3. beneath the dome
transcript
Dr. Kabakar: Usually, if you go and look at elections, the guy with the better head of hair is more likely going to win. Think of the presidential elections. The last time we had bald guys running was Eisenhower and Stevenson and they both were bald.
Lily: Hey I’m Lily Sloane. This is “A Therapist Walks into a Bar.” A podcast that brings therapy to you.
Adam: With the amount of things I've gone through in my adult life. That's the least of my fucking worries. I have friends who are 22 years old who have lost their hair. They are fantastic human beings. If I can actually see, walk, use my hands, hair or not doesn't matter.
Dr. K: Because hair is power and sex in the minds of people who are interested in power and sex.
Lily: If I say body image, what do you think of? Stomach fat? Hips? Thigh gap? Laser hair removal? You probably think of women. And for good reason. Because women get a lot of pressure to look a certain way. But more and more, I’ve noticed this happen to men, too. And I think that’s worth talking about.
Dr K: Gavin Newsom's hair is going to win many elections. He's going to be our next senator, our next governor.
Woman: But, hey, if you've got a butt-ton of money and this is going to make you feel more secure in life and walking around, why not, more power to you. I think you could use your $20000 to something better. Go out there and do an amazing vacation.
Lily: If you haven’t guessed yet, I’m honing in on one aspect of men’s body image: hair loss. And I am so stoked because I got to collaborate with an incredible podcast called Mannish, a show all about masculinity and gender. Joining me is it’s host and creator, Jesse Rhodes.
Jesse: Hi.
Lily: Welcome.
Jesse: Thanks. I’m really excited to do this.
Lily: So at the start of the show we heard this guy:
Dr K: I’m Dr. Kabaker. I’m a physician in Oakland, CA. I practice facial plastic surgery with an emphasis on hair restoration, both reconstructive and cosmetic.
Lily: Jesse, you interviewed Dr. Kabaker and I know you had something you wanted to share.
Jesse: Yeah. I have to say, I was a little sceptical about this story at first. I mean we were brainstorming ideas for the show and you mentioned how many young balding guys you’ve known who felt insecure about their hair loss. And I felt like, is that really true, though. And then this thing happened. I went to interview Dr. Kabaker at his office. We were talking about procedures and celebrities with hair loss,
Dr. K: As most men, hair recedes as they get older...
Jesse: And then I felt his eyes on my hairline, and before I could even register it, he reached out and touched my head with his finger:
Dr. K: ...like you for instance, you've got some recession here, it's probably heredity, and you didn't have that when you were 16.
Jesse: Did you catch that? He said, “You’ve got some recession here.”
Dr. K: you've got some recession here.
Jesse: And it was like a frozen chill went down my spine. And then internal panic.
Lily: You didn’t know about the recession.
Jesse: I did, but I thought it was so subtle, no one else really noticed. And then he homed his eyes on my head and saw it. It was like that moment in a horror movie when the killer sees you hiding and makes eye contact.
Lily: Jesse, it’s really not obvious.
Jesse: Thank you.
Lily: But you’re anxiety about it doesn’t surprise me. While it can be really vulnerable, especially for men, to talk about their insecurities, they’re still there. This guy we spoke with at the bar was shared the humiliation that can with realizing he just couldn’t cover it up anymore.
Nate: And then the last time I ever had hair, I was walking to the subway and my hair was combed over and it was like, pretty much I just had all the hair around the crown of my head and it was just growing long along one side and it just all kind of flopped over and so I'm walking to the subway and the wind blows and it blows it back. And an old man laughs at me - and granted it's an old man laughing at a 23 year old for his comb over so pretty much I decided at that point that I would go home immediately and shave it all off. Which I did.
Jesse: Oh man. Well, you know I talked to this hairdresser.
Morgan: I'm Morgan Brown.
Jessie: she specializes in men’s haircuts and has had guys, usually young guys in their 20s, come to her freaking out about their hairline.
Morgan: Yeah, it's the younger ones that are really emotional. I had one, actually, call me frantically one day. He's like, "I need to come see you for like two minutes. Am I balding? Am I balding? Someone told me I'm balding."
J: So he wanted you to like look and give your opinion about whether or not he was receding?
M: Yes.
J: Could you tell?
M: He was fine.
J: He was fine.
Lily: And if you had any doubt about men’s insecurity about their hair, watch an episode of Curb Your Enthusiasm or Seinfeld or just browse around on Youtube:
Joe: Urgent. I just got a question that freaked me the fuck out. Someone asked me, “Joe, are you going bald?” That’s like the worst thing, not the worst thing, but one of the worst things I ever want to hear.
Lily: That’s Joe and he’s standing in front of a mirror holding a camcorder. He’s super ripped and covered in tattoos and he’s freaking out. The video is called WTF? Am I Going Bald? Question mark question mark exclamation point exclamation point.
Joe: And when I go and get my haircut, they’re always telling me, “oh, you have the thickest hair. You’ll never have to worry about going bald.” I’m like, “Freakin sweet.” So, I don’t know. Does it look like I am? You tell me. I’m kind of freakin out right now. This sucks. I’m only 24.
Jesse: Yeah, I mean what feels so hard about it is having this happen to you before it’s socially acceptable - like an older guy might be able to accept it, but to be only 24 or even younger. Yikes.
Lily: Ok - We're talking about insecurity and this is a show about therapy, so I also have to ask, would you consider talking about it with a therapist? Like, if it were between therapy and some kind of scalp treatment, which would you choose?
