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Chapter 2
The Psychology of Hair Loss

“It takes two to hear the truth—one to speak and another to hear.”
—Henry David Thoreau, American philosopher

Chapter 1 gave you some insight into the business of hair replacement and how some doctors and hair providers may not be as straightforward as you might like to think they are. The best way to fully protect yourself is through knowledge—to become aware of the facts and understand how and why you may be vulnerable. Unfortunately, there is one thing that often stands in the way of most people gaining this knowledge—their emotions.
This chapter looks at the reactions you are likely to have regarding hair loss, and helps you understand them. It explains how and why this is a particularly vulnerable time for you—a time during which it is all too easy to make unwise decisions. It then presents guidelines for handling your emotions in a constructive way, which will allow you to gain the knowledge you need to make the best and most satisfying hair-replacement choices.

First the Couch, Then the Table
At this point in the book, you may be wondering, “Aren’t we supposed to be talking about hair?” Well, we are talking about hair, we’re just approaching it from a different angle. Many men and women are vulnerable because hair loss has specific psychological and emotional symptoms that can result in harmful behavior. It’s important to understand these symptoms to insure the long-term health and safety of your head. Therefore, before you get to lie down on the operating table or choose another way to manage your hair loss, you must first lie down on the psychoanalyst’s couch—figuratively speaking—in order to understand the psychology of baldness as it relates to you.
So how will understanding the psychology of baldness help treat your hair loss? As a prospective hair-treatment consumer, you can never understand the outside of your head (your hair loss), until you first understand the inside of your head (the emotional reaction to your hair loss). This understanding will help you to think logically, thereby leading you to the best doctor or hair provider, who will then propose the most appropriate surgical technique or hair addition for you.

Common MALE Reactions to Hair Loss
Hair loss can produce a host of reactions, including panic, anger, denial, and jealousy. While most men will face some or all of these reactions, they will experience them differently.

Panic
Fueled by fear and desperation, many men panic at the sight of their thinning hair. Specifically, this triggers masculinity issues. Many worry: Will women find me unattractive? Will I look too old to get that promotion at work? Will people consider me “over the hill?” and on and on . . . Hair loss can and often does evoke the feeling that life as you know it is over. In this respect, baldness is perceived as a matter of life and death.
Take the example of Harold Brodkey, whose story appeared in The New Yorker magazine. The sixty-nine-year-old went to the doctor for a routine physical and some lab tests. When he returned for the results a week later, his doctor told him that he had a terminal illness. After letting the truth of the statement soak in for a moment, Harold’s first words were, “Look, it’s only death. It’s not like losing your hair.” Apparently, the saying “Time heals all wounds” doesn’t always heal the wound of male pattern baldness—at least not in this case. Of course, rationally, Mr. Brodkey knew the difference between death and the death of hair follicles. Emotionally, however, he associated the loss of his hair with a fate worse than death.

Denial
Denial plays a role in almost every reaction and emotion that a man feels about his hair loss. Men want to deny everything—that they are losing their hair, that they find it upsetting, and that they cannot handle it emotionally. Recognizing and coping with denial, which is a lie to oneself, is the most important and yet the most difficult part of understanding the psychology of baldness. How can you find the truth if you’re starting with a lie? Denial prevents an accurate assessment of the condition of baldness and its realistic treatment options; and this can lead to poor treatment choices. Why do you think that close to a billion dollars is spent on bogus baldness cures every year?

