The Hairdex Questionnaire
Date (required)
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Below you will find a number of problems that may arise in connection with your hair loss. Please mark with a cross to what extent each statement applies to you personally
Q1 - My scalp hurts 0. Never1. Rarely2. Sometimes3. Often4. Always
Q2 - The condition of my hair affects how well I sleep 0. Never1. Rarely2. Sometimes3. Often4. Always
Q3 - I worry that there might be something seriously wrong with my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q4 - The condition of my hair hinders me from working or doing leisure activities 0. Never1. