Dear Patti,
I hadn’t thought about men losing their hair before age 30, so when I turned 20 two years ago and friends started joking about me going bald, I was shocked.

At first I told myself it wasn’t true. Then I kept asking family and friends if my hair looked like I was going bald. My worst fears are now confirmed: My hairline is definitely retreating and my hair is steadily thinning. It’s making me very depressed. I hate to look in the mirror and at times become obsessive checking for more hair loss. Becoming so self-conscious about my appearance has made it hard to enjoy going out socially. My two brothers think it’s pathetic that a man should be so concerned about something as frivolous as hair loss: “It’s only hair. Deal with it. Get over it. It’s part of life.” They don’t understand that I’d love to accept my baldness instead of constantly feeling shame and utter dread of becoming even balder.

A cosmetic surgeon diagnosed male-pattern baldness and said I might be a surgery candidate. He’s concerned, however, that I may be suffering from hair loss dysmorphic disorder, which needs assessment first. He referred me to a psychotherapist trained in this area that I will be seeing soon.

— Andrew

Dear Andrew,
You are not alone. Hair loss is very common and affects millions of people throughout the world. Male-pattern baldness — androgenic alopecia — is the most common type. Approximately half of all men will be thinning substantially before their 50th birthday, and up to 85 percent will experience thinning during their lifetime. As one ages, hair loss becomes an acceptable — and commonplace — sign of transition. It’s also generally less important to others than the person experiencing hair loss tends to think. Each man is affected differently regarding the impact hair loss has on his self-esteem, and it’s not abnormal to initially have feelings of confusion and despair. If one cannot adjust to this transition, however, and experiences enormous chronic suffering and deep shame as an emotional response to feeling inferior, that can be a concern.

Hair loss dysmorphic disorder is a subset of body dysmorphic disorder (BDD), characterized by a preoccupation of a perceived flaw in the appearance of one’s hair. A recent study of 500 patients with BDD showed that hair loss was the second most common issue at 56 percent.

BDD — also known as dysmorphophobia (fear of having a deformity) — is a somatoform disorder, a chronic mental illness in which one is constantly thinking about a flaw in appearance because of a specific body part. Whether that flaw is minor or imagined, BDD is sometimes called “imagined ugliness” and, deeming his or her appearance to be shameful, the person is often distressed to be seen and judged as “defective” by others. These individuals might also obsess intensely about their appearance for many hours a day. Poor body image can lower self-esteem and goes hand-in-hand with depression and social anxiety.

BDD usually doesn’t get better on its own and, if untreated, may get worse over time. Shame often keeps individuals from seeking treatment, causing many cases to go unrecognized. I’m glad you’re seeing health providers to address your symptoms. Treatment often includes a combination of medication and psychotherapy. Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are being used.

Psychotherapy that focuses on changing thinking and behaviors to correct false beliefs about the defect and to minimize compulsive behavior is extremely useful. It’s also therapeutically important to experience the shame and let it pass without internalizing. You’ll want to carefully explore the historical events and connected feelings contributing to your difficulty coping with baldness and explore your critical inner voice in terms of how you perceive yourself. You’ll learn how to replace negative thoughts with positive ones, such as reminding yourself of your good qualities. When you lose your hair, you don’t lose your personality, your intelligence, sense of humor, or the looks of your face and body. You are the same person that your friends and family love. If through treatment you can learn to accept your hair loss, it will make it easier for others to accept it as well.

Lastly, to quote Bruce Willis, “I don’t make a big deal out of it. Whether you’re a man or not comes from your heart — not from how much hair you have on your head.”  

Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email Visit her Web site,