Why Does Hair Fall from the Top of the Head?
In this video, UCLA-trained facial plastic surgeon Dr. Hootan Zandifar—double board-certified by the American Board of Otolaryngology–Head & Neck Surgery and the American Board of Facial Plastic Surgery—answers one of the most common questions he hears at his Beverly Hills practice: why do people lose hair on top of their head but keep it on the sides and back?
The answer lies in genetics and hormones, and understanding it is the first step toward knowing whether an FUE hair transplant may be right for you.
- Androgenic alopecia, driven by the hormone byproduct DHT, is the most common cause of hair loss in both men and women.
- Hair on top of the scalp has DHT-sensitive receptors; hair on the sides and back generally does not—explaining the classic pattern of loss.
- Diffuse, all-over thinning may point to causes other than androgenic alopecia and warrants further medical investigation.
- The DHT resistance of donor-zone follicles is the biological foundation that makes FUE hair transplant results long-lasting.
Androgenic Alopecia: The Root Cause
As Dr. Zandifar explains, the most common cause of hair loss in both men and women is androgenic alopecia, also called male pattern baldness. A byproduct of testosterone called dihydrotestosterone (DHT) binds to receptors on certain hair follicles, causing them to thin and eventually fall out. This process only affects people who carry a genetic predisposition to it.
Because the follicles on top of the scalp carry these DHT-sensitive receptors while those on the sides and back generally do not, hair loss concentrates at the crown and hairline. When thinning appears evenly across the entire scalp, Dr. Zandifar notes that other causes—such as hormone deficiencies, medical conditions, or medication side effects—should be investigated.
Why the Donor Zone Matters for FUE
This receptor difference is precisely what makes FUE (Follicular Unit Extraction) hair transplantation a viable long-term solution. During an FUE procedure, follicles are harvested individually from the DHT-resistant donor area at the back and sides of the scalp—the same region Dr. Zandifar describes as naturally protected from androgenic alopecia.
Because these transplanted follicles retain the genetic characteristics of their donor origin, they continue to resist DHT after being moved to the thinning areas on top of the scalp. This biological principle underpins the durability of FUE results for appropriate candidates.
Candidacy: What Your Hair Loss Pattern Reveals
A clearly defined pattern of loss on the top of the scalp—with a stable, dense donor zone on the sides and back—is a strong indicator of classic androgenic alopecia and often signals good candidacy for FUE. Dr. Zandifar and his team evaluate each patient’s loss pattern, donor density, and overall scalp health before recommending any surgical approach.
Patients whose thinning is diffuse across the entire scalp may require additional medical evaluation to rule out systemic causes before a transplant is considered. A thorough consultation is the only way to determine the right path forward for your individual situation.
Full Video Transcript
so why does hair fall from top of people's head and not the back and the side I mean why do people undergo hair loss the most common cause of hair loss is a condition called androgenic alopecia or male pattern baldness now don't be surprised this is also the most common cause of hair loss in women and what it is is that this is the effect of the byproduct of testosterone on hair follicles now a byproduct of testosterone called dihydrotestosterone can attach certain receptors on hair follicles and call them cause them to thin and fall out now this only happens to people that have a genetic predisposition to it it so happens that the hairs on top of our scalps have this receptors and this hairs on the side of our scalp and in the back of our scalp don't that's the reason why those who suffer from hair loss tend to suffer from hair loss on top of their head and not on the side in the back if we notice people have thinning all over we tend to look for other causes of hair loss is it hormone deficiency in medical condition side effects of medication and so on and so forth but the typical cause of hair loss which is the male pattern baldness happens because of the effects of testosterone hormone onto hair follicles which is why we see it more in men than we do in women although it does also happen in women
Have questions about fue hair transplant?
Talk with Dr. Hootan Zandifar — Beverly Hills & Santa Monica.
Frequently Asked Questions
- What is DHT and why does it cause hair loss?
- Dihydrotestosterone (DHT) is a byproduct of testosterone. As Dr. Zandifar explains, it can attach to receptors on certain hair follicles and cause them to thin and fall out in people who have a genetic predisposition to androgenic alopecia.
- Can women experience androgenic alopecia?
- Yes. Dr. Zandifar specifically notes that androgenic alopecia is also the most common cause of hair loss in women, though it tends to present less prominently than in men due to hormonal differences.
- Why doesn't hair fall out from the back and sides of the scalp?
- According to Dr. Zandifar, follicles on the sides and back of the scalp lack the DHT-sensitive receptors found on top, making them naturally resistant to the hormone-driven thinning process.
- How does understanding hair loss patterns help with FUE planning?
- Knowing that donor-zone follicles are DHT-resistant allows Dr. Zandifar to select grafts that are likely to remain stable after transplantation. A well-defined androgenic loss pattern on top with a healthy donor zone is a key factor in determining FUE candidacy.
