Andreas Krämer Hair4life



Hair loss sufferer, consultant since 2004, co-author of the book “Hair Transplantation Guidebook” by Alliance4Hair, founder of Propatient with lawyer Chr. Bomke, co-founder of the HTTC training center for doctors. Known from SWR, SAT 1, ZDF, Spiegel and many others. About Us


Humans occupy a special position among their closest relatives in the animal kingdom as “naked apes” (12). Strictly speaking, of course, we are not really naked; the distribution of the hair coat merely shows a pattern characteristic of humans. Whatever the reasons may have been for the extensive reduction of the hair coat – from a purely biological-medical point of view we can state: When it comes to mere survival, hair is not necessary. On the other hand, we have to realise that hair plays an extraordinarily important role, especially in social and psychological terms, just as it does in many areas of life such as sport, wellness, going out, or just in general.

The importance of hair can be seen not least in the amount of time and money we spend on its care. For most women, the cumulative expenditure of time is likely to amount to several months, in some cases even years. However, hair is not only an important topic for women, but also for men.

For the “stronger sex”, the fear of hair loss is in the foreground. Several hundred million men worldwide are affected by the typical manifestation of male hair loss, hereditary (androgenetic) alopecia. According to a study by the EMNID Institute, 40 percent of German men between the ages of 30 and 50 have personally experienced hair loss. 15 percent have at least pronounced receding hairlines, and 3 percent have only a crown of hair (17). For most men, the loss of hair is at least unpleasant; for some it is linked to serious psychological problems (2). In addition, there is evidence that baldness can lead to real negative social consequences (2,17). In the fight against baldness, men expend considerable resources. For example, US men are reported to spend more than $7 billion per year on this (7).

The enormous importance of hair is not a recentphenomenon in modern Western society. Significantly, one of the oldest medicines known to medical history is a remedy for male pattern baldness: 4,000 years ago, the ancient Egyptians rubbed a tincture of ground dog paws and donkey hooves fried in oil on their bald heads. We know similar bizarre concoctions from various centuries and from all parts of the world (8). But the fight against baldness does not stop there. Even if it is “only” about the mere beautification of the hair, an enormous effort has been made since time immemorial and all over the world; and this by both men and women. Countless testimonies from history, ethnology and archaeology prove that hair has played a prominent role at all times and in all cultures and still does today (3,8,11,13,16).


Since our hair coat is not absolutely necessary from a purely biological-medical point of view, it is clear that when it comes to hair, it is first and foremost a matter of appearance. If you are dissatisfied with your hair, you are dissatisfied with your appearance. This makes hair a psychological issuein a very central sense.

Both everyday experience and social-scientific research make it unmistakably clear: appearance counts(5,6,10,11,18) . Our physical appearance plays a crucial role in how we are seen by others and how we see ourselves; and it has a multitude of real psychological and social consequences. It is therefore not surprising that people all over the world try to change their appearance to conform to social and individual standards. Primitive cultures often make serious physical changes that are long-lasting and often painful, appearing to our eyes as mutilations. In modern cultures, the changes are mostly of a more temporary nature. One of the simplest and at the same time most important and effective ways to change appearance is through hair.

In order to understand the immense importance of hair, three closely related points must be considered, which can be characterised by the keywords variability, manipulability and signalling function .

Hair has a very large Variabilityvariability. For example, it shows significant differences in terms of colour, length, texture, style, fullness, location and authenticity. Variations in these dimensions can cause significant differencesin appearance.

Hair is readily available as a “naturally renewable resource” – at least for those fortunate enough to have hair – and it can be manipulated in many ways (cut, combed, curled, braided, dyed, shaved, etc.). The ease with which it can be manipulated opens up unique design possibilities that can have a significant impact on one’s outer appearance.

Hair has a number of signalling functions that are extremely important for our social life. For example, they provide clues about age, gender, ethnic group, social (sub)group, social rank and, last but not least, individuality.

Hair is important because it has a decisive influence on outward appearance – similar to losing weight when the body weight was previously higher – and because it conveys important information about its wearer. This information can relate to biological qualitiesas well as to social identityand individuality.


