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The Psychological Impact of Hair Loss

Posted Aug 24 2008 1:49pm
DAVID FOLK THOMAS: Everyone deals with hair loss differently. Some people just take it as a fact of life, but for a lot of people it's a source of anxiety and depression. If hair loss is troubling you, what can you do to overcome your emotional distress, and if treatment fails, what can you do to prepare yourself for more hair loss?

Joining us to talk about the psychological side of hair loss are two experts. On my left is Dr. Peter Halperin, and next to Peteris Dr. Marc Avram. Both Peter and Marc are Assistant Professors in the Department of Dermatology at Weill Medical College of Cornell University and New York Hospital in New York City, and Peter, Marc, thanks for joining us here today.

Let's start talking about the psychological impact of hair loss, and Peter, I'll start with you. What are some common reactions when people start losing their hair?

PETER HALPERIN, MD: It can be devastating, David. People hate losing their hair. It's so important to make a good first impression, what somebody looks like.And people make assumptions that they are losing something about their control of their life or looking older, things they really can't reverse when they start losing their hair.

DAVID FOLK THOMAS: Marc, as far as that goes, is that, like Peter just mentioned, devastating? So far, I have not experienced that, but sometimes I see people, and other people say, "Well, they don't look bad." They've lost their hair, but it seems like what Peter said, it's a lot more devastating than those of us on the outside looking in can imagine.

MARC AVRAM, MD: There's a great variety in how much it affects people. I think no one, given the choice, would want to lose their hair. Some people don't like it but accept it. A lot of people really don't like it, but don't really know exactly what they can do to stop it, and some people that we see are really devastated to the point where it impacts their actions and inactions in life. So it can seriously affect people to the point where it paralyzes them in what they do socially and professionally in their life.

DAVID FOLK THOMAS: Like their self-esteem and so forth?

MARC AVRAM, MD: Yes. It can be all different ages. It can be men and women, different backgrounds. It has really nothing to do with education, economic status. It really depends how it affects someone in terms of -- it may affect someone in a very devastating way professionally. Someone who's in front of the camera or someone who needs to be in the public begins to lose their hair. It could be someone who's on a college campus, is the only one in the frat house that's losing their hair and gets teased. So it can make a big impact on people.

DAVID FOLK THOMAS: What different effects, if any, are there between men and women losing hair?

MARC AVRAM, MD: I think for women it's much more devastating than men. There is Sean Connery. It is socially acceptable for men not to have hair if he doesn't want to. For a lot of men, millions and millions of men don't like it, and seek treatments, both medical and surgical, for it. In women there are no role models to have thinning hair, and unfortunately a lot of the investigation, the medications, the awareness even in the medical community is directed toward men and hair loss, when in fact tens of millions of women have hair loss, and really there's no social acceptability to have thinning hair as a woman.

DAVID FOLK THOMAS: Peter, what about treatments for these effects of hair loss on people as far as having low self-esteem or anxiety?

PETER HALPERIN, MD: There are many treatments, both medical and surgical, and the treatments vary for men and women, so that men might consider -- men have an extra option. They can take something called finasteride, which is an oral medication that's available to them to stop hair loss and even promote hair growth, whereas women really don't have that option. Women have a topical option which is okay, pretty good, and they have surgical options, and unfortunately it stops there. They have to rely on wigs and coverings and things like that.

DAVID FOLK THOMAS: Now, we're mentioning men and women both experiencing this, but is the rate higher for men, or am I seeing women out there who I don't realize have thinning hair because maybe they're covering it up with a wig. But is it equal percentages of men and women losing it, or is it still more of a male thing?

MARC AVRAM, MD: It's comparable. The hair loss pattern is different in a man and a woman. Men, as we all know, can develop bald areas. They can lose all the hair on top. For a woman, it's very rare to do that. Women maintain their hairline. It just becomes diffusely thin on top, so it's a different pattern of loss, so it's less obvious in a woman to see the hair loss, but I'd say it's comparable in number. In men it can just be more visible. I think you are right. There's also more women, because of what I mentioned before about the inability of our society to accept women with thinning hair, that will do something to make sure that you don't notice it when you walk down the street.

DAVID FOLK THOMAS: What about any hurdles out there for successful treatment to hair loss? What are the problems facing that for the medical profession?

PETER HALPERIN, MD: The problem is understanding the genetics of hair loss and stopping it at that point, and that's what we don't understand. We don't exactly understand what genes a person has that contributes to hair loss, and if we did, we could stop it. One of the medications that we use, finasteride, is geared toward interfering with one mechanism of hair loss, so it's a start. It's a good start.

MARC AVRAM, MD: I think also one of the problems from the surgical point of view is that for 30, 40 years, hair transplantation was done with plugs, and if people have any awareness of the surgical option, unfortunately it's often the person they once met at a party that had plugs on their forehead. That's a definition of a failed surgery, cosmetically. Today, for men and women, in the right candidate, you can consistently produce undetectable transplanted hair.

Medically, I think as well, there isn't enough education in the medical field about what these medications that Peter mentioned can do and can't do in terms of what's successful and what's not successful in terms of treatment. Often, patients come into our office and say, "The treatment didn't work, because I'm not seeing hair grow." Well, when you have hair loss, if you can maintain the hair that you're thinning, just hold it where you're at, that's successful, because the natural progression is for it to keep going, to keep losing it. I think often even the medical community isn't fully aware of what these medications and what surgery can really do for hair loss.

DAVID FOLK THOMAS: You both are maybe advising or treating people who are dealing with hair loss, and we're talking about the psychological impact. Is it recommended that they seek counseling, usually? Do you even broach that subject with your patients? Peter, I'll start with you, and then Marc.

PETER HALPERIN, MD: It depends where they are. If they're just so tearful and it just is causing an inability to work, an inability to socialize, changing their life in a real negative way, then yes, we would broach that subject, recommend some type of intervention by a psychiatrist or psychologist. It all depends how they accept it. Everybody's different. Marc said that, and it's absolutely true.

DAVID FOLK THOMAS: Marc can wrap it up. I'll give you the last word.

MARC AVRAM, MD: I agree. That's why I think often patients -- Peter sees this also -- often if you just sit down and listen to someone who's losing their hair, really listen to what they're saying and understand what they're explaining, that alone will help a lot of people, because again, particularly in women, often hair loss is dismissed. You don't see baldness, you don't see the thinning hair. You see a hairline attacked. You look across, the husband says, "Honey, what's the problem? Look at my head." The doctor says -- her family practitioner, OB/GYN -- says, "Who cares? You still have hair up there," and you kind of dismiss it. It makes people more and more anxious. It's often just listening to someone, and acknowledging they have a problem helps. And if someone has a bigger problem, like Peter says, they absolutely should seek further counseling.

DAVID FOLK THOMAS: This just came to me, but we have less than a minute or 30 seconds to wrap it up. You know, Michael Jordan and famous athletes shaving their heads, and that seems to come more in style. Would you say you see patients that when they start to lose their hair say, "Well, I'm just going to shave it all off," and what's that phenomenon about?

MARC AVRAM, MD: I actually think one of the things people do is the opposite, which is a big mistake cosmetically. When people's hair starts thinning, they actually grow their hair longer and do the comb-over, which cosmetically is a disaster. It draws more attention to the thinning. If there's anything to do, it's to keep your hair short and balanced. It does make your hair appear fuller. So shorter hair, actually, if you're thinning, works cosmetically.

DAVID FOLK THOMAS: Thank you, both of you, Peter and Marc for taking time. That's all the time we have today. My name is David Folk Thomas, and we will see you next time.

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