Jesse: I knew this question would come. I guess it would feel weird to go to a therapist about balding.
Lily: Yeah?
Jesse: I mean, it’s so trife. Like part of me would be super upset about going bald, but part of me would know it’s such a petty concern. I think I’d hate myself for caring.
Lily: And yet you care.
Jesse: And yet I care.
Lily: Well, that’s what we’re gonna unpack here - the emotional underside of your dome. This episode has two parts, part one: the thriving hair loss prevention industry and Part two: we’ll look at the underlying motivations that drive men to take drastic measures as well as how we can approach this differently.
Robby: I know a friend of mine, he's losing his hair, he's maybe about eight years older than me, seven or eight, he got some implants, he spent some money, and now has a head of hair. And he looks great. And it makes him feel... I know it's about himself looking in the mirror and feeling better about himself.
Morgan: One of my clients, who went out for drinks afterward, and he started telling me the woes of becoming older. And he was 40 and still dating and taking propecia to grow hair, but then the propecia has side effects so than he is taking viagra for the side-effects, and the viagra caused a migraine, which then he's taking medication for the migraine which causes an ulcer.
J: What? This is crazy! So then what? What do you do once you have an ulcer?
M: Is it better to have hair or not?
J: Yeah, I think I might quit at that point.
M: All for the sake of having hair, yeah.
J: And what did he end up deciding to do about it, after the ulcer?
M: He kept taking it.
J: Oh my god. No. Is he okay? Is he alive?
M: I haven't seen him in a while.
Doctors: Topical minoxidil, rogaine, finasteride, propecia, low level laser therapy, prp, which is platelet-rich plasma, laser comb device, fill-in powders and the scalp micro-pigmentation, we use wigs, laser helmet devices, extensions, hair-fibers, which is like a little powder, surgery.
Jesse: If you want to retain your hair, there's a pill called propecia and there's a lotion called Rogaine. If you want to cover it up, there's the age old solution of using a wig. If you want to feel like you're in a sci-fi book, you can wear a laser helmet that stimulates hair growth, or you can get plasma rich blood injected into your scalp. Some people even get their scalps tattooed to look like stubble. And then of course there's transplants, which have been around for decades, but only recently began to look any good.
In fact, according to The International Society of Hair Restoration Surgery, 2.5 billion dollars was spent on those surgeries in 2014. And if we include things like propecia and rogaine, that number would be much higher. So to better understand this thriving world of male cosmetics, and transplants in particular, I went back to someone with a lot of experience.
Jesse: Is it okay if I close the door, just for sound’s sake.
Computer: AOL: Welcome, you've got mail!
Jesse: This is Dr. Kabaker, the plastic surgeon we heard from earlier.
Dr. Kabaker is something of a big name in the industry. He’s been practicing for over 40 years. His office is located next to a noisy alley just north of downtown Oakland. The hallway of his office is decorated with these sculpture-paintings: bare-breasted, paint splattered women emerging from blank canvases he bought on a cruise ship. Inside Dr. Kabaker’s office are photographed portraits of current and former golden retrievers, a human skull, a small metal sculpture of a surgeon working over a patient, and a computer screen which prominently displays an America Online Logo. Dr. Kabaker is 77 years old.
Jesse: I have to ask.. this will be on the radio, and for people who can't see you, you are bald, and have you ever considered doing it yourself?
Lily: Wait, he’s bald?
Jesse: Yes. Like really bald.
Lily: He opted out of a transplant?
Dr. K: Yes I did. Many years ago, one of my teachers was a very prominent hair transplant surgeon in LA. I asked him about a transplant, he said, "Oh, you're going to be very bald. You'll have to have a lot of work done, keep it very long and comb it back." And then I was thinking, gee, I was 30, 31, and even if I didn't get a full head, I'd do without it. And I'm glad I didn't have it done then because I'd be one of those old pluggy cases that they'd have to touch up and modernize and I'd have to keep my hair very long.
Lily: He’s not making a very good argument for transplants. Isn’t that like a chef who won’t eat his own cooking?
Jesse: Well, back when he was younger, hair transplants had that pluggy, doll’s head look. Now hair transplants are surprisingly convincing.
Lily: Would that have changed his decision?
Dr. K: Probably. If someone said they could move 3000 or 4000 in two sessions, I probably would have had it done.
Lily: Okay. Fair enough. He might do it. But that “probably” sounds pretty hesitant
Jesse: Right. So I prodded him a little to make a case for cosmetics.
Jesse: My co-host for this episode is, she's a therapist. So she really has this mindset, you know, accept your body and accept aging. Don't fight it. So what do you say to people who-
Dr K: I'll keep the language clean, it's the absolute opposite of what work has been throughout my life…
Lily: Did he just have to restrain himself from swearing at me? I love him.
Dr. K: You have to have the right person for it, but I've seen people just turn around 180 degrees and go on with their life when they get something taken care of. When you look in the mirror and see a shadow of your former self where you could get some of it back, why not.
Jesse: For Kabaker everyone, including you, does this. For him, it’s just being human.
Kabaker: It's self image. Feeling good about yourself and positive. Why you get good grooming, why you choose a particular bit of clothing, the car that you get. Hair does identify you.
