Barbara Williams didn’t get married just to change her name – of course not. But the opportunity to have a new surname was certainly an attractive proposition. Williams has had trichotillomania, a condition that causes her to pull out her hair compulsively, since she was nine – and her original name was Balde. Well, it wasn’t ideal.

A 63-year-old picture framer from Warwickshire, Williams believes that her trichotillomania was triggered by the stress of her mother leaving the family home. She would lie awake at night and tug out great handfuls of hair, before rolling it up into a ball and hiding it behind the bed. By her 30s, she was totally bald. “It was just awful,” she sighs. “I couldn’t even watch shampoo adverts on the television. There would be a horrible feeling in my chest.”

She wore wigs, but found them hot and uncomfortable. Then, when she turned 50, Williams decided: enough. She would be open with people about her condition and they could take her as they found her. “I felt dirty and like I would be rejected,” she says. “In fact, when I started telling people, it was a fantastic relief, like a great weight had been taken off my shoulders.”

Facebook Twitter Pinterest ‘I am so done with hiding’ ... Ricki Lake in New York last week. Photograph: MediaPunch/Rex/Shutterstock

Williams is far from the only woman to embrace her baldness. The US talkshow host Ricki Lake recently went public with her 30-year struggle with hair loss, explaining that her hair started falling out when she appeared in the 1988 film Hairspray. “There have been a few times where I have even felt suicidal over it,” she wrote in a heartfelt Facebook post. “Almost no one in my life knew the level of deep pain and trauma I was experiencing.” Lake wore hair extensions, but the process of having them fitted was expensive, time-consuming and painful. She has decided to stop wearing extensions or wigs. “I am so done with hiding,” Lake wrote.

Other celebrities have spoken out about female hair loss. The British TV presenter and 90s lads’ mags regular Gail Porter was diagnosed with alopecia in her 30s and has talked about her experience openly. After winning gold at the London Olympics in 2012, the cyclist Joanna Rowsell Shand, who also has alopecia, appeared on the podium jubilant and bald.

Lake, Porter and Rowsell Shand are high-profile advocates for the growing number of women choosing to accept their baldness, rather than hiding or disguising it. “Wigs have been a massive hindrance,” says Alice Austin, a 32-year-old social worker from Nottingham. She started losing her hair due to alopecia when she was in primary school. By nine, Austin’s hair had fallen out so much that she started wearing wigs to school. “They were these horrendously thick NHS wigs,” she remembers. “The kids would call me ‘Wiggy’.”

In secondary school, a boy pulled off Austin’s wig as she was walking up a flight of stairs. When Austin played netball, students would chant “Wiggy wiggy wiggy”. “It was traumatic for me, because how you look is so important when you’re a teenager,” she says. “It massively knocked my confidence.” She says wearing a wig is not fun: your scalp itches, sudden bursts of wind induce terror – and you can forget about swimming in the sea on holiday.

Motherhood changed things for Austin. “I turned 30 and thought: I have to get a grip on myself,” Austin says. “I’m a mum. Kids are so perceptive.” She stopped wearing her wig as often, deciding to play netball without it, or to do the school run bald. In summer, when the weather is warm, Austin hardly ever wears her wig. “I could never have done that before,” she says. Last year, for the first time, she didn’t renew her NHS wig prescription.

Female hair loss can happen for a variety of reasons. “The most common reason is a disturbance in the hair cycle,” says Dr David Fenton, a London-based dermatologist and spokesman for the British Association of Dermatologists. “More follicles enter the resting phase as a reaction to something that’s happened in your life, whether it’s fever, weight loss, illness, stress or thyroid dysfunction.” This condition is called telogen effluvium. “As long as you can identify the reason for telogen effluvium, it usually grows back,” says Fenton. “Occasionally, it will precipitate the female equivalent of genetic hair loss, which will require long-term therapy to prevent you losing more hair.”

Women can also experience hair loss due to hormone changes after the menopause, or if they have polycystic ovarian syndrome. In this instance, doctors may prescribe antiandrogen contraceptives, which block the excessive production of male sex hormones in the body, which is known to cause hair loss. Alopecia occurs when the body’s immune system goes into overdrive and begins targeting hair follicles in error.