Humiliation
Men often complain to us that their hair loss has caused them to become a joke among their friends. Many claim that they first realized they were balding when their “best friend” announced it in the locker room, causing other guys to take notice and then start taunting. Feeling panicked, the person experiencing hair loss finds himself in a defensive position. He’s also in a bind. If he reacts to the teasing with anything other than mute acceptance, he risks being perceived as less than a man, which is exactly how he may already feel due to his thinning hair. So, the best of his seemingly bad options is to take the teasing “like a man” without comment.
The public nature of male confrontation only makes a difficult situation worse, and almost always produces feelings of severe humiliation. These feelings can be intense, and because facing them can be painful, avoidance (denial) is sometimes the preferred option.
On the day of his surgery, a patient of Dr. Marritt brought along his wife. To show her what would be done during the procedure, Dr. Marritt unexpectedly called the woman from the waiting room into the operating room. What ensued was an awkward period of silence between the man and his wife as they stared uncomfortably at each other. Afterward, she told Dr. Marritt that in sixteen years of marriage, she had never seen her husband’s bald head exposed. He was so ashamed of his baldness and so fearful of letting his wife see it that he had taken great pains to hide it. He would get up at five in the morning to shower and dress before she got out of bed. It was an unspoken rule that she was not allowed in the bathroom while he was dressing and blow-drying his hair.
How humiliated this man must have been, feeling the need to hide his baldness from his own wife. She was the one person who vowed to love him in sickness and in health, for richer or poorer, but apparently (he feared), not through baldness.

Desperation
After living with the humiliation of hair loss, many men become desperate to decrease their emotional pain, which often triggers impulsive behavior. Here’s an example. Before coming to our office, a patient had met with a “hair specialist,” who told him that his hair loss was caused by the lack of humidity in his hometown. It was recommended that he buy a head steamer. Desperate to “cure” his baldness, the patient actually moved to Florida because of its humid climate. After living a short time in this new location, not only was he still bald, he was sweaty, too! It didn’t take long for him to realize that losing hair had little to do with humidity.

Fixation
The confrontational teasing discussed earlier can also provoke fixation, which often co-exists with desperation. Fixation is a psychological condition often caused by some overwhelming trauma, like the death of a loved one or a nasty divorce. If unable to integrate the psychic repercussions of the trauma, a person may become fixated or stuck in his emotional development by harboring all the feelings associated with that trauma, sometimes for years after the event.
To further explain, consider forty-five-year-old Stewart, who visited our office several years ago. He was completely bald in the back of his head with only a few hairs growing in the front. When Dr. Harris began to draw a hairline on the front of his head during the consultation, Stewart demanded that all of the grafts be placed in the back of his head. Dr. Harris then took him to the mirror and showed him that by covering only the back area, there wouldn’t be any change in his facial appearance.
After further discussion, Stewart revealed that he wanted the hair transplanted in that area because of something that had happened years ago. A “friend” in his college gym class had made a comment regarding the spreading monk’s spot on the back of Stewart’s head. The comment quickly escalated into severe teasing, and from that point on, Stewart became fixated on that area of his baldness. It was as if an emotional branding iron had burned that spot with a “B for Bald.” Regardless of how bald he had become over the rest of his head, hair loss meant only one thing to him—the bald spot on the back of his head.

Subconscious Jealousy
Typically, bald men experience jealousy because they desperately covet what their non-bald brothers have. Terry Bradshaw, the Pittsburgh Steelers’ famed quarterback of the seventies, while acting as color commentator for Super Bowl XXIII, called John Elway of the Denver Broncos spoiled, overpaid, and overrated as a quarterback. Elway calmly responded by saying that Bradshaw was just jealous because the salaries were so much lower when he played. Nine years later in 1998’s Super Bowl XXXII, John Elway and the Broncos emerged victorious. Once again, Terry Bradshaw was the color commentator for the event. At one point during the game, Bradshaw reluctantly admitted that he was jealous of Elway’s salary . . . and of Elway’s hair.

