The Psychology of Hair Loss
By John P. Cole, MD & Paul Rose, MD & Truett Bridges, MD

It really is all about loss, isn’t it? Some would disagree and cry "vanity, it’s all vanity!" Let’s forget for a moment about hair specifically, and talk about what happens when humans sustain a loss of any kind.

Well, we grieve. How we grieve depends upon myriad factors: our personalities, racial and ethnic background, age and gender, our emotional state at the moment, the culture of the day. Whether we’ve lost a spouse through death or divorce, a limb from an accident, a breast because of cancer, or our financial stability via job change or economic hard times, we will all experience grief in our own way. This is not to say that all losses are equivalent; obviously they are not.

We all cope with these losses in different ways, and society as a whole grants us "permission" for a certain degree and measure of grief. After a certain, rather poorly defined period of time, we are to get over it and come to some sort of acceptance of our fate. Our acceptance may be minimal or grudging, our coping dysfunctional, but we move on.

Some people decide to not just accept their fate, but to take action, to utilize some device or procedure to ameliorate or lessen the impact of their loss. Society as a whole has prevailing attitudes regarding these choices, as do different individuals. Certainly no one would belittle the cancer patient who chooses a breast prosthesis or implant, or who wears a wig to disguise her hair loss from chemotherapy. Neither would we deride those utilizing prosthetic limbs, or even a man having a silicone device in place of a cancerous testicle that had been removed. The motives of the burn patient having reconstructive surgery to repair a ravaged face are understood by all.

Well, you may say, these are functional parts that have been lost, a bit different from the overarching vanity of hairpieces or hair transplants. Is that really always the case? The post-menopausal woman certainly doesn’t "need" the breast; her breast-feeding days are long since finished. The man recovering from testicular cancer can do fine with just one, in fact, he can survive with none. The burn patient will get along just fine physically without the missing skin.

The point is this: regardless of the attitude of the culture of the moment, loss of any kind affects people in different ways. Some individuals with hair loss do fine. They may feel "bald is beautiful" and shave their heads. Actor Yul Brenner never grew out his hair after shaving it for his role in "The King and I"; his entire career became based on that "look". Others, however, feel the loss, or impending loss, of their hair acutely. They may become depressed and anxious, their self-esteem may plunge, and they may become more and more withdrawn from the world. Their various attempts to disguise the balding may inhibit their desire to run, swim, or perform any exercise, or to be outdoors where sweating or the blowing of the wind might occur. They often begin to avoid intimate contact with others. These can constitute major negative effects on physical and psycho-emotional health. Is it then, "just vanity" to attempt to recover the loss that many experience with balding? We think not.

Men and women express many different motives for desiring hair restoration. Perhaps they wish to look as young as they feel, or they may see it as a gift to themselves for all the hard work they have done. Some see it as a step up in the business world, or they may see it as a requirement if they work in the entertainment industry. Women often strongly identify their femininity with having long, thick hair. Some people simply see their desire for attractive hair as integral to their overall sense of wellbeing. Regardless of the motives, which may be complex and multifold, the decisions need to be educated ones; often the desperate patient becomes easy game for the unprincipled wig maker or surgeon who plays on their fears and panic for immediate financial gain. This can lead to wasted money, or at worst, cosmetically tragic consequences.