Introduction
- Hair loss, though physically harmless, can be distressing.
- A multi-billion dollar industry exploits this distress with covert marketing of largely ineffective, sometimes harmful, products.
- There is a need for psychoeducational resources that challenge the interpretation of hair loss as inevitably distressing and in need of ‘treatments’.
- This paper examines the cultural stigma of hair loss, particularly driven by its commercial medicalisation into a disease. It argues for improved medical education and stricter regulation of businesses profiting from hair loss distress.
Hair loss or alopecia is one of the most common bodily changes people experience over their lifetimes (NHS, 2018). There are different alopecia types including areata (patchy hair loss), androgenetic (genetic and hormonal hair loss) and cicratials (scarring hair loss). Areata has a lifetime prevalence rate of about 2% (Jankowski, 2024) and androgenetic has a prevalence of about 35% (Salman et al., 2017) though this differs by sex and age.
Any hair loss is not necessarily a disease because it is largely physically harmless. For example, whilst a hairless scalp risks greater UV damage, it also benefits from increased Vitamin D production (Durusoy et al., 2009). Relatedly, whilst some forms of hair loss can occur alongside underlying diseases, hair loss is a symptom not a cause (Rajabi et al., 2018). Even dermatological experts do not necessarily refer to alopecia as a disease. For example, Alopecia areata has been referred to as an “independent medical entity” (Rajabi et al., 2018, p. 33) whilst androgenetic alopecia has been called a “basically cosmetic condition” (Trueb, 2021, p. 22). Longitudinal research also confirms the obvious. People with baldness (another form of hair loss) live just as long as those with hair (Menotti et al., 2006; Schnohr et al., 1998).
Hair loss’ physical insignificance does not mean it is an easy psychological experience. Unfortunately, the appearance-fixated society we live in often makes the experience challenging. Hair loss in contemporary TV, film and media is rarely depicted and the few exceptions tend to associate it with villainy, aggression or aging (Bock et al., 2018; Jankowski et al., 2014; Kyriakou et al., 2021). Researchers (Kyriakou et al., 2021) recently studied the top rated 100 film villains and their heroic counterparts. They found villains often had hair loss (64%) which was rare in heroes (22%). Especially as heroes typically had slight hair loss whilst villains had more extensive. The researchers tied this to a common media pattern; when characters turn evil they often lose their hair (think Scott Evil in Austin Powers). Furthermore, haired actors tend to shave their heads to portray villains (e.g., Mark Wahlberg in Flight Risk, Tom Cruise in Tropic Thunder), and conversely, bald actors don wigs when playing heroes (e.g., Corey Stoll in The Strain, Sean Connery as James Bond; Edwards, 2025). Still, hair loss’s psychological impact is mixed; some people report acceptance, spiritual growth and neutrality with it (Frith and Jankowski, 2023; Holmes, 2014; Jankowski et al., 2024; Rajabi et al., 2018). Unfortunately others can feel unattractive, anxious and distressed (Holmes, 2014; Jankowski et al., 2024).
A multi-billion dollar, global, industry profits from this distress. Hair loss cosmetics, pharmaceutical drugs and wigs are marketed as ‘treatments’ to hair loss. Often covertly. For example, research, forums and social media pages – that appear to be seemingly objective – are increasingly sponsored, curated and biased by this industry (Behbahani et al., 2020; Harvey, 2013; Jankowski and Frith, 2022; Li et al., 2019). In other words, hair loss media is often pushing people to ‘treat’ their hair loss with whatever cosmetic, drug, wig or surgical product is sponsoring them. In my forthcoming book, Branding Baldness, I trace how men’s baldness has been steadily transformed by anti-baldness companies from a mildly annoying bodily change to a devastating disease in need of ‘treatments’. I highlight how baldness wasn’t always interpreted in this way, as demonstrated by 17th century monks’ tonsures to Ancient Egyptian balding hairstyles. I rebut 10 myths about men’s baldness that businesses promote.
