The Best Time I Had Alopecia

by Tracy Wan

“Baby, I think you’re balding.”

The rare hubris of being an Asian woman born into a family of shampoo-commercial-grade manes had granted me a misplaced confidence: I did not expect to hear these words in my lifetime. But as we all know, or will soon find out, life loves a good joke. And so, on a trip to Mexico in December — the sole purpose of which was to evade stress — it caught up with me in the form of a gaping bald spot.

“Maybe it’s the way your hair is parted when it’s wet,” my boyfriend offered unconvincingly, his tone revealing that he regretted any participation in this discovery. I’d just come out of the shower after an arduous day of oceanside loafing. “It’s really not that noticeable.”

But ever the contrarian, I reached back and gingerly probed the tender, hairless skin, a foreign texture and alienating landscape that seemed to go on forever. For a second, I felt a strange sense of comfort: knowing you’re being lied to can sometimes make you feel loved.

As I poked at the back of my skull, my boyfriend reached for my phone — mostly so that I wouldn’t start Googling different iterations of ‘bald circle’ + ‘am I dying.’ “I’m going to take some pictures,” he said. “You’ll want them later.” I silently admired his instincts. For a size reference, he fished a shiny loonie out of his wallet and placed it next to, then on top of, my hairless patch. In another time and mental space, I would have been delighted by how perfectly it fit.

Over an unreliable Skype connection, my doctor friend in Montreal reassured me that it was not what I thought. “You don’t have brain cancer, Tracy,” she said impatiently, familiar with the overdramatic neuroticism central to my personal brand. “That’s not how it works.” After a few questions, she ruled out lupus and syphilis. Unofficially and likely unprofessionally, she diagnosed me with what I would later confirm in-clinic: alopecia areata. I spent the rest of the trip trying not to think about it. We all know how that goes.

The Five Stages of Hair Loss Grief:

1. Denial

Alopecia areata sounds like a rare flower but is just a more impressive name for circular hair loss. It’s an autoimmune disease for which stress is the primary cause — vastly unhelpful to anyone seeking a remedy. When alopecia is triggered, your body fails to recognize itself and attacks healthy hair follicles as though they were tiny alien transplants. It usually happens to scalp hair or beard hair, but no hair is safe. In some cases it evolves — from areata (spots) to totalis (your whole scalp) to universalis (as the Latin root would suggest, everything).

I did not want to resign myself to this fate, which is why I spent my first week back in Canada searching for alternative realities. Among them, a second opinion, as unprofessional as the first: could a fungal infection be the cause? I bought a bottle of extra-strength Nizoral (an antifungal shampoo) at the drugstore, spiked it with tea tree oil, and used it religiously — twice a week, for four weeks. The results: in lieu of a tender bald spot, I developed a taut, dry bald spot.

2. Anger

From birth, women are taught to self-efface — lose weight, fade scars, wax legs — our beauty existing only to the limits of our standards. It’s a precarious dance: patriarchy has no rhyme or reason. Less is more, except when it pertains to hair. But not all hair.

You would think that the mere act of being alive for twenty-five years would have armed me with a quiet resistance to cosmetic shame. But knowing such hypocrisies didn’t make me any less immune; despite my own pride and deliberate effort not to give a shit, alopecia made me hyper-aware of my body on display. I made sure to never stand against the wind in public, carefully combing over the rest of my locks whenever the back of my head felt exposed to the cold.

This admission feels absurd but necessary: for months, I was afraid of exposing strangers to a hairless patch of skin, too embarrassed by the possibility to feel at ease when the back of my head was in another human’s sightlines. I caught myself subconsciously empathizing with middle-aged white men, which was even more infuriating. It’s the Catch-22 of alopecia: stress begets hair loss, which begets more stress. I started patting the back of my head compulsively, to check for accidental exposure; head accessories were back in rotation. When I collected the hairs from my shower drain, I found myself worrying that I was worrying too much.

I had never given a day’s thought to my hair, or what it meant to have some, until it started falling out in ropes. “You really don’t know what you have until it’s gone,” I texted a friend absent-mindedly. “You’re fine,” she texted back. She didn’t care for my clichés. But she was also right: what did I think I deserved from the universe? After all, my health wasn’t compromised; it’s not contagious; the recovery rate is better than that of most autoimmune diseases. There wasn’t even any pain to speak of. “You’re fine,” I repeated to myself, rolling the words around like stress balls. “It is just hair.”

3. Bargaining

When you’re averse to seeking professional medical help, or averse to acknowledging that you are a skeleton wrapped by flesh at all, knowing there isn’t a specific cure for your illness is a relief. After all, depending on which website you consult manically in the middle of the night, 50–60% of those with alopecia areata notice hair regrowth within a year without any treatment. This statistic made me an instant fan of probability.