Facebook Twitter Pinterest ‘People judge women without hair. Hair is so important in the media’ ... Christala Fletcher, who has alopecia. Photograph: Jill Mead/The Guardian

Black women who wear braids may also experience traction alopecia, which is hair loss caused by very tight hairstyles. Doctors can help minimise hair loss – minoxidil solution, sold commercially as Regaine lotion, is an effective over-the-counter solution for alopecia – but they can’t prevent alopecia attacks coming on. “Alopecia can be very upsetting, because it happens so suddenly,” says Fenton. “One week you have hair, then in a few weeks you can be bald. Attacks may flare up suddenly. Every time it happens, the person grieves.”

Hair loss is particularly devastating for women, as femininity in western cultures is typically associated with long, flowing hair. “You can’t overestimate the social, emotional and psychological effects of hair loss on a woman, particularly if that person’s hair has been a major feature of their appearance,” says Fenton.

Christala Fletcher, who is 27 and from west London, has alopecia. She decided to shave her head when she was 19, after experiencing near-total hair loss. “It’s a mess, being a bald woman in our society,” she says. “People judge women without hair. Hair is so important in the media. It’s supposedly what makes you a woman.”

Accepting your baldness in a society that connotes hair with femininity is cathartic. “Before, I felt like the wig dictated to me, as if I had to wear it whether I wanted to or not,” says Austin. “Now, I feel like I have a choice. I’d been stripped of that for so long.” But it may take years – and loving support – to get to a place where you are comfortable going bald in public. Many women find that online communities can be an important source of affirmation: Alopecia UK has a popular Facebook group, while there are forums for people with trichotillomania, too.

The decision to shave what is left of your hair can feel momentous. “It was really tough,” says Fletcher of her decision to shave her head. Her sister helped her get through it. “She got the razor and said: ‘Let’s do this together.’ I had this patch of hair on the top of my head that I’d been holding on to so deeply.”

But going out in public bald is often an anticlimax. “It was less scary than I thought,” says Juliet Fitzpatrick, a 55-year-old admin worker from Hertfordshire. After being diagnosed with breast cancer in 2016, Fitzpatrick’s hair fell out due to chemotherapy. She decided to eschew wigs or headwraps. “For me, wearing a wig didn’t feel right. It felt like a pretence, like I was covering something up.”

When her children graduated from university, Fitzpatrick asked them if they wanted her to wear a wig. They said no. “I said: ‘That’s good, because I don’t want to wear one!’” Going bald felt empowering. “I needed something positive to come out of this horrible experience; for me, it was not wearing a wig and just being who I was at that particular point in my life.”

Facebook Twitter Pinterest ‘I needed something positive to come out of this horrible experience’ ... Juliet Fitzpatrick, who lost her hair during treatment for cancer, at her children’s graduation ceremonies. Photograph: Image supplied by Juliet Fitzpatrick

Most of the time, going wig-free in public is a positive experience. “People are much kinder than you think,” says Austin. “When you’ve been bullied as a child, you think all people are nasty, mean and horrible, but people are much more understanding than you realise.” That said, well-intentioned strangers tend to assume that, if you are bald, you have cancer. “I always felt that people felt sorry for me because they thought I had cancer,” says Williams. “I was getting sympathy I didn’t deserve.”

But not everyone is understanding. “It takes a person with thick skin to rock a bald head proudly,” Fletcher says. And there are situations in which being a bald woman can be stressful. Williams hates going to public toilets, because she worries that she will be mistaken for a man. “I’ll come out of a cubicle and women will do a double-take, or women walk into the bathroom and they’re not sure if they’ve accidentally walked into the gents.”

Recently, Austin was on holiday in Cyprus for a friend’s wedding. “It was the first time I’d really embraced the alopecia,” she says. “I was walking around the pool without a headscarf on, and this mother of a little girl came up to me and burst into tears. She told me that her daughter had started losing her hair the year before and she didn’t know what to do.”

Austin hopes for a relaxing of traditional beauty standards, so that by the time that girl has grown up being bald won’t be so unusual. “I think we’re seeing more people in the public eye who are different,” Austin says. “Our definitions of what is beautiful are changing. Women can be beautiful without hair.”