From the beginning of receding hairline to a balding crown. The majority of men will be confronted with hair loss at some point in their lives. Something that can be mentally very hard, especially for younger men. “But there are things that can slow down or reverse the process,” say experts. Dermatologist Stefanie Bracke and hair surgeon Bijan Feriduni answer eight readers’ questions and also tell us how much it costs. “There is no single shampoo that does the job.”
Dermatologist Stefanie Bracke and hair surgeon Bijan Feriduni answer 8 questions from men about hair loss. © getty
“In practice, we get an incredible number of questions about hair loss, also from men,” says dermatologist Stefanie Bracke, who counts Gert Verhulst among her patients. “Men usually know that they have hereditary baldness and that it is completely normal, but you still see that they struggle with it emotionally. In addition, dermatology, the only medical discipline with a recognized training in hair problems, is over-requested. There is a lot of demand for everything that has to do with the skin, and that leads to long waiting lists that can sometimes last months. If you keep losing hair, that can be very frustrating. So I completely understand that people have questions and are looking for the correct information.”
What are the main causes of hair loss in men? (Kidex)
“Number one is undoubtedly androgenetic alopecia, also known as the hereditary form of baldness,” says Dr. Bracke. “Under the influence of the hormone dihydrotestosterone (DHT), the hair follicles of some men become smaller. The hair becomes less and less thick, contains less and less pigment and eventually disappears completely. This happens to a lot of men.” It is estimated that at least seventy percent will experience it at some point.
The other causes are much rarer. They only concern a few percent of the population. Something we sometimes see, for example, is telogen effluvium. In this condition, your hair falls out everywhere as a man, so not just at the temples or on the crown. This is often a reaction to a period of stress, and occurs about two to three months later. Alopecia areata also occurs occasionally in men. This is an autoimmune disease, in which your own body actually turns against your hair follicles. Bald, round spots are very typical. This hair can grow back. Other rare causes include certain medications or fungal infections on the scalp.”
I am losing more and more hair. Should I start a treatment now or should I wait until I am bald? (Cédric)
“I assume that this man suffers from the hereditary form of male pattern baldness,” says Dr. Bracke. “As mentioned earlier, the hair follicle will gradually become smaller and eventually completely shrivel up. If you let it get to that point, medication will no longer have any effect. My advice is therefore to intervene as soon as possible when you start to notice the first signs. The sooner you start, the more hair density you can often maintain.”
For those who are already bald, only a hair transplant can work. “But here too, there are conditions,” says Dr. Bijan Feriduni. He specializes in hair transplants and has helped former cyclist Niels Albert, among others. “For example, a clear diagnosis must still be made and it must be demonstrated that medication has no effect after 12 to 18 months. It is also crucial that the donor area is of sufficient quality to make a transplant possible. In men, the donor area is often the hairline at the back of the head.”
Are there things you really shouldn't try against hair loss? (Jurgen)
“Many people are often desperately looking for a solution for their hair loss and companies dare to profit from that,” says Dr. Bracke. “There are various products that have little to no decisive effect on your hair loss. Shampoo is one of them. A substance must remain on the scalp for at least six hours to be able to work properly. A shampoo can therefore never have sufficient effect. The same applies to taking hair supplements or vitamins. This is only useful if we can really demonstrate a clear deficiency in your blood. Otherwise it will have no effect. Also an important one for men, who often do sports: do not use anabolic steroids. This may give you more muscle, but we know that it can also accelerate the process of hair loss.”
I am 20 years old and my hair is receding. What should I do? (Jozef)
“If you still see hairs, we can intervene with medication and we usually get the hair loss under control quite well. We generally do this with two types: finasteride (or dutasteride) and minoxidil. Finasteride or dutasteride will inhibit the conversion of testosterone into dihydrotestosterone – the cause of hair loss. Minoxidil will improve the blood flow to the hair follicles and thus stimulate growth. It is important that you take both types. For example, if you only take minoxidil, you will get more hair, but it will still fall out after a while. Both medications are available in pill form and lotion form. We now opt more quickly for the pill form, because patients use it more faithfully. Please note that you have to repeat this every day for the rest of your life. Hair loss is not something that we can cure, but only keep under control. In addition to this medication, we can also do PRP. With this, we inject your own blood plasma with a high concentration of platelets into your scalp. For some people it can give an extra boost to the hair. It will never work on its own. The minoxidil and finasteride remain essential. Moreover, PRP is quite expensive. A session costs 350 euros.”
This is how much classic hair loss medication costs
- Minoxidil 1 mg (60 capsules): € 17
- Finasteride 1 mg (60 capsules): € 20,55
- Topical Minoxidil: 3 bottles (for approx. 6 months): about € 40
“These medications are all prescription,” says Dr. Bracke. “If you are waiting for a dermatologist, you can still get a minoxidil lotion (2%) from the pharmacy. This is available over the counter and can improve hair growth somewhat.”
How come I'm only starting to experience hair loss at 42, while my brothers are starting to experience it at 25? (Alessandro)
“Hereditary hair loss is unpredictable,” says Dr. Bracke. “Even twins will not lose their hair at exactly the same time. One person may have inherited a slightly higher sensitivity to dihydrotestosterone (DHT) and will be bald by age 30, while the other will only have thinning hair by age 50. The only thing we know for sure is that the older you get, the more likely you are to lose your hair.”
I have been suffering from temporary bald spots in my stubble for a few years now. What could be causing this? (Eddy)
“I suspect that this is about the autoimmune disease alopecia areata,” says Dr. Bracke. “In this case, your own body turns against the hair follicles. You can have it on your scalp, but also in your beard or on your eyebrows. It often concerns temporary bald spots, which disappear after a few months. What can work is injecting cortisone into the bald spots, which makes the hair grow back. Although it is not a guarantee. The spots can always reappear somewhere else.”
How much does a hair transplant cost? (Franky)
“It depends on how many grafts are needed,” says Dr. Feriduni. “A graft is a piece of skin tissue with one or more hair follicles. In Belgium, the price is on average between 4,000 and 12,000 euros, excluding VAT. This usually includes the intake interview, the treatment itself and the follow-up.
That amount can be lower abroad. There you usually pay between 3,000 and 4,000 euros for the flight, treatment and accommodation. That seems attractive, but unfortunately we regularly find that the end result does not always meet expectations. Then a corrective treatment is needed, which can weigh heavily emotionally and financially. In addition, it is also the case that complications are sometimes more difficult to treat, since patients are already back in Belgium.”
What are the complications of a hair transplant? (Wesley)
“The most common reactions immediately after the procedure are slight swelling or redness in the treated area,” says Dr. Feriduni. “This is a normal reaction of the body to both the procedure and the local anesthesia. This usually disappears spontaneously within a few days. Other temporary side effects may include itching, a slight burning sensation in the donor area or temporary numbness of the scalp. Serious or long-term complications are rare.”
“With medication, the most common side effect is extra hair growth,” Dr. Bracke adds in conclusion. “We see that men sometimes get extra hair on their arms or beard, although that is not a problem for most. With finasteride, there is also the rare side effect that it could cause a loss of potency, because it prevents the conversion of testosterone to dihydrotestosterone. But I have never experienced this with any of my patients.”
Glenn Haex, HLN, 27-06-25, 09:00