By Robert M. Bernstein M.D., F.A.A.D

Hair loss is a problem for millions of men and women, both young and old. It can decrease self-esteem and confidence, and limit the ability to enjoy life to the fullest. Balding affects people in different ways, but certain emotional reactions seem to be shared by many.

Hair Loss and the Mating Game

The most common concern that people have when they begin to lose their hair is that they will be less attractive to the opposite sex. The interesting thing is that this is often only the view of the person that is balding and not that person’s partner. The spouse, or friend of those experiencing hair loss, commonly state that the only thing that bothers them is that it makes their partner depressed. The balding does not bother them per se.

It is interesting that women sometimes express that they want their spouses to look good for the wedding pictures, but once married, they become far less concerned. In fact, when a married man suddenly becomes interested in having a hair transplant, we have seen the spouse become suspicious of extra-marital interests and object to the procedure.

Balding on the Job

Another concern is that the person with hair loss feels he or she looks older than they actually are and will not be as competitive in the work force. Unfortunately, studies have shown that this is a real concern. When employers are screening job applicants, all other things being equal, those with hair are viewed more favorably than those who are bald.

Mirror Mirror on the Wall

People experiencing hair loss complain that the way they look does not fit with their own image of themselves. This occurs when someone begins to lose hair early i.e., in their late teens or twenties, but it is as much a problem when someone has had a full-head of hair for years (and is used to receiving compliments about their hair) and then their hair thins unexpectedly in middle age.

Hair loss is a universal marker for aging, with ones locks gradually diminishing over time. Your body slowly changes as well, with more sagging and wrinkles and ones muscle mass decreasing. However, hair loss can also occur suddenly at a young age, making you appear much older than you actually are.

Another aspect of balding is that people feel a loss of control. Hair is one of the few body parts that you can actually manipulate yourself. You can grow hair long, cut if off, you can wave it, dye it, or pull it back in a pony-tail. It serves as a form of self-expression. As people start to lose this form of self-expression, they can become depressed and withdrawn. But not everyone responds this way. People react very differently to their hair loss, with some considering it only a minor nuisance and others finding it so debilitating that they won’t be seen in public without their head covered.

So Did You Hear the One About…

One of the things that makes going bald difficult is that, for some reason, people feel that commenting or joking about hair loss is “fair game” when they wouldn’t dare mention that someone had bad skin, or had a limp. I often point out to patients, that just because people chose to comment about thinning hair, doesn’t mean they are judging that person or really care much about it. It just seems to be a socially acceptable thing to mention.

It’s Harder for Some Than For Others

Hair loss can be difficult for anyone, but there are a few psychological conditions that can make the situation even tougher. In particular depression, obsessive compulsive disorder (OCD), and body dysmorphic disease (BDD), can pose particular challenges in dealing with hair loss. For an overview on BDD see the slide show lecture by Dr. J. Thompson titled: Body Dysmorphic Disorder: Diagnosis and Management (powerpoint slide presentation).

He Thinks, She Thinks

Women seem to believe that female hair loss is less acceptable than hair loss in men. While this may be true, the vast majority of women have hair loss in a pattern that can be easily camouflaged. Women are often reassured when they realize that about 40% of women experience hair loss over their lifetime, but it is to such a small degree that it is rarely recognized by the opposite sex.

Mane Options

The important things to remember are that hair loss is very common, it is much more acceptable as one ages, and it is generally less important to other people than the person experiencing hair loss thinks. That said, it is not unreasonable to be upset about going bald. Fortunately, for those who are bothered by their hair loss, there are now excellent medications to prevent hair loss and excellent surgical treatments to restore hair once it is gone.


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