Jesse: This really made me think. I already do small grooming stuff. Like I mousse my hair and shave my eyebrows because, frankly, I just can’t with the unibrow. And I certainly buy clothing that I hope makes me look sharp. I might not ever do something as extreme as hair surgery, but I think I get it more now. There’s this spectrum of self-image, and we’re all on it. And who am I to judge some guy who cares about his scalp as much as I care about my eyebrows. If it makes you happy, why not? Life is short.
Dr. K: This is why people do body-building. Why they buy expensive clothes. Why they tailor things. It's, you know, human beings are human beings. They each want to do the best they can, be attractive and be positive, and successful. And appearance is part of that in most people.
Lily: So, before we move on, Jesse I know you learned a lot about the wacky history of hair loss treatment - even more evidence that this is something that has bothered men throughout civilization. So what are some of the strangest things people tried?
Jesse: Oh man...yeah, ok. To name a few, Hippocrates applied sheep’s urine to his bald spot. A first century physician recommended boiling live snakes and using the broth. Physicians in the 1800s believed that the pool of blood in scalp blisters would nourish the hair roots…
Lily: No, that’s not good.
Jesse: Yeah, I know. But one of my favorite theories about the cause of hairloss is the beard induced overheating of the skull.
Lily: Oy...that’s doesn’t bode well for the hipsters…
Jesse: No, it certainly does not.
Rob: I'm Rob Schene, I'm a marriage and family therapist, a certified group therapist, my focus and my practice has been very much related to men's issues and I do a lot of men's work, I run a few men's groups.
Lily: So here’s the part where I bring in some therapists to talk about hair loss - what might be happening on a deeper level for those experiencing it and how to work with that. So when I asked Rob about this he talked about this in terms of vitality.
Rob: I guess is the word that we're using, and it’s that word describes a few different things, the hair, it's maybe sexuality even, its life force, that when you're in teens and 20s is really powerful and it just starts to change and I think balding, in some ways, shows us that, too early, sometimes. Oh shit, this is going to change. And it is changing and I'm going to change and what does that mean about me, who am I?
Lily: So there’s all these other things connected to the balding but...
Lily: I'm just curious how, if you've kind of seen it show up with men individually or groups talking about insecurities, about the way that they look?
Rob: No.
Lily: Really?
Rob: No. That does not happen very often. I do not think men are comfortable doing that.
Lily: I was going to say, I know that they are feeling those things.
Rob: I have a very good sense that they are. And that does not tend to get talked about.
Lily: What do you imagine they do with those insecurities that we assume are there?
Rob: They tuck it away. They maybe don't acknowledge it too often themselves.
Lily: And here’s another colleague of mine:
Molly: My name is Molly Merson and I am a psychotherapist living in Berkeley California.
Lily: And she adds her own thoughts on the meaning of hair loss anxiety.
I think that men are conditioned and socialized to be the ones that are supposed to be in control of their body, of their emotions, including the body of money and work, so I think when a man starts to lose his hair he starts to lose that feeling of control and potency. It's a pretty scary proposition to feel like you have all this responsibility, a lot of which is culturally endowed, but none of the control. I'd absolutely include balding as a loss - not just of hair and the person you're used to seeing in the mirror - but a psychic loss of control, a reminder of change, entropy, and ultimately death.
Jesse: Whoa. Shit just got real.
Lily: Yep.
Jesse: So you’re talking about the underlying emotions and fears that come up during hairloss.
Lily: Exactly. You made a case for hiding hair loss. We all do things to look more attractive - shaving, toupees, surgery (if you have that kind of money). We heard the “why not, if it makes you happy argument?” So now we’ll dig into the value of looking at this before jumping to fix the problem.
Jesse: Ok, let’s hear it.
Nate: I'm fine with it. It peaks, it's a little pointy on the top. I think for me the biggest worry about not having hair was "am I gonna get girls"?
Jesse: Tell me more about that.
Nate: Um, it doesn't make a difference. I think most women don't care. I've heard from a number of women where they're like "I don't care, my dad was bald." Maybe I'm only meeting women who had bald dads and it's some kind of Freudian thing.
Jordan: Yeah, so my name is Jordan Wolfe. I'm a licensed mental health counselor.
Lily: Jordan is based out of Seattle Washington.
Jordan: I specialize in men’s work, midlife crisis, midlife transitions, but no one wants to identify it that way unless they're really deep in.
Lily: Also, Jordan is bald.
Jordan: And I just thought, there was something in me that wanted to accept, that does want to accept where I'm at. 16:55 And you know, realizing from the bird's eye view that we're all going to get older, most of men are going to lose their hair to some degree, ultimately, you know, we're going that direction. And so, for me, I think I've kind of thought about that line. How much do I do to enhance my appearance cosmetically and how much do I say, you know, this is a fact of life and let it go.
Lily: So we talked about self expression. But what is “self-expression” even about? We’re kind of on this endless quest to be unconditionally loved, just as we are. But even in our very early human interactions, we learn to do all kinds of things to try to make ourselves more lovable.
Jesse: So it’s like, little baby Jesse is born, he says, “love me.” And then he’s like, I don’t feel loved enough, maybe it’s my unibrow.
Lily: Um...You had a unibrow as a baby?
Jesse: Haha. No, it was just… er, nevermind.
Lily: No, it’s a good point. Brene Brown (you may have seen her TED talks on vulnerability) writes a lot about shame, which can certainly come up around physical attributes. She likes to distinguish between “belonging” and “fitting in”. What we really need is to belong - which means being accepted as we are, but for all kinds of reasons - society, family, etc - we instead try to change ourselves to fit in.
