As a psychoanalyst, I’ve seen how reflecting on the emotional symbolism of hair loss can be therapeutic for many men
It was low self-esteem that led Lionel to begin psychoanalysis. From the outset, he spoke to me with courage about his fears, but I could tell he was nervous, and it didn’t take long for his concerns about hair loss to emerge. I hadn’t noticed his receding hairline, though once he drew my attention to it, I thought I could see what he was worried about. His hair was ever-so-thinner at the front of his scalp – perhaps more so than you’d expect for someone in their mid-20s.
There are many causes of hair loss, but ‘pattern hair loss’ – the kind that occurs naturally with age – is the most common. Although it can have an emotional effect on women too, I’m going to focus on how I’ve seen it affect men. For men, it typically manifests either as a receding front hairline, thinning on the crown of the head, or both. By the age of 50, around half of men are affected. Whether it occurs or not seems to come down to a combination of genetics and levels of male hormones circulating in the bloodstream.
This kind of hair loss in men is so common, you might not have given it much thought. However, it’s well documented that it can cause many men significant psychological distress. Even if you have given it some consideration, you might have assumed the reasons for the distress were obvious – especially given widespread ideas about the significance of hair for people’s identity, attractiveness and ageing.
It’s true of course that hair is an integral aspect of many men’s identity. Our culture places a high value on full, healthy hair as a sign of attractiveness. Men worry about being judged, even ridiculed, for their hair loss. It points to the loss of youth and vitality as men move toward middle age.
However, while some men do come to therapy with explicit concerns about their hair loss, other times their distress about it is far less obvious (even to them). As a psychoanalytic psychotherapist, I seek to help patients deepen their reflective capacity in relation to their emotional distress so that they can better understand what it means to them, and help them understand the historical roots of that distress. It’s in this context that I’ve seen how men sometimes aren’t consciously aware of how and why their hair loss is affecting them; sometimes it emerges only over time as our therapy conversation unfolds – as happened with Lionel and other clients I’ve seen. The good thing is, with this deeper understanding in hand, they are better positioned to choose how to respond.
Hair crosses the boundaries between inside and outside, hidden and shared
Before I share some more details of my work with Lionel – whose story is emblematic of many of clients I’ve seen – it’s helpful to pause and consider the psychological meaning of hair. As the Canadian sociologist Anthony Synnott put it in his paper ‘Shame and Glory’ (1987), hair might be ‘our most powerful symbol of individual and group identity – powerful first because it is physical and therefore extremely personal, and second because, although personal, it is also public rather than private.’ In this way, hair crosses the boundaries between inside and outside, hidden and shared. ‘Perhaps,’ the British psychoanalyst Alessandra Lemma wrote in her book Minding the Body (2015), ‘because hair begins inside of us, its roots invisible, and then grows outside, some part of us feels exposed by its journey, as if it carries secret truths from within and broadcasts them from the tops of our heads.’
Echoing Lemma, I suggest that, for many clients, their hair is deeply linked with their early relationship to their mother’s body and how they experienced their eventual separation from it. Unlike most other parts of the body, except nails and skin, hair can be cut and regrown, making it a pliable medium through which to express one’s difficulties around separation and individuation. Drawing on a paper written in the 1930s by the Hungarian psychoanalyst Imre Hermann, in which he emphasised the centrality of our desire to cling to the mother’s body in early life and the profound impact of the dissolution of this primary dyadic union, Lemma suggested that hair cutting – and hair loss, I add – may resonate with a person’s early experiences of disruption to their maternal relationship. I saw this play out in therapy with Lionel.
He and I began our therapy sessions shortly after the COVID-19 outbreak, so we met via video calls. During our first meeting, I was struck by how he seemed to use the screen as a mirror, as a way of inspecting his own face, and how he would then adjust the bangs of his hair. I asked him about this. With a sigh, he responded: ‘I’m worried that I’m losing my hair. I think that my hairline is receding, and I see that in the picture of me that shows up on my screen.’
I asked what this meant to him, and he answered without hesitation: ‘That I won’t be desirable to women anymore. That I’ll be ugly, unattractive. They’ll laugh at me.’ These fears of rejection and loneliness became an important thread in our work together. Eventually, I discovered that they bore a striking resemblance to his painful feelings of separation during childhood, when his mother travelled internationally for work, often for weeks at a time.
