Androgenetic Alopecia and Mental Health

Androgenetic alopecia is the most common type of hair loss. Despite its high prevalence, it is often considered a minor dermatological condition, defined solely by its physical manifestations. However, its impact extends beyond physical appearance, significantly affecting self-esteem, anxiety levels, depression and overall quality of life.

Hair plays a crucial role in self-identity and social perception. Studies indicate that individuals with androgenetic alopecia  suffer higher levels of anxiety and depression, though its psychological burden may be lower than conditions such as alopecia areata (AA). The Dermatology Life Quality Index (DLQI) scores AGA at 2.5, compared to 5.8 for AA, highlighting a moderate but notable impact on well-being.

  Understimated Psychosocial Impact  

Physical appearance is a key factor in human identity. At first glance, people tend to focus on facial features and hair, which serve as indicators of well-being¹.  Research underscores the profound emotional distress caused by hair loss:

• Hair loss and chemotherapy: nearly 50% of female patients consider hair loss the most distressing aspect of treatment, with 8% opting to forgo chemotherapy due to this concern².

• Menopause and telogen effluvium: although less studied, hair thinning during menopause significantly affects self-image and quality of life³.

• Alopecia and mental health: a multicentre study conducted in 13 European countries claimed  that individuals with alopecia shows significantly higher levels of anxiety and depression compared to general population. In their sample, 41% of alopecia subjects reported stressful life events in the past six months, compared to 31% of the control group. It also found that women with alopecia reported worse quality of life compared to men, particularly in dimensions such as pain and anxiety/depression. Additionally, subjects over the age of 50 experienced greater impairment in overall well-being, as measured by the EQ-5D index^4.

• Several studies have reported that hair dissatisfaction can lead to a concomitant decline in quality of life, affecting overall body image perception ultimately. Factors such as single marital status, young age and a strong desire for medical intervention have been associated with a higher risk of psychological distress⁶.Regarding hair loss treatment, research suggests that even a modest improvement in hair density can significantly enhance psychological well-being^4,5. These findings highlight the importance of effective interventions against hair loss, as they directly contribute to improved mental health outcomes⁶.

  Psychological and Social Consequences  

Hair loss can significantly impact social interactions, as individuals may feel less attractive, embarrassed or perceived themselves as looking older than their actual age. These factors can affect dating, professional settings and overall daily life.

In the following table several negative patient-perceived effects of hair loss are reported (Hadshiew et al. (2004))

In severe cases, alopecia may trigger obsessive thoughts about appearance body dysmorphic disorder, or mild obsessive-compulsive disorder requiring psychiatric treatment^6,7. Alopecia is also associated with psychiatric comorbidities such as depression, personality disorders, anxiety and substance use.

Cultural and gender differences are also patent. The psychological impact is more pronounced in women than in men, who, despite being more commonly affected, tend to cope better with self-perception changes^6,8.

Titeca et al. (2019) further reported that AGA patients who have demanded medical attention multiple times experience a significantly greater psychological impact, reinforcing the idea that dissatisfaction with available treatments can worsen emotional distress.

Because of aforementioned emotional responses, stress-induced molecules such as catecholamines, prolactin, ACTH, CRH, b-endorphins and glucocorticoids are released^9,10. In fact, Peters et al.¹¹ identified nerve growth factor and substance P as promoters of hair growth inhibition. Consequently, stress can exacerbate the progression of alopecia, creating positive feedback whose effects are counterproductive, culminating in a vicious cycle. 

  Psychosocial well-being assessment  

When clinical conditions are accompanied by psychosocial comorbidities, a multidisciplinary treatment approach is often necessary. Given that many alopecia patients experience dissatisfaction with their medical care, physicians should prioritise a personalised approach.

It is crucial that healthcare professionals set realistic treatment expectations, otherwise psychological outcomes may worsen and treatment discontinuation may occur⁶.

Various scales have been developed over the years to assess psychological impact. The Hair Loss Effects Questionnaire, the Multidimensional Body-Self Relations Questionnaire or the Alopecia Disability Questionnaire are some examples.

A specific diagnosis is essential for adequate clinical management⁶.

Regarding to hair loss treatment, a modest hair density is enough to report a remarkable psychological mood enhancement^4,5. This is further evidence of the great need to ensure an effective intervention against hair loss to  improve mental health outcomes⁶too.