Jesse: Ah, that’s a really different thing. It’s like if my unibrow -
Lily: Jesse! Enough with the unibrow!
Jesse: I thought therapists were supposed to let you talk.
Lily: I’m so sorry. Do you want to process this?
Jesse: Oh my god. NO!
Lily: Okie dokie. I could be wrong, but I suspect that anyone who will pay 20k plus on hair transplants is dealing, with feeling he is not worthy, on some fundamental level, without it. And that’s what’s problematic.
When I think about the cost of hair transplant surgery and the kind of access and privilege necessary to get it and then the privilege that may come with having that full head of hair, I wonder: what kind of growth gets skirted? What skills do we end up lacking as a result of not having to deal with loss and change like most people? Do we end up with more fragile egos?
Molly: We don't get our everything all the time. We have to have boundaries and loss and goodbyes so that we can have a hello again. It's a coming together and a pulling away and a coming together.
Lily: Eventually, no matter how much money or privilege you have, you still can’t have everything you want. At most you’re applying a bandaid - postponing the inevitable. You’re still gonna die.
Jesse: Sure, but why not shoot for a better quality of life while you’re alive?
Lily: Well, I agree. But what’s going to give you a better quality of life? A full head of hair for 20k? Or learning to endure and even embrace change?
Molly: So I mean I guess in thinking about hair loss, it's a part of this shift of everyday we're a little different. And much of that has little to do with our own conscious intentions about who we are or where we want to be in our life. Sometimes yes absolutely you put work in and you can often get something for that, but that's not always how it works. And you can't really prepare for loss. You just have to experience it and hope that you can find resilience in your community, in your chosen people, in your family, in yourself to be able to work with that.
Jesse: Huh - it sounds like she’s saying talk it out with your friends.
Lily: Yes! In a way. She’s saying the best antidote to loss is actually in our relationships with others - community. Therapy is all about about building this resilience to change and loss, the things out of our control, through human connection - through learning how to feel like you belong somewhere. It’s also a place to get more aware of the beliefs and emotions that drive us to do the things we do to feel we belong.
Jesse: Interesting. How many years of therapy before I can stop showering?
Lily: I’m not proposing that everyone just stop everything they do to groom themselves or modify their bodies. But if you understand your motivations a little better you can pause and say “is this worth it?” “What am I trying to get out of this?” “Is there something deeper I’m missing here?” “Am I caught in a hamster wheel of self-rejection?”
Finding those answers for yourself isn’t always easy and us therapists tend to lean towards self-acceptance as a way towards a better life. This doesn’t mean people can’t work to improve themselves, it’s just hard to even know where to start if we’re so caught up in the anxiety of hating ourselves.
Rob: If I wasn't able to be loving towards the changes that I'm going through, I think it would be a big challenge. And what I mean by that, if I can put words to it, I feel myself getting wiser with age and expanding in other ways outside this vital energy outside my body or looks. So I'm stepping out in the world in a different way, in a different capacity that I feel proud of, so I don't really need to feel proud of my body or looks. So there's a kind of different feeling of worth I guess that I'm discovering in myself.
Jordan: I think, that confidence in people is attractive and so I think there's something about giving our allegiance and putting our value and identifying with our inherent psychological, emotional, mental strengths, our qualities and the felt sense in our body of confidence. I think that's to me how I kind of in a way, move beyond that whole question of like do I look good or not. It depends on when you get me or whose standard.
Molly: Accept it, is kind of an easier said than done kind of thing but it is a part of that. It's a part of really being able to name "yes we live in loss all the time". To different varying degrees of direct loss, complex loss, systemic loss, pain, violence, all these things, projections from the outside world about who we are, who we're allowed to be. It kind of happens. It's just part of being human.
Lily: So did I change your mind?
Jesse: Yeah. If I’m being honest, I feel like I could go bald right now and be fine. I’m ready. But, fast forward 2 months, and I will probably get sucked back into those old fears about my body. Propecia might start looking pretty good further down the line.
Lily: Nothing's ever permanent. Not even your resolve.
Jesse: Yeah… do they have a pill for that?
Lily: Thank you so much for listening. For more of Jesse please check out Mannish on iTunes or Soundcloud.
Jesse: Special thanks to our guests Morgan Brown, Dr. Kabaker, Dr. Bernard P. Nusbaum, Dr. Ron Shapiro
Lily: Rob Schene, Jordan Wolfe, Molly Merson, and the strangers at the bar.
Jesse: Thank you Shoshana Walter for editorial support.
Lily: And Topher M. Lewis for the music. Links to all these amazing people are available at A Therapist Walks Into a Bar [dot] com.
Don’t forget to share this episode and leave a review in iTunes.
J: This episode was brought to you by Uni-brow No-More, a wax hair removal formula made especially for your forehead. I personally use this product and I’ve never looked or felt better.
L: Plus, it’s a great way keep suppressing your fear of dying alone.
Lily: Hey I’m Lily Sloane. This is “A Therapist Walks into a Bar.” A podcast that brings therapy to you.
Adam: With the amount of things I've gone through in my adult life. That's the least of my fucking worries. I have friends who are 22 years old who have lost their hair. They are fantastic human beings. If I can actually see, walk, use my hands, hair or not doesn't matter.
Dr. K: Because hair is power and sex in the minds of people who are interested in power and sex.
