What causes male pattern baldness?
Most men begin to notice thinning hair or a receding hairline in their 20s. But although male hair loss is incredibly common, it can still be very distressing and negatively affect self-esteem. Dr Max Pemberton explores the psychological impact of balding and what to do if you're losing your confidence along with your tresses.
By the age of 50, half of all men will have noticeable hair loss. By the age of 60, it will affect around two thirds. The majority of men, therefore, will at some point in their life, have hair loss.
It's so common, in fact, going bald could be considered a normal part of being male. It's actually more unusual not to go bald. Yet despite how common male pattern baldness is, it causes untold distress and anguish to men. It's strongly associated with the development of depression, anxiety and poor self-image.
I work in mental health and I see a surprising number of men who confide in me that the distress they experienced from their hair loss has led to their mental health problems. Yet men rarely discuss openly how much upset their hair loss is causing them. It's a shameful secret.
Sometimes the first anyone knows that it's even been on their mind is when they have a hair transplant. I have one friend who started going bald in his 20s. He was so upset about it, he told me later, that he would sometimes feel unable to leave the house. He had stubble tattooed on to his head (an increasingly popular intervention that looks very convincing) to give him a full hairline. His wife, who he met after the procedure still doesn't know that what she thinks is his hair is actually a clever tattoo.
I find it incredible that they've been together five years, yet he still doesn't feel able to open up to her about his hair loss and what he's had done but it shows how sensitive this is for men.
Even more take anti-hair loss medication, such as finasteride, on the quiet. It seems astonishing that something that is going to affect the majority of us at some point in our lives is still considered so shameful and embarrassing. Those who try to do something are mocked for being vain, while those who are balding are mocked and ridiculed for being old and unattractive.
I know of at least four of my friends taking finasteride, and that's just those who have confided in me. I suspect there are many more, but they feel unable to discuss it because hair loss is such a sensitive issue for so many men.
A reminder of our own mortality
What's more, it doesn't just affect older men. A fifth of men will experience significant hair loss by the age of 20, meaning that this is something that is an issue affecting many of us, both young and old alike.
In fact, I think society really fails to grasp quite the level of distress hair loss can cause men. It tends not to matter how many times it is stated that many people find baldness attractive; the process of going bald is still bound up with a loss of virility and masculinity, in a way that the menopause is often linked to a loss of femininity for women.
There's an enduring idea that a man's hair is linked with ideas of strength and power - think of the biblical story of Samson and Delilah, where the source of his strength was his hair until she cut it off while he was sleeping. The image of a fat, balding old man who is mocked because of his looks strikes horror into the heart of many young men who find themselves thinning.
But it's more than just a fear of being laughed at. Because of its association with ageing, baldness reminds us of our mortality. It speaks on a deep level to how we perceive ourselves and how we think others view us. There is a sense of powerlessness and impotence - our bodies out of control.
Anxieties around hair loss often get bound up with other anxieties about our bodies and feed into insecurities about our appearance or low self-esteem. Single men often worry that they will never find a partner, and those with a partner worry that as they lose their hair their partners will stop finding them attractive.
Of course, many men are able to embrace their thinning hair. Just look at Bruce Willis and Jason Statham. Some guys adopt a close-shaved look and frame it in terms of evidence of their masculinity and manliness. Good for them. For those who struggle to accept the change and lament their hair loss, there is a multi-billion pound industry that, I'm sorry to say, promises a lot but tends not to deliver.
There is no magic pill or miracle surgery to reverse hair loss. Even finasteride only actually causes re-growth of hair in a small number of people who take it, with it simply slowing the rate of loss for most. It only provides about 30% improvement in hair loss over six months. Hair grafts and transplants have limitations and are very costly with results varying considerably. Shampoos and lotions and potions have limited - if any - effect.
That's why I often recommend men who are struggling with going bald see a clinical psychologist to have a course of cognitive behavioural therapy (CBT) to address their distress and help them to change their thinking about their hair loss. It sounds unlikely, but it really does work.
The fact is, it is much easier - and cheaper - to learn to accept the hair loss than it is to reverse it.