the intrafollicular immunosuppressive environment.Clinical presentation and diagnostic approach
The clinical hallmark of alopecia areata is one or several well-demarcated, round or oval patches of non-scarring hair loss on the scalp, though any hair-bearing skin can be affected. At the active margin, “exclamation-mark” hairs — short, broken hairs that are narrower at the proximal end — are characteristic on dermoscopy (trichoscopy), together with yellow dots (follicular ostia filled with keratinous material) and black dots (cadaverised hairs). The Severity of Alopecia Tool (SALT) score quantifies scalp involvement by summing the percentage of hair loss across four regions of the scalp. Nail changes — pitting, trachyonychia, Beau’s lines — are common and are more frequent in children and in extensive disease (PMID 29791718). The differential diagnosis includes telogen effluvium (acute diffuse shedding with a preserved parting width, triggered by a physiological stressor 2–3 months earlier), tinea capitis (scaly patches with broken hairs and positive fungal culture), trichotillomania (irregular, angulated patches with hairs broken at different lengths, without true balding), and androgenetic alopecia (patterned, chronic thinning without patches). The distinction is usually made on history and trichoscopy alone; scalp biopsy is reserved for diagnostically uncertain cases and shows peribulbar lymphocytic inflammation (“swarm of bees”) centred on anagen follicles.Start a consultation
Hair-growth consultation
Answer the hair-growth questionnaire and a registered doctor reviews it.
They decide whether treatment is appropriate, which one, and at what dose —
and declining is a normal outcome. See what it costs
and how the review works.