Feelings of Isolation
Even though most men who are balding share the same feelings, each man, ironically, tends to feel completely alone. Please remember that you are not alone. For nearly three decades, we have spoken to thousands of men—every size, shape, and color—about their hair loss. They all have fears, desires, and needs. Unfortunately, many men also felt constrained and isolated by social pressures dictating that they shouldn’t display such feelings, much less concern over their appearance. Men often feel that they must hold in their emotions and appear stoic and strong; showing their feelings is considered a sign of weakness. Unfortunately, these efforts to appear strong serve only to isolate them from one another.
Conversely, women don’t have such emotional constraints. They tend to be more comfortable in expressing their feelings and maintaining their beauty by whatever means necessary. Comedienne Phyllis Diller openly and shamelessly talked and even joked about her facelifts for years. But how is it possible for men to get hair, much less get hair appropriately, without admitting that they want it?

Understanding Your Reactions
After many years of talking to patients, it is clear that there are several major reasons for the range of feelings that men experience over hair loss. While these may not be the only reasons, the following discussions may help shed light on your own reactions to hair loss.

Society’s Values
Hair has fascinated humans since the beginning of time. Different from the hair of most other mammals, human hair is extremely visible as an identifying trait. As a result, hair has assumed an extremely symbolic role in human life, defining political, social, religious, sexual, and economic status.
In 1991, a man from the Neolithic Age was found frozen in a glacier near the Austrian-Italian border. Interestingly, this man, who was believed to be around 5,300 years old, had hair that was cut in a very neat, precise style. He must have considered the appearance of his hair important.
But styles come and go. During the 1700s, both men and women of the upper classes wore wigs. Some of these hairpieces were very elaborate, and included such ornamentation as birdcages (complete with live birds), small models of famous buildings, and other intricate decorations. It was simply the fashion. Today, however, no prominent businessman—the “aristocrat” of our times—would wear a wig adorned with anything. It’s just not the trend. What’s important to understand is that values change, and while cultures the world over have their individual beliefs and rules concerning appropriate hairstyles, these beliefs are always changing.
Currently, American culture places a great deal of value on youth, and, therefore, on a youthful appearance. Because a full head of hair is associated with being young, it is considered a good thing. Unfortunately, on the flip side, balding is associated with aging. The fact, of course, is that intrinsically, hair or the lack of it is neither good nor bad. No one in any field of scientific study has served up a plausible reason why humans even have hair in the first place. The problem is only that our society values a full head of hair—at least for the moment. So remember that while you are experiencing real feelings, part of their intensity is nothing more than a response to the subjective beliefs of society.

It’s Not the Hair, It’s the Loss
Some of the most stressful situations in life, such as the death of a loved one, the loss of a job, or the diagnosis of a life-threatening illness, will elicit predictable feelings of sadness, fear, anger, frustration, and panic. Although initially these stressful situations may appear different from one another, a second look reveals a common denominator—loss. The problem with hair loss isn’t really the lack of hair, but the emotional response to the loss.
Along with losing your hair, you are also losing the dream of youth, mostly because baldness makes one look older. Hair loss has always been associated with aging (even the baldest man at age sixty had hair at sixteen). That’s just the way male pattern baldness works. It is a condition of advancing age. Thoughts of getting older, however, eventually trigger thoughts of death, which we spend the majority of our lives trying to avoid. For most men, the unconscious association regarding hair loss is:

Loss of hair = Loss of youth = Inevitable aging = Death

These associative links have a domino effect. Once the mind has completed the chain, man’s most basic instinct—survival—takes over immediately. It mobilizes a combination of desperation and denial. And although everyone knows that “No one lives forever,” no one wants to believe it. So people comfort themselves by saying, “I’m not that bald; I’m still young.” But eventually, progressive baldness becomes difficult to ignore because of its high visibility. This is why men may cover their heads with hats or begin parting their hair a bit lower than they should—anything not to see their hair loss. Out of sight, out of mind. And there’s nothing wrong with a little denial. But be careful. A little denial can quickly become a lot of denial. And it often does.

