Theory: Due to a psychophysiological conditioning by interpersonal mimic interaction, a permanent tension of the facial musculature (mimic musculature) and the masticatory musculature occurs, which increases in the course of life and is not perceived by the affected person, whereupon metabolic and/or circulatory disturbances and/or tissue hardenings (fibrosis) occur, which in the final result lead to hair loss.

Description of the process of psychophysiological conditioning:

The state of mind (emotion) inferred by outside persons from a person's physically relaxed face does not match that person's actual state of mind. For example, a person in question may be neutral minded, but based on facial features (facial expressions) is perceived by outside persons as, for example, threatening, aggressive, conniving, gloating, or disgusted. The lack of correspondence between the actual state of mind and the state of mind perceived by surrounding persons is registered (subconsciously) by the mind of the affected person. As a result, in the physical areas identified by the mind as causative for the "misinterpretation" of the state of mind (e.g. mouth and jaw area, eye area), persistent, subliminal states of tension occur, which ultimately lead to hair loss.

Through the described psychophysiological conditioning, a psychophysiological reflex is formed: Subconsciously, "autonomous" parts of the mind continuously check one's own facial features – even if there are no persons in the vicinity – which results in a permanent, subliminal tension of the mimic muscles and the masticatory muscles. The own face and head shape is permanently a part of the conscious and unconscious perception of the affected persons – different from persons who are not affected by the described form of hair loss. One could say that the face of the affected person – on the psychophysiological level – is treated like an out-of-control body part that needs to be brought under control, with the hair loss being only a side effect.

Example 1:

In a man with eyes that appear "piercing" to outsiders or an eye area that appears threatening or irritating, a permanent, subliminal tension of the following muscles arise:

• Musculus frontalis (function: frowning, raising the eyebrows)

• Musculus occipitalis (function: smoothing the forehead)

• Musculus corrugator supercilii (function: pulling down the eyebrow, wrinkling the forehead)

The final result of the permanent tension of the mentioned muscles is hair loss in the forehead and temple area. The connection of the galea aponeurotica may also cause hair loss on the vertex and tonsure. Simultaneous tension of the above-mentioned mimic muscles is not necessarily visible in a person's facial expression – just as, for example, the biceps and triceps can be tensed at the same time and the arm can still hang down and make a relaxed impression on outsiders. Because the tightness of the aforementioned muscles builds up over time and is in a subliminal range, it is not necessarily noticed by the affected person.

Example 2:

In a man with a pronounced upper and lower jaw, a slightly open and slanted mouth in a physically relaxed state, and partially visible teeth – which in combination can have a threatening or irritating impression on surrounding people – a permanent, subliminal tension of the following muscles arise:

• Musculus buccinator (function: pressing the jaws)

• Musculus orbicularis oris (function: contraction of the mouth opening)

• Musculus depressor anguli oris (function: lowering the corner of the mouth)

• Musculus risorius (function: lateral and headward movement of the corner of the mouth, retraction of the dimple of the cheek – laughing muscle)

• Musculus zygomaticus (function: pulls the corner of the mouth up and back – smile muscle)

• Musculus levator labii superioris (function: lifting the upper lip)

• Musculus depressor labii inferioris (function: lowering the lower lip)

• Musculus levator anguli oris (function: lifting the corner of the mouth)

• Musculus masseter (function: lifting and lateral movement of the lower jaw)

• Musculus temporalis (function: jaw closure, retraction of the lower jaw)

• Musculus pterygoideus medialis (function: lifting of the lower jaw, jaw closure)

• Musculus pterygoideus lateralis (function: opening of the jaw, advancement of the lower jaw, grinding movements from right to left or vice versa)

• Musculus mylohyoideus (function: opening the mouth, raising the hyoid bone)

• Musculus geniohyoideus (function: advancement of the hyoid bone – involved in mouth opening)

• Musculus digastricus (function: opener of the oral fissure – involved in mouth opening)

The final result of the permanent and subliminal tension of the mentioned muscles is hair loss in the tonsure area.

The Theory described perhaps answer the following questions:

Q: Why does hair loss occur exclusively on the (upper) head?

A: The face, the mimic musculature and the masticatory musculature are exclusively located on the head. The assumption is that the tightening of the mentioned muscles primarily impedes blood drainage and thus the removal of metabolic products. On the lower side and back of the head, the tension is less and the distance that blood must travel in the tense area is shorter.

Q: How can the Norwood hair pattern be explained?

A: The Norwood hair loss pattern results from the tension pattern generated by mimic muscles and the masticatory muscles.

Q: How is hair loss "inherited"?

A: Head and face shape is genetic. The head and face shape of a son resembles the head and face shape of his father and mother (but more like the father's). Due to the similar head and face shape, the son is exposed to the same "misinterpretations" and the corresponding mimic reactions of people around him as his father and is thus subject to the same subconscious psychophysiological conditioning process, which leads to similar states of tension and, as a result, to a similarly pronounced hair loss. The finding that hair loss is supposedly inherited through the mother may indicate that the mimic response of women – for example, to the facial features of their male partners and children – is significant in the expression of the described psychophysiological reflex.

Q: Why are significantly more men than women affected by "genetic" hair loss?

A: The physiological differences (e.g. lower muscle mass and strength) are probably decisive. For example, the same degree of psychophysiological conditioning described above that results in hair loss in the male does not result in hair loss in the female because of the lower mass and strength of the facial and masseter muscles. Apart from the physiological differences, the heads and faces of men generally appear more "threatening" to onlookers than those of women.

Q: How does hair loss in twins (same genetic makeup) develop differently?

A: The twins may have grown up in different environments where people "react" differently to the same face and head shape. Likewise, it could be that the twins are differently "sensitive" to mimic responses to their head and face shape. The result would be different psychophysiologically induced states of tension and different degrees of hair loss.

Q: How can the successes be explained by medication use?

A: Some of the drugs used so far improve blood flow in areas affected by the described tension states (e.g. minoxidil). The use of estrogen leads to a reduction in muscle mass and strength, which may also affect the mimic and masticatory muscles. Accordingly, this muscle reduction may lead to an improvement of blood flow in the areas affected by the described tension conditions.

Q: How can the alleged successes due to the use of muscle relaxants in the face be explained?

A: The muscle relaxants used in the face relax parts of the mimic musculature, which partially abolishes the described tension states that lead to hair loss.

Q: Why are isolated/uncontacted groups not affected or less affected by "genetic" hair loss?

A: They are more often smaller groups of people where everyone knows and interacts with each other from birth. Meeting strangers on a daily basis and interpreting their state of mind based on facial features is not a normal occurrence for these people. Hair loss could therefore also be described as a disease of an anonymous and numerically large society. In the anonymous, technicized societies, in which people are usually clothed up to the head, the focus during interaction is furthermore mainly on the face or the head, which possibly intensifies the described psychophysiological reflex.

Q: What are the possible reasons for the failure of research into the cause of "genetic" hair loss?

A:

• Photographs of faces are largely useless as a basis for a pattern recognition because people taking photographs of themselves or being photographed by others usually adjust ("disarm") their faces. It is rare to see physically relaxed faces in photographs. This is equally true when observing the facial features of the people surrounding one, where physically relaxed faces are also rarely seen.

• The impression that facial features have on an outside person is something very subjective, making pattern recognition difficult.

• A person's sensitivity to other people's mimic reactions to their own facial features is something very subjective, making pattern recognition difficult.

• It is a common assumption that a person's facial features (facial expressions) basically represent their state of mind, since everyone has adjustable facial expressions – which is not the case. For example, a relaxed-looking face is not necessarily a physically relaxed face.