I realised my hair was starting to thin when the follicular facts were aggressively spelled out to me by my barber. I was in my mid-thirties and had what I assumed was a completely normal head of dark hair, which had been cut by the same jovial Syrian barber in central London for the previous decade. “It’s definitely going, mate,” he said. He pulled at my hair and shook his head like a builder sizing up a roof in need of major work. “No way you’ll be able to get married once your hair goes.” I was in the foothills of a condition that, according to the British Association of Dermatologists, affects about 50 per cent of men by the time they’re 50. It’s most commonly known as male pattern hair loss, but can also include a range of alopecia-based conditions from a temporary bald patch to a full and sudden loss of everything, including your eyelashes.

For many men, losing their hair is a traumatic experience. “I think deep down I did get depressed when I realised it was happening,” says stylist and writer Mr Jason Jules. “I was in my late thirties. It felt like I’d only just managed to get a sense of myself, to actually like my appearance and all of a sudden it was falling apart.” Mr Darren Fowler, owner of the Fowler35 salon in Fitzrovia, London, has seen first hand how profoundly upsetting many men find any degree of hair loss. “Generally speaking, I wouldn’t broach the subject unless someone has brought up their hair loss specifically,” he says. “It can be a particularly sensitive subject for some men.” 

This sense of a very genuine loss – of hair, but also identity – comes through strongly in the testimonials gathered by the charity Alopecia UK. A recent online discussion it hosted revealed just how hard hair loss can hit. One successful, otherwise confident man said, “When I first got it, I hid for a year.” Some recalled how periods of great stress had triggered the process, their hair loss then compounding their misery. Some had gone from normality to total hair loss in six weeks, some experienced it as an intermittent condition and lived with the constant fear of it recurring. One man resigned from his job to avoid seeing other people. “I have days when it’ll be the only thing on my mind, especially when you’re in crowded places,” said one man. “You feel like the centre of attention, even when you know you’re not.”

On some level, this reaction to a simple, unavoidable physical change seems disproportionate. But hair loss represents something much bigger. “Freud said the ego, in other words the self, is first and foremost a body ego,” says Dr Stephen Blumenthal, a clinical psychologist and psychoanalyst who has been addressing patients’ issues of depression, anxiety, psychosexual difficulties and anger management for more than 25 years. “We begin to get a sense of ourselves, first and foremost from our bodies. The thing with the body is that all our anxieties about what are ordinary conflicts become focused on a particular area. If you don’t have an internal language for your emotions, which a lot of men don’t, I think it’s quite typical that men find the feeling of vulnerability – and shame, particularly – very difficult to bear. It’s displaced onto an aspect of your body and the fantasy becomes that if you can change that then you can get rid of that feeling, which really resides in a more emotional place.”

While many of these issues have been made worse by the image-obsessed culture in which we live, advances in procedures such as hair replacement have also exacerbated the problem. “We think that we’re offering solutions to people, but that just feeds a kind of tyranny,” says Dr Blumenthal. “It draws attention to the ‘shame’ of baldness, which is actually just an ordinary thing.”

Mr Fowler also talks of the extreme measures men will go to and recalls a client with a full head of hair who was very slightly receding. “He had been using literally every hair treatment supplement he could, so was spending about £800 per month,” says Mr Fowler. “It was very likely to be a much deeper psychological issue driving this so, with his agreement, I referred him to a therapist to explore these issues.” Many men are far less fortunate and end up on an unscrupulous, expensive cycle of flaw-finding and treatments.

“It is important to find [a therapist] who is compassionate and with whom you can engage emotionally, but who is also challenging rather than simply supportive,” says Mr Blumenthal. He advises checking a therapist’s credentials with the British Psychoanalytic Council or the UK Council for Psychotherapy. “Unfortunately, we often hear from people that they struggle initially with their GP, sometimes feeling they’re dismissive of the impact their hair loss is having,” says Ms Amy Johnson, operations manager of Alopecia UK.

“We know that men do not access support networks in the same way as women,” says Ms Jen Chambers, charity development manager at Alopecia UK. “We’ve often been told that men feel as though they’re expected to just get on with it.” The charity has recorded higher levels of depression and anxiety among those with hair loss and seen how some men can experience a profound sense of cognitive dissonance when the person they see in the mirror no longer matches their image of themselves. “I would recommend anyone struggling with their hair loss to get in touch with us,” says Ms Chambers. “They can benefit from the valuable peer support that is available through the charity. It can make all the difference to be in touch with others who understand what you’re going through.”

The charity has seen how men have begun to find a way to live with their new appearance after accessing its services. “Peer support is such a central part of what we do at the charity,” says Ms Chambers. “It helps to normalise some of the things you feel when experiencing hair loss.” The group has a private page on Facebook with more than 9,000 members providing mutual support.

Fred, 37, works in media and developed alopecia areata, which swiftly spread into a network of patches throughout his beard and hair. “At 35, I never thought I’d have a combover,” he says. “I had to shave off my beard so you don’t see the patches.” He speaks bluntly about the impact his alopecia had on him. “I hadn’t quite appreciated how much my hair was part of my identity and how much it impacted the way I looked. I lost control of that part of me. It was like being forced to wear clothes that you wouldn’t be seen dead in. I saw a person I didn’t want to see in the mirror. I stopped dating.”

Aidan, 20, is a trainee actor, who fears that hair loss will scupper his chances of making it in the industry. “Some days, I don’t leave the house,” he says. “It can easily be compared to grief. Nobody should ever underestimate the mental impact hair loss has on men. It has evoked a lot of anxiety in me, which I battle daily.”

Accepting the way our appearance changes – and coming to love it anyway – is one of the challenges of getting older, but it has real value both spiritually and aesthetically. “What I like about not having any hair is that it’s kind of timeless,” says Mr Jules. “When I look back at pictures of myself and I have semi-afros and stuff like that I think, how uncool, how dated they look. I wish I’d cut my hair to this length long before I went bald and had no choice in the matter. So what if you’re bald? For me personally, shaving the whole thing off, going clean so to speak, allowed me to move on with my life. In many ways, it was quite liberating.”

Aidan talks of how, while he is still experimenting with various topical and medical treatments as well as concealers (“L’Oréal’s Magic Retouch works well for me”), he realises that the long-term solution lies in the work that he has started on himself. “I have embarked on a bit of a spiritual journey, which is helping,” he says. “Something I have learnt is that the aim is to feel confident and happy, not to have a full head of hair.”

Dr Blumenthal discusses the topic of attempting to achieve “perfection”. “The whole cosmetic surgery explosion attempts to deny an important fact of life, namely that we age,” he says. “While it is important to look good and that can make you feel good, we simply can’t stop the clock. It represents a fantasy of limitlessness, yet our limitations – that our whole self is embodied by this ageing shell, which will deteriorate and die one day – is actually a source of meaning.”

He recommends reading The Examined Life by Mr Stephen Grosz and Maybe You Should Talk To Someone by Ms Lori Gottlieb, which both describe the therapeutic journey and touch on the ageing process.

“This is exactly when men struggle the most,” says Dr Blumenthal. “At that point where you aren’t as strong physically and perhaps mentally and when younger rivals start to challenge your position.” But he says this can be a moment of reinvention, if we view it the right way. “A crisis of middle age can give rise to the opportunity to find a renewed sense of meaning in life,” he says.