Even as boys there are a few facts about body hair that we all know. We know that we’ll start to grow hair on our legs, arms and chest; we know that we’ll get pubes and beards, and, unfortunately, we know that there’s a chance we’re hurtling towards a future where the hair on top of our head disappears altogether.
Alopecia barbae is thought to be an auto-immune condition where your body attacks its own hairs, believing them to be foreign
Some facts about body hair are less well known though. Who knew that hair would appear on their gooch, also known as the perineum, or on their back, or that our moustaches would eventually start inside our noses rather than underneath them? But if you didn’t know these things as a boy, it doesn’t take long for most men to be confronted with the difficult-to-shave truths.
There is one fact about body hair that even into adulthood many men remain ignorant of though, so we’ll ask you: did you know that men can lose their beard?
Men losing their beards
The condition that causes men to lose some or all of their beard is called alopecia barbae. You may already be familiar with alopecia areata, which typically causes bald spots to appear on the scalps of men, women and children. You may also have heard of alopecia totalis, which is when someone loses all the hair on their scalp, and alopecia universalis – the complete loss of hair on the scalp and body – but unless you’ve got it, no one really knows that alopecia barbae exists.
“I’d never heard of or come across anyone who’d lost their beard in isolation,” says 38-year-old freelance photographer Paul Johnson. “I first noticed a 5 pence circle on the neck line, which I didn’t really think anything of at first, until it spread to palm size. I’m now left with just my moustache and a few patches of hair on the jaw line.”
Like Johnson, 43-year-old Ryan Strand’s first experience of alopecia barbae came when a 5 pence-shaped piece of his beard disappeared. After a few weeks, he explains, he noticed the patch get visibly larger and became concerned enough to seek medical advice.
“The patch grew and grew to the point that I lost pretty much the entire left-hand side of my beard,” says Strand. “As I’m dark haired, I couldn’t even get away with cutting it down to stubble, so I ended up having to shave my beard close, twice a day, otherwise it just looked embarrassing.”
What is alopecia barbae?
Alopecia barbae is thought to be an auto-immune condition where your body attacks its own hairs, believing them to be foreign. Nobody knows what causes it, but historically there’s been a presumed association with both psychological and physical stress, which is what both Johnson and Strand believe was behind their outbreak.
“The stress on my body was great,” says Johnson. “It wouldn’t be out of the norm for me to run 10 miles on a Saturday morning then sink six to seven pints in the afternoon, sleep poorly, train half-hearted on a Sunday and then be back full on from Monday to Friday.”
Johnson explains that the mental stresses that most of us feel, things like worrying over work or what the future has in store, also contributed to his alopecia. “I believe that the dent on the mental side of my health has shown itself in the form of alopecia. It’s no coincidence whatsoever,” says Johnson.
Getting alopecia barbae diagnosed
As well as not knowing what causes alopecia barbae, we also don’t know how long it takes for beard hair to grow back and the treatments for it aren’t all that effective. Thanks, medicine.
Still, being men, we’ve prepared our whole lives for the possibility of losing our hair. But that’s the hair on our head. Losing hair from an area you didn’t expect, even if all you’ve lost is a 5-pence shaped circle in your beard, can be traumatic. Most men, when confronted with this reality, will look to their GP for answers, but because knowledge of the condition is so limited, the advice offered by GPs can be equally limited.
“The doctor I saw was female, and she didn’t seem too bothered. She diagnosed my issue as alopecia, but then proceeded to tell me I should count myself lucky that I’m not a woman suffering with alopecia areata, as that is far more stressful and embarrassing,” says Strand. “I was dumbstruck. I pointed out that it is just as embarrassing for me as a man, to only be able to grow half a beard. Her response was to tell me to shave it, but I choose to have a beard, and it was an incredibly big deal to me.”
Maybe Strand’s doctor is right. Maybe it is worse for a woman to lose the hair on her head than it is for men to lose some or all of their beard, but there are no benefits to constructing a hierarchy of who feels better about their alopecia. Losing hair when you didn’t expect to can be tough to deal with, for anyone.
Specialist treatments for alopecia barbae
It can be difficult to be empathetic when you’re so far removed from the issue you’re dealing with, but Strand’s doctor’s reaction seems like an extreme version of the kind of treatment alopecia barbae sufferers can expect to receive. Johnson, for example, explains that most people, and especially men, react to his alopecia by saying “It doesn’t really matter. It’s only your beard.” Still, support is out there and as Johnson points out: “We’re lucky to live in a time where it’s easy to chat to fellow sufferers online who are more than willing to share their experience of what works for them and what doesn’t.”
For specialist advice though, alopecia barbae sufferers can consult a dermatologist, and preferably one who specialises in hair loss. They won’t have a magic cure, but as consultant dermatologist at The Dermatology Clinic Dr Daniel Glass explains, they will be better placed than a GP to give you an honest assessment about whether your hair is likely to grow back.
“If a patient had one patch of alopecia in the beard area then there is a good chance that it will regrow spontaneously over time without treatment,” says Glass. “However, if it is more widespread, there will be less chance of it growing back spontaneously and it may require treatment. Sometimes, to encourage the hair to grow back more rapidly, I would recommend either a steroid cream or injection, or other drugs which can alter the inflammation around the hair follicles which cause alopecia areata.”
Although steroids are more commonly associated with juice head gym bros, they’re useful in treating auto-immune diseases because steroids modulate the immune system, so they can dampen down immune activity. They’re by no means guaranteed to be an effective treatment, and for some people, especially those of us who work out and exercise regularly, it can be difficult to break the long-built associations we have with steroids. Johnson, for example, says that he has been offered steroid injections, but “pumping steroids into my beard and head just doesn’t seem that logical to me.”
For men not keen on “pumping steroids” into their face, there are new treatments emerging that look promising, but, according to Dr Greg Williams, hair transplant surgeon at the Farjo Hair Institute and CCR Expo board member, “Some of them at the moment have quite high side-effect profiles and toxicities, so they’re not mainstream.”
Micro-pigmentation tattooing is also an option for patients looking to immediately replace lost stubble, and as Williams explains, it’s an alternative that costs hundreds rather than thousands of pounds and can be done in a way that lets you try it to see what it looks like first.
“It’s different from artistic tattooing, this is medical tattooing. It’s called semi-permanent tattooing because the depth that you put the pigment in will determine how long it’s going to stay,” says Williams. “You can put it where it disappears in a couple of weeks or months or [you can put it] deeper, where it lasts for a couple of years or deeper still where it’s permanent.”
Glass says that he would advise patients to wait for at least a year before exploring permanent options. They should also try to reduce the factors that are thought to exacerbate alopecia barbae, the primary one being stress, before getting a permanent face tattoo. Strand did just that, and it worked for him.
“My beard started growing back around a year after my first patch appeared. I mentioned that I felt stress was a major factor in my alopecia, and to give you a bit of background, I had some severe financial issues after going through a break-up. I ended up with no alternative but to go bankrupt, and amazingly my beard started growing back almost immediately after doing so,” says Strand. “It was as if my body had breathed a huge sigh of relief.”