Baldness on the crown of the head
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Hair thinning at the crown of the head refers to progressive thinning of the hair in the vertex area, most commonly observed in men but also occurring in women. Clinically, this is a typical location for androgenetic alopecia (AGA) – a chronic, genetically predisposed condition of hair follicles dependent on androgens. This process involves the gradual miniaturization of hair follicles, shortening of the anagen (growth) phase, and lengthening of the telogen (resting) phase. As a result, the hair becomes thinner, shorter, and lighter until it eventually becomes clinically invisible. Hair loss in this area can also have other causes, thus requiring dermatological differentiation and, in selected cases, systemic diagnostics.
Hair loss on the top of the head – causes
The most common cause of hair loss in the vertex area is androgenetic alopecia. The mechanism involves the hypersensitivity of hair follicles to dihydrotestosterone (DHT), an active derivative of testosterone formed with the help of the enzyme 5-alpha-reductase. In genetically predisposed individuals, DHT leads to:
- shortening of the anagen phase,
- miniaturization of hair follicles,
- replacement of terminal hairs with vellus hairs,
- reduction in hair density and diameter.
Other possible causes of hair loss on the top of the head include:
- telogen effluvium – diffuse hair shedding following stress, infection, surgery, pregnancy;
- alopecia areata – an autoimmune disease leading to focal hair loss;
- scarring alopecia – associated with permanent follicle destruction (e.g., in the course of lichen planopilaris);
- chronic inflammatory conditions of the scalp (seborrheic dermatitis, fungal infections);
- mechanical factors (chronic hair tension – traction alopecia).
In women, hair loss on the top of the head may present as so-called "diffuse central thinning" without receding of the frontal hairline, which distinguishes it from the typical male pattern (Hamilton-Norwood scale).
Hair loss on the top of the head and health problems
Although androgenetic alopecia is a localized skin condition, numerous epidemiological studies indicate its possible connections with systemic disorders, especially in men with early-onset AGA.
The most frequently analyzed associations include:
- metabolic syndrome (visceral obesity, insulin resistance, dyslipidemia),
- arterial hypertension,
- increased risk of ischemic heart disease,
- disorders of carbohydrate metabolism,
- hyperandrogenism in women (e.g., in the course of PCOS).
The mechanisms linking AGA with metabolic diseases include, among others:
- a common genetic background,
- chronic low-grade inflammation,
- microcirculation disorders,
- the effect of androgens on lipid metabolism and insulin sensitivity.
In clinical practice, it is worth considering general diagnostics in patients with:
- sudden worsening of hair loss,
- coexisting abdominal obesity,
- menstrual disorders (in women),
- endocrinological symptoms (e.g., hirsutism, treatment-resistant acne).
Basic tests include: blood count, ferritin, TSH, FT3, FT4, vitamin D, androgen levels (in women), blood glucose, and lipid profile.
Hair loss on the crown of the head – treatment
The treatment of hair loss at the crown of the head depends on the etiology and the degree of advancement of the process. In the case of androgenetic alopecia, topical, general, and procedural therapies are used.
Pharmacological treatment:
- Topical Minoxidil (2–5%) – prolongs the anagen phase, increases hair diameter;
- Finasteride (in men) – type II 5-alpha-reductase inhibitor, reduces DHT concentration;
- Dutasteride – a stronger 5-alpha-reductase inhibitor (used off-label);
- in women: anti-androgen treatment (e.g., spironolactone, after medical consultation).
Procedural therapies used in aesthetic medicine and trichology:
- Needle mesotherapy of the scalp (nutritional cocktails, biomimetic peptides),
- Platelet-rich plasma (PRP),
- treatments using growth factors,
- Carbon dioxide therapy of the scalp,
- Microneedle radiofrequency stimulating angiogenesis and neocollagenesis,
- light therapies (LLLT).
In advanced cases, hair transplantation using the FUE or FUT method is considered, which involves the autologous transfer of hair follicles from the occipital area to the bald area.
The effectiveness of the treatment depends on:
- early initiation of therapy,
- consistency,
- individual response of hair follicles,
- simultaneous correction of systemic factors.
It should be emphasized that follicle miniaturization is a progressive process, so the therapy is long-term and maintenance-oriented. Early intervention increases the chance of halting the process and partially restoring hair density.