Baldness Makes You Look Different
Unlike other visible signs of aging, such as wrinkles or a sagging chin, which tend to creep up slowly over many years, baldness can strike suddenly, swiftly, and extensively. One patient who came to our office had started to lose his hair at age nineteen. By twenty-three, he had little more than a horseshoe of hair around the perimeter of his head. His youthful appearance had disappeared as he was transformed into a replica of his father, seemingly in the blink of an eye. He said of his hair loss, “I look twenty-five from the eyes down, and sixty from the eyebrows up.” Not surprisingly, he could not accept the difference between his self-image and his actual appearance.
Part of the difficulty in accepting his appearance was due to the high visibility of baldness as a sign of aging—much more so than crow’s feet or a sagging chin. Let’s compare. Crow’s feet and sagging chins are usually measured in millimeters; the results of which, while not welcome, are not dramatic enough to make a twenty-five year old suddenly look like his grandfather. And perhaps more important is the fact that wrinkles, by and large, are tolerated in men. Men who have lined faces are sometimes thought of as rugged or distinguished. In stark contrast to such “rugged” wrinkles, baldness can be measured in square inches, visible even from across a crowded room. Such a dramatic and extensive change in appearance serves only to increase the sense of loss of a familiar self-image, making it more difficult to accept.
The difference between self-image and reality may also exist for the man who has just lost his first few hairs. Although he may still have almost all of his hair, initial panic may cause him to imagine himself looking like a billiard ball by next week. The anticipated loss of his youthful self-image can consume him with fear. Either way, whether anticipated or actual, a psychological conflict arises from a perceived difference between the picture in the mind and the picture in the mirror. For the young man who balds quickly, the change in appearance is most dramatic and alarming. Of course, in the minds of all men, no time is considered a good time to bald.

The Influence of Testosterone
Testosterone is a hormone that serves an important biochemical function within the male body. In addition to giving men their competitiveness and sexual drive, testosterone causes them to become assertive, mark their territory, and take action—traits that typically define “maleness.” But lose one hair and this same “maleness” may prompt one to act too quickly. Remember the man we discussed earlier in the chapter who moved to Florida? A man’s very nature may interfere with his ability to act calmly and rationally while handling the emotional repercussions of hair loss.

What Should You Do?
Can you help yourself deal with these unsettling emotions? Although you may never be pleased by the fact that you are losing your hair, there are several steps you can take to help overcome your heightened emotional state. Begin with an honest look at what you expect to achieve with hair replacement—what are your goals? Try to verbalize your feelings—your pain, fears, and frustrations—with someone you trust. Also, allow yourself some time to grieve over your hair loss. Finally, do your homework and become aware of all of your options. These few steps, which are detailed in the following discussion, will help you to calmly assess both the reality of your situation and your options.

Understand Your Goals
There are two ultimate goals you can hope to achieve with hair replacement—getting hair and feeling better about yourself. Most men think that getting hair is more important, and by achieving that goal, they will automatically feel better. While the lucky man may succeed by approaching the situation from such a perspective, most men will fail. Remember, your unhappiness with hair loss is not caused only by the simple loss of your hair, but with other issues—lost youth, changing self-image, and damaged self-esteem. As mentioned before, these issues, if left unresolved, often become unconscious motivations that push you into making unwise or premature decisions. As a result, the most important goal for the man experiencing hair loss is to confront these issues and attempt to work through them—to find a way to feel better about himself before he starts the search for hair.
But many men will argue, “Exactly how can I feel better about myself if I’m unhappy about my hair loss?” The idea is to separate the hair loss from your self-esteem. Clearly, your worth—your competence as a man and your ability to be a good person, for instance—is not dependent on your hairline. Many men, nevertheless, make such associations whether they admit it or not, and sometimes, whether they know it or not. The point is to first realize that you may be making such destructive associations, and then realign the way you think. By allowing yourself to go through a grieving process and by talking out your feelings, you may actually discover that you can be happy without a full head of hair. If not, at least you’ll be ready to calmly review your hair-replacement options, and then choose an approach that is best for you.