Lily: If I say body image, what do you think of? Stomach fat? Hips? Thigh gap? Laser hair removal? You probably think of women. And for good reason. Because women get a lot of pressure to look a certain way. But more and more, I’ve noticed this happen to men, too. And I think that’s worth talking about.
Dr K: Gavin Newsom's hair is going to win many elections. He's going to be our next senator, our next governor.
Woman: But, hey, if you've got a butt-ton of money and this is going to make you feel more secure in life and walking around, why not, more power to you. I think you could use your $20000 to something better. Go out there and do an amazing vacation.
Lily: If you haven’t guessed yet, I’m honing in on one aspect of men’s body image: hair loss. And I am so stoked because I got to collaborate with an incredible podcast called Mannish, a show all about masculinity and gender. Joining me is it’s host and creator, Jesse Rhodes.
Jesse: Hi.
Lily: Welcome.
Jesse: Thanks. I’m really excited to do this.
Lily: So at the start of the show we heard this guy:
Dr K: I’m Dr. Kabaker. I’m a physician in Oakland, CA. I practice facial plastic surgery with an emphasis on hair restoration, both reconstructive and cosmetic.
Lily: Jesse, you interviewed Dr. Kabaker and I know you had something you wanted to share.
Jesse: Yeah. I have to say, I was a little sceptical about this story at first. I mean we were brainstorming ideas for the show and you mentioned how many young balding guys you’ve known who felt insecure about their hair loss. And I felt like, is that really true, though. And then this thing happened. I went to interview Dr. Kabaker at his office. We were talking about procedures and celebrities with hair loss,
Dr. K: As most men, hair recedes as they get older...
Jesse: And then I felt his eyes on my hairline, and before I could even register it, he reached out and touched my head with his finger:
Dr. K: ...like you for instance, you've got some recession here, it's probably heredity, and you didn't have that when you were 16.
Jesse: Did you catch that? He said, “You’ve got some recession here.”
Dr. K: you've got some recession here.
Jesse: And it was like a frozen chill went down my spine. And then internal panic.
Lily: You didn’t know about the recession.
Jesse: I did, but I thought it was so subtle, no one else really noticed. And then he homed his eyes on my head and saw it. It was like that moment in a horror movie when the killer sees you hiding and makes eye contact.
Lily: Jesse, it’s really not obvious.
Jesse: Thank you.
Lily: But you’re anxiety about it doesn’t surprise me. While it can be really vulnerable, especially for men, to talk about their insecurities, they’re still there. This guy we spoke with at the bar was shared the humiliation that can with realizing he just couldn’t cover it up anymore.
Nate: And then the last time I ever had hair, I was walking to the subway and my hair was combed over and it was like, pretty much I just had all the hair around the crown of my head and it was just growing long along one side and it just all kind of flopped over and so I'm walking to the subway and the wind blows and it blows it back. And an old man laughs at me - and granted it's an old man laughing at a 23 year old for his comb over so pretty much I decided at that point that I would go home immediately and shave it all off. Which I did.
Jesse: Oh man. Well, you know I talked to this hairdresser.
Morgan: I'm Morgan Brown.
Jessie: she specializes in men’s haircuts and has had guys, usually young guys in their 20s, come to her freaking out about their hairline.
Morgan: Yeah, it's the younger ones that are really emotional. I had one, actually, call me frantically one day. He's like, "I need to come see you for like two minutes. Am I balding? Am I balding? Someone told me I'm balding."
J: So he wanted you to like look and give your opinion about whether or not he was receding?
M: Yes.
J: Could you tell?
M: He was fine.
J: He was fine.
Lily: And if you had any doubt about men’s insecurity about their hair, watch an episode of Curb Your Enthusiasm or Seinfeld or just browse around on Youtube:
Joe: Urgent. I just got a question that freaked me the fuck out. Someone asked me, “Joe, are you going bald?” That’s like the worst thing, not the worst thing, but one of the worst things I ever want to hear.
Lily: That’s Joe and he’s standing in front of a mirror holding a camcorder. He’s super ripped and covered in tattoos and he’s freaking out. The video is called WTF? Am I Going Bald? Question mark question mark exclamation point exclamation point.
Joe: And when I go and get my haircut, they’re always telling me, “oh, you have the thickest hair. You’ll never have to worry about going bald.” I’m like, “Freakin sweet.” So, I don’t know. Does it look like I am? You tell me. I’m kind of freakin out right now. This sucks. I’m only 24.
Jesse: Yeah, I mean what feels so hard about it is having this happen to you before it’s socially acceptable - like an older guy might be able to accept it, but to be only 24 or even younger. Yikes.
Lily: Ok - We're talking about insecurity and this is a show about therapy, so I also have to ask, would you consider talking about it with a therapist? Like, if it were between therapy and some kind of scalp treatment, which would you choose?
Jesse: I knew this question would come. I guess it would feel weird to go to a therapist about balding.
Lily: Yeah?
Jesse: I mean, it’s so trife. Like part of me would be super upset about going bald, but part of me would know it’s such a petty concern. I think I’d hate myself for caring.
Lily: And yet you care.
Jesse: And yet I care.
Lily: Well, that’s what we’re gonna unpack here - the emotional underside of your dome. This episode has two parts, part one: the thriving hair loss prevention industry and Part two: we’ll look at the underlying motivations that drive men to take drastic measures as well as how we can approach this differently.