There is probably no culture that is completely indifferent to hair. All over the world, hair is associated with certain symbolic functions. Although social symbols change over time and can be interpreted differently by different social groups, cross-cultural trends can certainly be identified. Synnott (16) highlights the following principles:

  • different sexes have different hair
  • Head hair and body hair have different meanings
  • different ideologies show up in different hair

In terms of symbolic connections between hair length and sexuality, trends emerge across different cultures:

  • long hair: unrestricted sexuality
  • short, partially shaved or closely tied hair: restricted sexuality
  • clean-shaven head: celibacy.

The battle against male pattern baldness, which has been going on since time immemorial, indicates that male pattern baldnessis viewed negatively in almost all cultures. Although the typical manifestation of male pattern baldness (androgenetic alopecia) can be regarded as a “male sexual characteristic”, it is mostly not seen as a symbol of increased masculinity. On the contrary, baldness was and is interpreted in many cultures rather as a symbolof old age and death and of diminishing masculinity.


Androgenetic alopecia undoubtedly has biological causes. Thus, its causal control is a matter of medicine. However, the effects of male pattern baldness are primarily psychological. From a psychological point of view, the issue of hair loss can be viewed from different perspectives (which are not independent of each other):

  • Effect on others (external image)
  • Psychological consequences (self-image, psychological problems)
  • Personality correlates –
  • Social consequences (e.g. partnership, profession)
  • Possibilities of psycho-social and therapeutic support.

An overview of the (relatively sparse) psychological research on hereditary hair loss in men can be found in Cash (2).
In the following, we will limit ourselves to one partial aspect, namely the question “How does baldness affect the observer?”. This aspect is of particular importance because it can be the starting point of far-reaching psychological and social problems. If it made no difference at all in the eyes of our fellow men whether we were bald or had a full head of hair, then the question of the psychological and social consequences of hair loss would become superfluous. But everyday experience already shows that this condition is certainly not fulfilled.

So far, only a few psychological studies on the impression of male pattern baldness are available (for an overview see 1,2,14). Overall, however, it is clear that baldness is predominantly viewed negatively. For example, in a study by Cash (1), bald men were thought to have lower self-esteem and less success in life; at the same time, they appeared to be less likeable and less attractive; and they were thought to be significantly older.

An interesting consideration has been put forward by Muscarella and Cunningham (14).While some authors suggest that baldness has developed over evolutionary time as a signal of male dominance, Muscarella and Cunningham point out that a bald male head is more consistent with the childlike schema (“babyface” characteristics). Accordingly, the authors assume that baldness has evolved as an indicator of social appeasement. With the help of retouched photos, they were able to show that one and the same person with a bald head appeared less aggressive than with a full head of hair and at the same time scored higher on the dimension ‘appeasement’ (shy, feminine, babyface, naïve, friendly). In addition, the bald people also scored more positively on a factor that included aspects of intelligence and social agreeableness. On this point, however, Cash (1) had shown different results: There was no effect with regard to assessed intelligence; and with regard to social acceptability, bald people scored significantly worse.

At Saarland University, we have so far completed two studies on the impression effect of male baldness. In the first study, face photos of 90 men aged 20 to 60 were presented. The assessment was made with regard to characteristics that can be understood as components of male partner value, namely: Attractiveness, sexual attractiveness, health, masculinity, occupational prestige, fashion, “baby face”, mood, age (6). In addition, an independent judge group assessed the degree of hair loss according to Norwood’s classification (15). The results show that baldness has a negative effect in almost every respect. However, after the age of the persons assessed was removed, only two statistically significant findings remained: bald men are estimated to be older than they actually are, and they are less sexually attractive than men with fuller hair.