They say the best revenge is living well, even if it’s against your own body, and so I did: threw back a cocktail of supplements every morning, exercised regularly, went to bed early. But autoimmune diseases don’t give a shit about your bartering tactics. By February, despite bombing myself with self-care — an attempt to reverse the attacks by killing them with kindness — the spot grew to 25% its original size. The circumference, and feel, of a baby’s fist.

At the walk-in clinic, the doctor was impressed. “That’s a healthy bald spot you got there,” she said.

Her choice of words stung, but also amused me: that we choose the word healthy to describe the abundance of anything, even absence. I asked her if my alopecia could have been triggered by something I did, like take hormonal birth control, even though the whole Internet advised against it. I asked her if there was something else I could have done. “Not really,” she replied. “It’s in your genes. Sometimes it’s stress, but sometimes it just shows up.” They gave me a referral to a dermatologist, who was only going to be available in a month. In the meantime, I was to sit tight. “There’s not much you can do,” she said. Which was precisely the problem.

4. Depression

It is a cruel but humbling fate bestowed upon humans that we inhabit a house of flesh as a tenant but never as landlord. Like anyone with a modicum of control issues, I felt anxious and helpless with alopecia, a prisoner of my own body. Weeks went by and I watched the crop circle on my scalp cover more and more ground, signaling the presence (but never the identity) of malicious forces at play.

And here’s the great thing about having Asian hair so thick you can practically floss with it: the strands are super easy to spot against any surface. I have spent a lot of free time scanning all of the tables, pillows, and floors of my life, obsessively collecting the evidence in a case against myself. But this is the universe’s punchline: when there is no suspect, there is no case. There is only hair littering your bathroom sink.

To occupy myself in the month between appointments, I researched home remedies to try despite my father’s pleas. “Please do not try some Internet solutions,” one of his emails said, when he heard about it from my sister. But I am exactly the kind of daughter he feared he raised, and so, I tried everything that had more than two positive reviews on the Internet (a really, really low bar):

1. Hot cayenne pepper paste (to draw blood to the area), for 30 mins, then rinse;
2. Onion juice (a mild topical steroid), to be juiced fresh and made in small batches;
3.A blend of essential oils — equal parts rosemary, lavender, cedarwood and thyme — (to promote relaxation, circulation and, let’s be honest, mask the smell of the onion juice);
4. Castor oil (promoted in beauty communities as a great, natural way to lengthen eyelashes);
5. A nameless concoction from a coworker’s Chinese herbalist (which smelled like echinacea and dirt, but purportedly reversed his girlfriend’s alopecia within weeks).

I tried everything, all at once, for a month, completely disregarding the benefits of an empirical methodology. After all, I wasn’t in it for the research; I was in it for the hair. By the end of February nothing had changed.

5. Acceptance.

Nothing, that is, except my perspective. At some point in the last month, I stopped worrying about the amount of hair I lost, and started caring — not just as a belated therapeutic tactic, but as a holistic measure — for myself. The supplements and exercises may not have reversed the hair loss, but they’ve helped with all other areas of my life: I felt more awake during the day, stronger, happier.

No longer anxious about a lifetime of wigs, I began thinking about alopecia with increasing fascination: what could this be? Can we attribute it to nature or nurture? What began as a strictly selfish search for a cure had evolved into an investigative curiosity about this inexplicable (yet fundamentally universal) condition. After all, how does a question raised by millions of people remain unanswered for so long?

“I don’t know what to tell you,” the dermatologist said when my appointment finally rolled around. He gave me the very strong impression that doctors hate not having the answers even more than we do. “You prevent alopecia from spreading by avoiding the conditions that trigger it.” Then, anticipating another series of question from me: “But no one knows what they are.”

He offered me three options: a cortisone shot (injected under the scalp, to reduce follicular inflammation and block the autoimmune attacks), a corticosteroid topical cream (to be applied 3x/day for I can’t recall how long but it seemed like forever), or time (literally as in, “time heals all wounds” — his joke). I asked him which option had a better success rate, but he didn’t have the answer to that, either. To validate the purpose of the whole appointment, I chose the cortisone shot.

When the derm measured my bald spot for his paperwork — 3.5 x 4.5 cms — a cooing sound escaped him. He handed me a mirror and swiveled me around so that I could see: a thin layer of fuzzy, short hairs have spread over my bald spot, like young grass struggling after a brutal winter. And because alopecia sometimes affects pigment production at the follicle level, he explained, the baby hairs are growing in white. “Cool,” I blurted out.

For the last year, I’d been flirting with the idea of dyeing my hair white, but feared that my hair would fall out from the chemicals. What alopecia took from me in strands, it gave back to me in strength: the emotional reassurance that I’d be fine, no matter the outcome. I made a mental note to tell my future colourist to match my new hairs, if they ever grow out. As of the time of writing, they haven’t. It’s fine.

Tracy Wan is a writer living in Toronto.