Robby: I know a friend of mine, he's losing his hair, he's maybe about eight years older than me, seven or eight, he got some implants, he spent some money, and now has a head of hair. And he looks great. And it makes him feel... I know it's about himself looking in the mirror and feeling better about himself.
Morgan: One of my clients, who went out for drinks afterward, and he started telling me the woes of becoming older. And he was 40 and still dating and taking propecia to grow hair, but then the propecia has side effects so than he is taking viagra for the side-effects, and the viagra caused a migraine, which then he's taking medication for the migraine which causes an ulcer.
J: What? This is crazy! So then what? What do you do once you have an ulcer?
M: Is it better to have hair or not?
J: Yeah, I think I might quit at that point.
M: All for the sake of having hair, yeah.
J: And what did he end up deciding to do about it, after the ulcer?
M: He kept taking it.
J: Oh my god. No. Is he okay? Is he alive?
M: I haven't seen him in a while.
Doctors: Topical minoxidil, rogaine, finasteride, propecia, low level laser therapy, prp, which is platelet-rich plasma, laser comb device, fill-in powders and the scalp micro-pigmentation, we use wigs, laser helmet devices, extensions, hair-fibers, which is like a little powder, surgery.
Jesse: If you want to retain your hair, there's a pill called propecia and there's a lotion called Rogaine. If you want to cover it up, there's the age old solution of using a wig. If you want to feel like you're in a sci-fi book, you can wear a laser helmet that stimulates hair growth, or you can get plasma rich blood injected into your scalp. Some people even get their scalps tattooed to look like stubble. And then of course there's transplants, which have been around for decades, but only recently began to look any good.
In fact, according to The International Society of Hair Restoration Surgery, 2.5 billion dollars was spent on those surgeries in 2014. And if we include things like propecia and rogaine, that number would be much higher. So to better understand this thriving world of male cosmetics, and transplants in particular, I went back to someone with a lot of experience.
Jesse: Is it okay if I close the door, just for sound’s sake.
Computer: AOL: Welcome, you've got mail!
Jesse: This is Dr. Kabaker, the plastic surgeon we heard from earlier.
Dr. Kabaker is something of a big name in the industry. He’s been practicing for over 40 years. His office is located next to a noisy alley just north of downtown Oakland. The hallway of his office is decorated with these sculpture-paintings: bare-breasted, paint splattered women emerging from blank canvases he bought on a cruise ship. Inside Dr. Kabaker’s office are photographed portraits of current and former golden retrievers, a human skull, a small metal sculpture of a surgeon working over a patient, and a computer screen which prominently displays an America Online Logo. Dr. Kabaker is 77 years old.
Jesse: I have to ask.. this will be on the radio, and for people who can't see you, you are bald, and have you ever considered doing it yourself?
Lily: Wait, he’s bald?
Jesse: Yes. Like really bald.
Lily: He opted out of a transplant?
Dr. K: Yes I did. Many years ago, one of my teachers was a very prominent hair transplant surgeon in LA. I asked him about a transplant, he said, "Oh, you're going to be very bald. You'll have to have a lot of work done, keep it very long and comb it back." And then I was thinking, gee, I was 30, 31, and even if I didn't get a full head, I'd do without it. And I'm glad I didn't have it done then because I'd be one of those old pluggy cases that they'd have to touch up and modernize and I'd have to keep my hair very long.
Lily: He’s not making a very good argument for transplants. Isn’t that like a chef who won’t eat his own cooking?
Jesse: Well, back when he was younger, hair transplants had that pluggy, doll’s head look. Now hair transplants are surprisingly convincing.
Lily: Would that have changed his decision?
Dr. K: Probably. If someone said they could move 3000 or 4000 in two sessions, I probably would have had it done.
Lily: Okay. Fair enough. He might do it. But that “probably” sounds pretty hesitant
Jesse: Right. So I prodded him a little to make a case for cosmetics.
Jesse: My co-host for this episode is, she's a therapist. So she really has this mindset, you know, accept your body and accept aging. Don't fight it. So what do you say to people who-
Dr K: I'll keep the language clean, it's the absolute opposite of what work has been throughout my life…
Lily: Did he just have to restrain himself from swearing at me? I love him.
Dr. K: You have to have the right person for it, but I've seen people just turn around 180 degrees and go on with their life when they get something taken care of. When you look in the mirror and see a shadow of your former self where you could get some of it back, why not.
Jesse: For Kabaker everyone, including you, does this. For him, it’s just being human.
Kabaker: It's self image. Feeling good about yourself and positive. Why you get good grooming, why you choose a particular bit of clothing, the car that you get. Hair does identify you.
Jesse: This really made me think. I already do small grooming stuff. Like I mousse my hair and shave my eyebrows because, frankly, I just can’t with the unibrow. And I certainly buy clothing that I hope makes me look sharp. I might not ever do something as extreme as hair surgery, but I think I get it more now. There’s this spectrum of self-image, and we’re all on it. And who am I to judge some guy who cares about his scalp as much as I care about my eyebrows. If it makes you happy, why not? Life is short.
Dr. K: This is why people do body-building. Why they buy expensive clothes. Why they tailor things. It's, you know, human beings are human beings. They each want to do the best they can, be attractive and be positive, and successful. And appearance is part of that in most people.
Lily: So, before we move on, Jesse I know you learned a lot about the wacky history of hair loss treatment - even more evidence that this is something that has bothered men throughout civilization. So what are some of the strangest things people tried?