Hair loss products run high risk for relatively low rewards. Firstly these products do not always work (Adil and Godwin, 2017; Fukumoto et al., 2009; Gupta et al., 2019; Rajabi et al., 2018). For example, two meta analyses (Adil and Godwin, 2017; Gupta et al., 2019) found that products such as PRP (protein rich plasma), finasteride, minoxidil, and dutasteride regrew about 8 to 24 hairs in a monitored squared centimetre of scalp on average. This is some hair regrowth. However, most scalps have around 120 hairs in the same size area (S. S. Han et al., 2004; Vecchio et al., 2002). Unsurprisingly, most people do not regard average ‘treatment’ regrowth to be ‘cosmetically meaningful’ (Wyrwich et al., 2022). A recently licensed ‘treatment’ for alopecia areata in the UK, ritlecitinib, is estimated by the European Medicines Agency (2023) to result in >80% hair regrowth but only for about a third of people taking it. It also carries risk of dizziness, throat infections, and acne and is too dangerous to use if a woman is pregnant. Secondly, hair loss products also risk wasted time, effort and even health, with side effects ranging from scalp infections to sexual impotence (Pompili et al., 2021; Satoh et al., 2000).
Myself and colleagues recently surveyed 357 bald men (Jankowski et al., 2024). We found most (69%) had been exposed to hair loss adverts including shampoos, pharmaceuticals and transplants. This exposure was common enough to cross national borders; half of our participants were from Africa, Asia and South America. Such adverts tend to frame hair loss as a devastating disease in need of ‘treatment’ (Harvey, 2013). We also found that this negative framing of hair loss makes bald men feel more distressed, misled and in need of ‘treatments’ (Razum et al., in prep.). In contrast, we found that when bald men read neutral, evidence-based messaging, they felt less anxious and less reckless in their baldness responses. Our study is the first to show that even short evidence based-information may offer some protection from the harms of hair loss advertising. As such, we have developed 8 animated videos and a blogsite to promote evidence-based thinking about one of the commonest forms of hair loss – men’s baldness.
Policy recommendations
- There is a need for commercially independent education for medical students about alopecia. It is recognised that dermatological education on the medical curriculum is too limited, that evidence-based guidance is lacking and that people with alopecia can find medical practitioners dismissive of their concerns (All Party Parliamentary Group on Skin, 2020; Jankowski and Kranz, 2023; Zucchelli et al., 2023). This education must also be racially diverse due to historical biases assuming all people have light skin or straight hair (Aryiku et al., 2015). Education should be racially diverse (Aryiku et al., 2015) and cover alopecia’s typology, psychosocial impact, the efficacy and safety of various interventions, and alternative responses like acceptance and shaving. Education about medicalisation (Moynihan et al., 2019) would also benefit practitioners.
- There is a need for better regulation of alopecia businesses. Businesses can make claims that ‘treatments’ are more effective, safe and pain free than they are in reality (Nagpal, 2017). These misleading claims need effective regulation beyond minimal fines. Forums, research and social media spaces should be transparent about their commercial biases including funding or ghost writing (see Graph 1). For example, Jankowski and Frith (2022) found evidence of 7 probable commercial conflicts of interest in psychological baldness studies that were not disclosed to the journal, even though most journals require disclosures. Jankowski and Kranz (2023) also found that commercially-biased research can mislead hair transplant surgeons and other professionals. Research, like other forms of hair loss media, should be used with caution.
- There is a need for psychoeducational resources. These can offer emotional support, improve knowledge and increase shared decision-making capacity if a person is considering hair loss products. This will allow such people to respond to their alopecia in the safest, sensible way possible. Ideally the resource would be combined with a commercially-independent, moderated, online forum for people with alopecia to be able to share information and support with each other, free from advertisers. These resources can show the other side of alopecia, the acceptance and even psychological benefits, that many people come to experience (Kranz et al., 2019; Welsh & Guy, 2009; Wiggins, 2014).
Conclusion
Whilst hair loss can be a psychologically challenging, it does not need to be a devasting nor diseased experience. Unfortunately, strong commercial pressures promote this negative experience to sell products that only modestly work and carry safety risks. Specifically, a multi-billion-dollar industry capitalises on the distress associated with hair loss, promoting products and treatments with exaggerated claims and often undisclosed commercial biases. Mine and colleagues’ research demonstrates the negative impact of such marketing on individuals experiencing hair loss, highlighting how it can increase anxiety and drive them towards potentially harmful or ineffective “treatments” without adequate medical monitoring. Conversely, exposure to neutral, evidence-based information about hair loss supports individuals to make informed responses about their own scalps. Resources that counter the commercially driven pressures are necessary then as is more effective regulation of the hair loss industry. Ultimately, this shift in perspective can help normalize hair loss as a common bodily change, rather than a disease.
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