Unlike other tissues of the body, scalp hair and body hair are not essential to our physical well-being. The loss of scalp hair by the physiologic process of balding (androgenetic alopecia) does not make us ill. The graying of hair by the physiologic process of aging does not induce any metabolic changes in our bodies.
Why, then, do we care so much when we lose hair by balding or lose hair color by aging?
We care because scalp hair isn't just any tissue. It has special significance for us that is manifested in social, cultural and religious settings. Our hair-especially our scalp hair-is one of the principal presentations of "self" we make to the world.
In modern, Western cultures, this presentation of "self" is enhanced by a variety of products marketed by a multi-billion-dollar hair cosmetics industry, reflecting the importance we give to presenting a properly prepared image of "self" to ourselves and to the world.
Hair transplantation and other surgical and pharmacologic methods of hair restoration were developed and came to maturity along with other medical advances of the Twentieth and Twenty-first Centuries. Surgical and pharmacologic hair restoration were rapidly accepted by the public. Innovative physician hair restoration specialists used improved medical knowledge of hair physiology to develop surgical techniques specifically for the purpose of creating a wholly "natural" appearance of transplanted hair. Survey data indicate that annually more than 360,000 persons world-wide avail themselves of surgical and/or medical hair restoration procedures.
Great cultural and religious symbolism is attached to hair and its display in many societies. In some traditional cultures, there are social and/or religious rules governing how, when and to whom a woman may display her scalp hair. A religiously symbolic meaning is seen in the shaven, bald scalps of male monks who choose a life of chastity and poverty.
In the "Hippie" era of the 1960s in the U.S. and Europe, men grew long hair as an indication of their standing as "outsiders" who refused to participate is a society they claimed to abhor. The symbolism was powerful, and it still defines the 1960s as the era of long male hair and "protest".
Scalp hair fashions of movie, television and pop music celebrities have a significant impact on hair styles of everyday life. The shaven, bald scalp of actor Yul Brynner in the 1970s and '80s presented male baldness as a symbol of male power and sexuality. At about the same time, the wavy, thick locks of actor James Dean were a symbol of teen-age angst. The short, military style hair of actor Clint Eastwood mirrored a general acceptance of the "crew cut" as a symbol of male authority and discipline.
Carefully shaped and styled hair is essential to the well-groomed look that traditionally symbolizes trustworthiness and sincerity in the business world. Contrarily, hair worn in a tangled and matted style may symbolize a significant cultural position when worn by a magnate of the pop music industry.
The enforcement of short-hair style on women is a practice associated with punishment. Loss of her hair, and by implication her "self", symbolizes the infraction of rules for which she is punished. In liberated countries of post-World War Two Europe, women who were identified as collaborators with occupying troops were often shaven bald and forced to march down the street before jeering crowds.
In the U.S., a few minutes spent scanning covers of popular magazines speaks volumes about the importance of hair length, hair color and hair styling as a presentation of "self". Hair is as important as body weight, body height and body shape in the totality of "body image"-the "self" we see in the mirror and the "self" we want to present to the world.
While hair styling is often associated with women more than with men, a look at "men's magazines" makes clear that men also take their hair style seriously. The man who pumps iron to sculpt an attractive body shape does not neglect the effect of his hair style on overall body image. Styles may range from the shaven heads of professional wrestlers to the movie-actor hair of Arnold Schwarzenegger, but muscles and hair go together in the sculpting of a body image.
We don't often think about the symbolic importance of scalp hair in our daily lives. Hair is, for most of us, a "fact of life". We may suddenly find ourselves thinking about it when our hair begins to thin. Faced with the loss of an important part of our social and cultural "self", we find ourselves making a decision: should hair loss be accepted as a "fact of life", or is hair restoration an option we want to consider?
The loss of scalp hair will not make us physically ill. However, loss of scalp hair may have emotional and psychological consequences.