Jesse: Oh man...yeah, ok. To name a few, Hippocrates applied sheep’s urine to his bald spot. A first century physician recommended boiling live snakes and using the broth. Physicians in the 1800s believed that the pool of blood in scalp blisters would nourish the hair roots…
Lily: No, that’s not good.
Jesse: Yeah, I know. But one of my favorite theories about the cause of hairloss is the beard induced overheating of the skull.
Lily: Oy...that’s doesn’t bode well for the hipsters…
Jesse: No, it certainly does not.
Rob: I'm Rob Schene, I'm a marriage and family therapist, a certified group therapist, my focus and my practice has been very much related to men's issues and I do a lot of men's work, I run a few men's groups.
Lily: So here’s the part where I bring in some therapists to talk about hair loss - what might be happening on a deeper level for those experiencing it and how to work with that. So when I asked Rob about this he talked about this in terms of vitality.
Rob: I guess is the word that we're using, and it’s that word describes a few different things, the hair, it's maybe sexuality even, its life force, that when you're in teens and 20s is really powerful and it just starts to change and I think balding, in some ways, shows us that, too early, sometimes. Oh shit, this is going to change. And it is changing and I'm going to change and what does that mean about me, who am I?
Lily: So there’s all these other things connected to the balding but...
Lily: I'm just curious how, if you've kind of seen it show up with men individually or groups talking about insecurities, about the way that they look?
Rob: No.
Lily: Really?
Rob: No. That does not happen very often. I do not think men are comfortable doing that.
Lily: I was going to say, I know that they are feeling those things.
Rob: I have a very good sense that they are. And that does not tend to get talked about.
Lily: What do you imagine they do with those insecurities that we assume are there?
Rob: They tuck it away. They maybe don't acknowledge it too often themselves.
Lily: And here’s another colleague of mine:
Molly: My name is Molly Merson and I am a psychotherapist living in Berkeley California.
Lily: And she adds her own thoughts on the meaning of hair loss anxiety.
I think that men are conditioned and socialized to be the ones that are supposed to be in control of their body, of their emotions, including the body of money and work, so I think when a man starts to lose his hair he starts to lose that feeling of control and potency. It's a pretty scary proposition to feel like you have all this responsibility, a lot of which is culturally endowed, but none of the control. I'd absolutely include balding as a loss - not just of hair and the person you're used to seeing in the mirror - but a psychic loss of control, a reminder of change, entropy, and ultimately death.
Jesse: Whoa. Shit just got real.
Lily: Yep.
Jesse: So you’re talking about the underlying emotions and fears that come up during hairloss.
Lily: Exactly. You made a case for hiding hair loss. We all do things to look more attractive - shaving, toupees, surgery (if you have that kind of money). We heard the “why not, if it makes you happy argument?” So now we’ll dig into the value of looking at this before jumping to fix the problem.
Jesse: Ok, let’s hear it.
Nate: I'm fine with it. It peaks, it's a little pointy on the top. I think for me the biggest worry about not having hair was "am I gonna get girls"?
Jesse: Tell me more about that.
Nate: Um, it doesn't make a difference. I think most women don't care. I've heard from a number of women where they're like "I don't care, my dad was bald." Maybe I'm only meeting women who had bald dads and it's some kind of Freudian thing.
Jordan: Yeah, so my name is Jordan Wolfe. I'm a licensed mental health counselor.
Lily: Jordan is based out of Seattle Washington.
Jordan: I specialize in men’s work, midlife crisis, midlife transitions, but no one wants to identify it that way unless they're really deep in.
Lily: Also, Jordan is bald.
Jordan: And I just thought, there was something in me that wanted to accept, that does want to accept where I'm at. 16:55 And you know, realizing from the bird's eye view that we're all going to get older, most of men are going to lose their hair to some degree, ultimately, you know, we're going that direction. And so, for me, I think I've kind of thought about that line. How much do I do to enhance my appearance cosmetically and how much do I say, you know, this is a fact of life and let it go.
Lily: So we talked about self expression. But what is “self-expression” even about? We’re kind of on this endless quest to be unconditionally loved, just as we are. But even in our very early human interactions, we learn to do all kinds of things to try to make ourselves more lovable.
Jesse: So it’s like, little baby Jesse is born, he says, “love me.” And then he’s like, I don’t feel loved enough, maybe it’s my unibrow.
Lily: Um...You had a unibrow as a baby?
Jesse: Haha. No, it was just… er, nevermind.
Lily: No, it’s a good point. Brene Brown (you may have seen her TED talks on vulnerability) writes a lot about shame, which can certainly come up around physical attributes. She likes to distinguish between “belonging” and “fitting in”. What we really need is to belong - which means being accepted as we are, but for all kinds of reasons - society, family, etc - we instead try to change ourselves to fit in.
Jesse: Ah, that’s a really different thing. It’s like if my unibrow -
Lily: Jesse! Enough with the unibrow!
Jesse: I thought therapists were supposed to let you talk.
Lily: I’m so sorry. Do you want to process this?
Jesse: Oh my god. NO!
Lily: Okie dokie. I could be wrong, but I suspect that anyone who will pay 20k plus on hair transplants is dealing, with feeling he is not worthy, on some fundamental level, without it. And that’s what’s problematic.