The second study was conducted via the internet. Two picture versions of each of 9 men were created: One with a full head of hair, the other with a bald head (for men with a full head of hair, the bald head was retouched by computer; for bald men, a full head of hair was achieved by a wig). More than 1,800 test subjects from all over the world took part in the study, which was available in German and English. 80 per cent of them were women. The test subjects each saw only one picture, which they were asked to judge with regard to 80 personality traits. From the individual judgements, four global dimensions of the personality impression could be obtained: Sexual attractiveness (e.g. sexy, seductive, success with women, good lover), suitability as a spouse (e.g. good-natured, family-oriented, faithful husband, good father), profession/career (success in profession, career-oriented, intelligent, respected profession) and self-confidence (self-confident, shy, nervous, reserved). Hair fullness had no statistically significant influence on the presumed suitability as a spouse and the assessed career success. In contrast, the men in the version with a full head of hair were rated as significantly more self-confident than in the version with a bald head. The effect was particularly strong with regard to sexual attractiveness: baldness led to considerable losses in sexual attractiveness. In addition, the men were estimated to be about 2 years older on average when they were bald.

Although the findings do not agree in all points, the psychological studies available so far allow some generalisations about the impression effect of male baldness. Bald men appear much older than men with a full head of hair. Moreover, bald men score much lower in terms of sexual attractiveness. Furthermore, they are considered less self-confident.

Overall, the bald stereotype has many more negative aspects than positive ones. Bald people seem to be on the fringes of social life in the eyes of others. Values such as youthfulness, sexual attractiveness, activity, exciting life, on the other hand, seem to be reserved for those who (still) have a full head of hair. Thus, the loss of hair contributes to a reduction in partner value.

This is probably one of the main reasons why men at all times and in all cultures faced the loss of their main hair with trepidation – and why at least some tried by all means to counteract this threat.

P.S.: Apparently, modern medicine is now providing us for the first time with means to combat hair loss causally (7).

Ronald Henss, Saarbrücken

Selected references 1. Cash, T. F. (1990). Losing hair, losing points?: The effects of male pattern baldness on social impression formation. Journal of Applied Social Psychology, 20, 154-167.
2. Cash, T. F. (1999). The psychological consequences of androgenetic alopecia: a review of the research literature. British Journal of Dermatology, 141, xxx-xxx.
3. Cooper, W. (1971). Hair. Sex, society, symbolism. New York: Stein and Day Publishers.
4. Guthrie, R. D. (1976). Body hot spots. The anatomy of human social organs and behaviour. New York: Van Nostrand Reinhold Company.
5. Henss, R. (1992). “Mirror, mirror on the wall …” Gender, age and physical attractiveness. Weinheim: Psychology Publishing Union.
6. Henss, R. (1998). Face and personal impression. Göttingen: Hogrefe. 7. Kaufman, K. D. et al. (1998). Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology, 39, 578-589.
8. Kligman, A. M. & Freeman, B. (1988). History of baldness from magic to medicine. Clinics in Dermatology, 6, 83-88.
9. Kobren, S. D. (1998). The bald truth. The first complete guide to preventing and treating hair loss. New York: Pocket Books.
10. Landau, T. (1993). Face to face. What faces reveal and what they hide. Heidelberg: Spektrum Akademischer Verlag.
11. Ligget, J. & Liggett, A. (1990). The tyranny of beauty. Munich: Heyne.
12. Morris, D. (1969). The naked monkey. Munich: Droemer Knaur.
13. Morris, D. (1986). Body signals: from the crown of the head to the chin. Munich: Heyne.
14. Muscarella, F. & Cunningham, M. R. (1996). The evolutionary significance and social perception of male pattern baldness and facial hair. Ethology and Sociobiology, 17, 99-117.
15. Norwood, O’T. T. (1975). Male pattern baldness: Classification and incidence.
Southern Medical Journal, 68, 1359-1365. 16. Synnott, A. (1987). Shame and glory: A sociology of hair. The British Journal of Sociology, 38, 381-413.
17. Tischer, B. (1999). Influence of hair loss on personnel decisions. Pullach: EMNID Institute.
18. Zebrowitz, L. A. (1997). Reading faces. Window to the soul?. Boulder: Westview Press. Hair and Identity From top left to bottom right: Lady Di; Ronald Reagan; Bob Marley; George Washington; Albert Einstein; Captain Kangaroo; Farrah Fawcett; Elvis Presley; Bo Derek; William Shakespeare; Groucho Marx; Yul Brynner or Telly Savallas After (10, pp. 118-119).Courtesy of Dr Ronald HenssOther links on the topic: PSYCHOLOGIE – Courage to go bald