As our conversation continued, other themes emerged that chime with medical and historical observations about hair. For many men, hair loss evokes anxieties about helplessness, powerlessness and dependency, akin to our experiences as young children. As Diane Simon explained in her book Hair (2000), in ancient cultures, in the hands of unknown others, one’s hair became one’s weak and unprotected self and, thus, ancient warriors often buried their hair to avoid it falling into enemy hands. Samson, one of the last judges of the ancient Israelites, upon losing his hair, also lost his strength. Lemma noted how his hair was cut when he lay sleeping, his head upon his lover Delilah’s knees.
Men who choose to shave their heads are perceived as more dominant
Over the years, many of my clients have expressed fears about hair loss that resonate with these ideas. Lionel often spoke to me about ‘waiting for it to happen’. In this vein, I am reminded of another client, Bruce, who described feeling gripped by anxiety as he made his way across the college campus, painfully aware of his receding hair line. Frustrated with the feeling of smallness it evoked in him, he laid out his plans to shave his head during the upcoming weekend. ‘I’m going to confront this head on,’ he said with a wry smile. And, in fact, his experiment was beneficial for him. Over the coming weeks, he reflected on how he had taken an active role in what was befalling him, instead of waiting for it to happen.
Bruce’s words reminded me of Sigmund Freud’s view that an active masculinity originates as a defence mechanism against the pleasures and perils of a passive femininity. The empirical literature suggests that male pattern baldness can signal to others that one has an increased propensity to nurture and caretake, which would be congruent with femininity as Freud conceived it.
Turning passive into active is a basic building block of the ego and a versatile defence mechanism throughout life. As the psychiatrist and psychoanalyst Richard Corradi argued, this is an important way of managing anxiety for many people, when that anxiety stems from feelings of helplessness – which is what hair loss evokes for many men. In imagining proactively shaving his head, Bruce was imbuing his experience of hair loss with a felt sense of activity and control where it would otherwise be absent. Consistent with this perspective, studies suggest that men who choose to shave their heads are perceived as more dominant and, in fact, that men who are perceived as losing their hair may improve their social standing by shaving their heads.
Yet another deeper meaning of hair loss relates to old age and death, which can also trigger anxiety. ‘I think it’s about death, really,’ Lionel began another a session, gesturing at his hair. ‘I mean, at the root of it.’ We both smiled, aware of the play on words. ‘Last week, we were talking about my knee injury and it got me thinking.’ The previous week, we had discussed a knee injury Lionel had sustained while jogging – he is a dedicated long-distance runner – that hadn’t healed for nearly a year. I raised the possibility that it might not heal at all, entirely, but could be a chronic vulnerability. This disturbed him, for it was the first sign of ‘wear and tear’ in his otherwise youthful body. His voice drew me back to the immediacy of our conversation: ‘My hair loss is like that… it’s something that’s changing, deteriorating I guess, about my body – for the worse – and that will never be repaired. And that is really depressing, isn’t it?’
Synnott proposed in his 1987 paper that baldness is a symbol of age and death. He argued that, for many people, hair loss is a profound narcissistic injury. In contrast to hair cutting, typically chosen by us, hair loss happens to us. It shatters our illusions of omnipotent control in relation to our own bodies. For many young men, hair loss is the first direct challenge to this illusion. As the anthropologist Ernest Becker emphasised in The Denial of Death (1973), in healthy development, a child can experience himself as omnipotent and indestructible; from this base of secure support, he increasingly develops a sense of his own power. Death, which hair loss signifies, is the ultimate challenge to this narcissistic illusion. In this vein, I recall one elderly client, Ramon, who insightfully reflected: ‘It started with losing my hair in my 40s. Now, though, the losses are even bigger. No more basketball, no more tennis. Hell, I’m lucky that I can still go on walks with my friends. You have to get used to giving up these things with grace.’
Lionel’s psychotherapy extended over several years. As he developed a better understanding of the emotional significance his hair loss held for him, he was increasingly able to manage the anxiety and shame that it evoked. Although the experience remained painful, it was now a tolerable pain and could exist alongside an increasingly developed sense of self-assurance and personal agency. He was able to explore the world of dating and relationships with more confidence, and to imagine that others might see him more positively than he’d assumed before.
Hair loss may seem less significant than many of the catastrophic losses psychotherapists are confronted with on a daily basis. But I hope to have shown that it is a deeply poignant and evocative experience for the young men who struggle with it.
This Psyche Idea is adapted from my paper ‘“How His Hair Is Growing Thin!”: On the Emotional Significance of Male Pattern Hair Loss’ (2023), published in the Journal of the American Psychoanalytic Association. My clients’ names have been changed to protect their identity.