When I think about the cost of hair transplant surgery and the kind of access and privilege necessary to get it and then the privilege that may come with having that full head of hair, I wonder: what kind of growth gets skirted? What skills do we end up lacking as a result of not having to deal with loss and change like most people? Do we end up with more fragile egos?
Molly: We don't get our everything all the time. We have to have boundaries and loss and goodbyes so that we can have a hello again. It's a coming together and a pulling away and a coming together.
Lily: Eventually, no matter how much money or privilege you have, you still can’t have everything you want. At most you’re applying a bandaid - postponing the inevitable. You’re still gonna die.
Jesse: Sure, but why not shoot for a better quality of life while you’re alive?
Lily: Well, I agree. But what’s going to give you a better quality of life? A full head of hair for 20k? Or learning to endure and even embrace change?
Molly: So I mean I guess in thinking about hair loss, it's a part of this shift of everyday we're a little different. And much of that has little to do with our own conscious intentions about who we are or where we want to be in our life. Sometimes yes absolutely you put work in and you can often get something for that, but that's not always how it works. And you can't really prepare for loss. You just have to experience it and hope that you can find resilience in your community, in your chosen people, in your family, in yourself to be able to work with that.
Jesse: Huh - it sounds like she’s saying talk it out with your friends.
Lily: Yes! In a way. She’s saying the best antidote to loss is actually in our relationships with others - community. Therapy is all about about building this resilience to change and loss, the things out of our control, through human connection - through learning how to feel like you belong somewhere. It’s also a place to get more aware of the beliefs and emotions that drive us to do the things we do to feel we belong.
Jesse: Interesting. How many years of therapy before I can stop showering?
Lily: I’m not proposing that everyone just stop everything they do to groom themselves or modify their bodies. But if you understand your motivations a little better you can pause and say “is this worth it?” “What am I trying to get out of this?” “Is there something deeper I’m missing here?” “Am I caught in a hamster wheel of self-rejection?”
Finding those answers for yourself isn’t always easy and us therapists tend to lean towards self-acceptance as a way towards a better life. This doesn’t mean people can’t work to improve themselves, it’s just hard to even know where to start if we’re so caught up in the anxiety of hating ourselves.
Rob: If I wasn't able to be loving towards the changes that I'm going through, I think it would be a big challenge. And what I mean by that, if I can put words to it, I feel myself getting wiser with age and expanding in other ways outside this vital energy outside my body or looks. So I'm stepping out in the world in a different way, in a different capacity that I feel proud of, so I don't really need to feel proud of my body or looks. So there's a kind of different feeling of worth I guess that I'm discovering in myself.
Jordan: I think, that confidence in people is attractive and so I think there's something about giving our allegiance and putting our value and identifying with our inherent psychological, emotional, mental strengths, our qualities and the felt sense in our body of confidence. I think that's to me how I kind of in a way, move beyond that whole question of like do I look good or not. It depends on when you get me or whose standard.
Molly: Accept it, is kind of an easier said than done kind of thing but it is a part of that. It's a part of really being able to name "yes we live in loss all the time". To different varying degrees of direct loss, complex loss, systemic loss, pain, violence, all these things, projections from the outside world about who we are, who we're allowed to be. It kind of happens. It's just part of being human.
Lily: So did I change your mind?
Jesse: Yeah. If I’m being honest, I feel like I could go bald right now and be fine. I’m ready. But, fast forward 2 months, and I will probably get sucked back into those old fears about my body. Propecia might start looking pretty good further down the line.
Lily: Nothing's ever permanent. Not even your resolve.
Jesse: Yeah… do they have a pill for that?
Lily: Thank you so much for listening. For more of Jesse please check out Mannish on iTunes or Soundcloud.
Jesse: Special thanks to our guests Morgan Brown, Dr. Kabaker, Dr. Bernard P. Nusbaum, Dr. Ron Shapiro
Lily: Rob Schene, Jordan Wolfe, Molly Merson, and the strangers at the bar.
Jesse: Thank you Shoshana Walter for editorial support.
Lily: And Topher M. Lewis for the music. Links to all these amazing people are available at A Therapist Walks Into a Bar [dot] com.
Don’t forget to share this episode and leave a review in iTunes.
J: This episode was brought to you by Uni-brow No-More, a wax hair removal formula made especially for your forehead. I personally use this product and I’ve never looked or felt better.
L: Plus, it’s a great way keep suppressing your fear of dying alone.
credits
Produced By:
Lily Sloane & Jesse Rhodes
Music:
Maruumba, Man of Mystery, The Pieces Fit, Mayday in the Morning by Topher M. Lewis
Lavender White by People Like Us and Old Fashioned Auto Piano obtained via creative commons at FreeSound.org
Additional Music & Sound Design by:
Lily Sloane
Other Media:
WTF am I going bald???!!!!
Special thanks to the strangers at the bar for sharing your stories, Lucky 13 for letting us fraternize with microphones on your patio, and Shoshana Walter for your feedback.
Lily Sloane & Jesse Rhodes
Music:
Maruumba, Man of Mystery, The Pieces Fit, Mayday in the Morning by Topher M. Lewis
Lavender White by People Like Us and Old Fashioned Auto Piano obtained via creative commons at FreeSound.org
Additional Music & Sound Design by:
Lily Sloane
Other Media:
WTF am I going bald???!!!!
Special thanks to the strangers at the bar for sharing your stories, Lucky 13 for letting us fraternize with microphones on your patio, and Shoshana Walter for your feedback.