First receding temples, then a bald spot and finally only a hair ring remains on the back of the head. Why does this surprise most men? And can something be done about it?

“As the age increases, the hair follicles age,” says Tristan van Dongen. He works as a doctor at Erasmus MC in Rotterdam and focuses on hair loss. “This reduces the number of new hairs and makes the remaining hair thinner and grayer.”

In men, this process can be accelerated by dihydrotestosterone (DHT), a conversion product of the “male-hormone” testosterone. Van Dongen: “Simply put, it comes down to DHT shrinking the hair follicles and allowing them to slowly close, causing the hair to eventually disappear.”

DHT plays a less significant role in balding women, mainly because they produce less testosterone than men. Why some women get bald prematurely is not yet clear. “The hair follicles are likely to produce less estrogen, which changes the hair growth cycle. Normally, estrogen protects the hair follicles.”

To a large extent, men losing their hair is genetically determined. There are also differences between population groups on this point. That way white men suffer more. The way balding men lose their hair is almost always the same. First the coves on the front become larger. Then the hair on top of the head becomes thinner. And finally there is a wreath of hair around the ears and the back of the head.


This is due to the anatomy of the head. Van Dongen: “On top of the head, under the skin, there is a large tendon leaf that connects different skull muscles. Due to, among other things, the growth of our heads, the skull muscles are pulling tighter on the tendon leaf. Research shows that the traction is greatest at the areas of the coves and the crown.”

The tension on the tendon ensures that the blood flow decreases and the pressure on the hair follicles increases, which in combination with the DHT causes the hair to slowly disappear. The fact that the hair around the ears and on the back of the head does not fall out is due to the fact that there is no tendon leaf, but well-blooded muscles under the skin.


Men who want to keep their hair must take measures early. “The sooner you are taking measures, the better the result will be. The chance is then greater that the hair follicles can still be saved. This can be done with a topical solution to improve blood circulation or tablets that inhibit the production of DHT. That treatment is lifelong.”

Men with a head as smooth as a bowling ball do not need to hope for a miracle. “With a hair transplant you rarely get a good result in that case, because there is no longer enough donor area to cover the entire top.”

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