Talk to Someone
Talk to your spouse, your brother, your priest—anyone you can trust to listen and understand your frustration and pain. If you have a close friend who has lost his hair, broach the topic with him (if you feel comfortable doing so). His reaction to hair loss may be different from yours, and a frank conversation may give you a new perspective. Most important, discuss your feelings with your doctor or a qualified hair provider before committing to any procedures.
Our experience has shown that many patients have difficulty talking at first. Caught up in the agony of panic and desperation, most feel that talking is a waste of time. Some consider it to be a sign of weakness and an invitation to more humiliation. Instead of viewing talking as a waste of time, money, and emotional energy, think of it as prevention. By talking about your feelings, understanding them, and acknowledging them, you can transform your pressing “need” to get hair into a simple and straightforward desire. If you don’t “need” to get hair, then you can wait; you know you have time. You can research your options calmly, and avoid being misled and deceived.
Sure you may want hair, but you won’t need it to bolster your self-esteem. You’ll probably never like your baldness, but talking about it will help you accept it. And accepting your hair loss will help make you the perfect candidate for hair replacement.
Allow Yourself to Grieve
As discussed earlier in this chapter, one cause of your emotional reaction stems from the sadness you feel over your loss. Therefore, it is vital that you allow yourself time to grieve. Grieving involves introspection, talking, thinking, feeling, crying, cursing, laughing, and screaming in no particular order, and for no particular period of time. It will take as long as it takes, but when it’s over, it’s over.
Denial and all of the other emotions you may be feeling have a potentially dangerous effect on your decision-making process. You may rush to do “something,” which means you are thinking short-term—looking for instant gratification. Nonetheless, it’s only natural to think such short-term, misguided thoughts when you are constantly bombarded with manipulative advertising that encourages you to act impulsively and “Just do it!” Doing, or acting out, is really an attempt to resolve painful feelings with a quick fix. Sadly, such attempts don’t work.
Many men with hair loss rush for the quick fix because they cannot imagine anything in the world that’s worse than being bald, but they have limited imaginations. Far worse is developing an infection from having a hairpiece sutured to your head. Far worse is having an alopecia-reduction scar running across the back of your head. Far worse is having poorly transplanted hair grafts that result in plugginess, which may ultimately force you to wear a hair addition.
The grieving process and the acceptance of hair loss will help you avoid such catastrophes. If you don’t “need” hair, but merely “want” it, you will be better prepared to hear the truth about what you can realistically do to get it. For any hair-replacement option, there must be an acceptance of some type of compromise. The exact nature of the compromises and the reasons why you must accept them will be fully discussed in Chapter 8, “Decisions, Decisions.”

Examine Your Options
There are very strict rules governing how to treat hair loss safely and permanently. Because of this, the amount of hair most men are able to get is restricted, so the vast majority get less hair than they want. Therefore, it is extremely important to think long and hard before making treatment decisions. The only way to ensure the long-term safety of your head is through the calm and thorough examination of your options and the clear knowledge of the various procedures and their limitations. These procedures will be detailed later in the book.

Tough Love
Maybe we’ve been a bit tough on you in this chapter, but we feel that it is necessary to break through your subconscious defenses of denial and desperation. These concepts are troublesome and especially difficult when understanding them ultimately means accepting compromise. Once you have truly grieved over the death of your hair, it will be easier for you to accept the fact that you cannot have it all back. This acceptance will make a significant difference in the hair-replacement choice you make.

CONCLUSION
Now that we have discussed the inside of your head, it’s time to move on to the outside. Chapter 3 explains what does and what does not cause baldness. This information will help you begin the process of outlining what you can do to realistically, safely, and permanently deal with your hair loss.

Excerpt(s) from THE HAIR REPLACEMENT REVOLUTION by James Harris, MD, and Emanuel Marritt, MD, Square One Publishers (c) 2003. Used by permission.

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