Men Get Trich Too? Why Trichotillomania Often Goes Undiagnosed in Men

Trichotillomania, commonly referred to as “trich” or hair pulling disorder, is a mental health disorder characterized by compulsive hair pulling that causes significant emotional distress and impaired interpersonal functioning. It’s estimated that trich affects about 1-4% of the population, with a lifetime prevalence of about 1.1% to 1.3%. 

Trich is often thought of as affecting primarily women and clinical data does support that. However, there is emerging evidence that seems to indicate that the prevalence of trich between men and women may actually be similar and that men may be significantly under-represented in those numbers. 

So why might trich go undiagnosed in men? The answer is a multifaceted one. 

Why Trichotillomania Goes Undiagnosed in Men

While there are no hard answers, it’s thought that differences in cultural norms, beliefs about seeking help, and even how hair loss is viewed can influence whether someone seeks help. Some of the possible factors include: 

Cultural Expectations and Gender Norms

Society often associates hair and grooming concerns more strongly with women, and in fact, a woman’s hair can hold strong cultural and religious meaning for some. 

In many cultures, men are expected to be “tough” and hair loss may be viewed more as vanity than a health concern. Hair pulling may be minimized as a “bad habit” rather than recognized as a mental health condition.

Misinterpretation as Normal Hair Loss

Male-pattern baldness is very common. Hair loss in men may be attributed to genetics or aging rather than pulling. This assumption can mask underlying trichotillomania, especially when clinicians don’t ask directly about grooming behaviors. And, given the stigma attached to hair pulling and hair loss, men especially may be reluctant to self-disclose. 

Stigma and Reluctance to Disclose

Trich is a disorder that is shrouded in stigma. This stigma can lead to secrecy, shame, or a belief that professional help isn’t appropriate. Men may feel additional stigma in admitting to a behavior seen as compulsive or “weak” or not masculine. 

Influence of Other Comorbidities 

Comorbid mental health disorders are common with trich. One study found that comorbidities may play a role in trich in men and women. OCD and focused pulling were more prevalent in males while women were twice as likely to have a comorbid depressive disorder. The study authors speculate that in women, their pulling may be more driven by negative affective states, and they may be more likely to seek help when pulling is accompanied by a mood disturbance. 

Differences in Pulling Patterns

Women with trichotillomania are more likely to pull hair from their scalp, eyebrows, or eyelashes. These areas are more visible and may create more distress. 

In contrast, men may be more likely to pull facial or body hair than scalp, which can make the condition easier to hide or go unnoticed and scalp hair loss to be overlooked as normal male-pattern balding. For example, a man who pulls from his beard may shave regularly, hiding the effects of pulling, which can delay self-identification of the disorder. 

Help-Seeking Behavior Differences

Research consistently notes that women are more likely than men to seek medical advice, including for trich. This difference means that many men with trich may go undiagnosed despite potentially having similar prevalence rates as women.

Tips for Improving Diagnosis in Men

1. Normalize the Conversation

One of the simplest ways to reduce underdiagnosis is to normalize talking about hair pulling. Men should know that trichotillomania is not a “bad habit” or a sign of weakness. It is a recognized mental health condition and treatment is available. “I hear you” or “How can I help you?” are powerful words that can help someone who is struggling. 

2. Include Men’s Experiences in Outreach

Seeing that there are other men experiencing trich can help men see that they are not alone and that their experienced are valid.

3. Look Beyond the Hair Loss

Healthcare providers should consider behavioral causes for hair loss, especially if the hair loss is patchy, uneven, or accompanied by reports of urges to pull. People sometimes pull from areas that are not readily noticeable. Healthcare professionals should include screening questions about BFRBs like trich as part of assessment. Sometimes asking the question signals that it’s safe to talk about it. 

4. Encourage Seeking Help

Seeking help from a mental health provider who specializes in BFRBs like trich is a game changer. Cognitive-behavioral therapy (CBT), specifically Habit Reversal Training (HRT), has been shown to be highly effective in managing trich. Family members, friends, and partners can be an important influence in encouraging their male loved ones to seek professional help.  

Final Thoughts

While under-represented in the data, men are thought to be equally affected by trich. The good news is, with awareness and support, we can close that gap. If you or your loved one is struggling with hair pulling, there are effective treatments that can help. 

At Trichstop, we have a team of experienced therapists who understand the unique concerns that men living with trich might have. Know that you are not alone and that there is help and support available. If you’re ready to take the next step towards healing, TrichStop is here to help. 

References

1. Thomson, Hannah & Farhat, Luis & Olfson, Emily & Levine, Jessica & Bloch, Michael. (2022). Prevalence and gender distribution of trichotillomania: A systematic review and meta-analysis. Journal of Psychiatric Research. 153. 10.1016/j.jpsychires.2022.06.058. https://www.researchgate.net/publication/361718502_Prevalence_and_gender_distribution_of_trichotillomania_A_systematic_review_and_meta-analysis

2. Grant, J. E., Dougherty, D. D., & Chamberlain, S. R. (2020). Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry research, 288, 112948. https://pmc.ncbi.nlm.nih.gov/articles/PMC7212053/

3. Christenson, G. A., MacKenzie, T. B., & Mitchell, J. E. (1994). Adult men and women with trichotillomania. A comparison of male and female characteristics. Psychosomatics, 35(2), 142–149. https://pubmed.ncbi.nlm.nih.gov/8171173/

4. Trichotillomania (hair-pulling disorder) - Symptoms and causes. (2022, May 17). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/trichotillomania/symptoms-causes/syc-20355188