  Coping strategies  

Traditional approaches to AGA have focused on medical treatments primarily, often overlooking its psychological comorbidity. Addressing psychosocial aspects should be regarded as an integral part of its management⁶.

• Medical Treatment:

  • Common pharmacological treatments include Minoxidil and Finasteride.

  • The psychological impact could be managed through antidepressants; however, some antidepressants may disrupt the hair growth cycle, potentially worsening the condition.

• Psychological Support:

  • Cognitive behavioral therapy can play a crucial role in restoring self-esteem and improving emotional well-being¹² .

• Lifestyle Changes:

  • Engaging in resistance and strength training exercises has been shown to alleviate depression and improve overall physical appearance and health.

  • Meditation, yoga and mindfulness practices promote relaxation and self-awareness, helping to reduce anxiety and dissatisfaction¹².

• Connecting with others:

  • Joining AGA support groups where participants can share their feelings and experiences is an excellent way to feel understood and supported.

  Conclusion  

Raising awareness about the psychological impact of androgenetic alopecia can help promote a sense of support among affected individuals and encourage the development of new therapeutic approaches.

Beyond its physical effects, hair loss has a profound psychological impact on self-perception. In summary, the impact of this condition should not be limited to its aesthetic implications, and therapeutic strategies must be intended to significantly reduce the overall burden of the disorder.

References

1. Adamowicz R, Załȩcki P, Dukiel A, Nowicka D. Association between Androgenetic Alopecia and Psychosocial Disease Burden: A Cross-Sectional Survey among Polish Men. Dermatol Res Pract. 2022;2022.

2. Trüeb RM, Tobin DJ. Aging hair. Aging Hair. Springer Berlin Heidelberg; 2010. 1–270 p. 

3. Blume-Peytavi U, Atkin S, Gieler U, Grimalt R. Skin academy: Hair, skin, hormones and menopause - Current status/knowledge on the management of hair disorders in menopausal women. Vol. 22, European Journal of Dermatology. 2012. p. 310–8. 

4. Titeca G, Goudetsidis L, Francq B, Sampogna F, Gieler U, Tomas-Aragones L, et al. ‘The psychosocial burden of alopecia areata and androgenetica’: a cross-sectional multicentre study among dermatological out-patients in 13 European countries. Journal of the European Academy of Dermatology and Venereology. 2020 Feb 1;34(2):406–11. 

5. Zhuang XS, Zheng YY, Xu JJ, Fan WX. Quality of life in women with female pattern hair loss and the impact of topical minoxidil treatment on quality of life in these patients. Exp Ther Med. 2013 Aug;6(2):542–6. 

6. Aukerman EL, Jafferany M. The psychological consequences of androgenetic alopecia: A systematic review. Vol. 22, Journal of Cosmetic Dermatology. John Wiley and Sons Inc; 2023. p. 89–95. 

7. Dhami L. Psychology of Hair Loss Patients and Importance of Counseling. Vol. 54, Indian Journal of Plastic Surgery. Georg Thieme Verlag; 2021. p. 411–5.

8. Frith H, Jankowski GS. Psychosocial impact of androgenetic alopecia on men: A systematic review and meta-analysis. Psychol Health Med. 2024;29(4):822–842. 

9. Hadshiew IM, Foitzik K, Arck PC, Paus R. Burden of hair loss: Stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia. Journal of Investigative Dermatology [Internet]. 2004 Sep 1 [cited 2022 Aug 27];123(3):455–7. Available from: http://www.jidonline.org/article/S0022202X15309635/fulltext

10. Erling Thom. J Drugs Dermatol. 15 (8). 2016 [cited 2025 Feb 26]. p. 1001–4 Stress and the Hair Growth Cycle: Cortisol-Induced Hair Growth Disruption - PubMed. Available from: https://pubmed.ncbi.nlm.nih.gov/27538002/

11. Milena E, Peters J, Handjiski B, Kuhlmei A, Hagen E, Bielas H, et al. Neurogenic Inflammation in Stress-Induced Termination of Murine Hair Growth Is Promoted by Nerve Growth Factor. 2004 Jul. 

12. Cheng Y, Lv LJ, Cui Y, Han XM, Zhang Y, Hu CX. Psychological stress impact neurotrophic factor levels in patients with androgenetic alopecia and correlated with disease progression. World J Psychiatry [Internet]. 2024 Oct 19;14(10):1437–47. Available from: https://www.wjgnet.com/2220-3206/full/v14/i10/1437.html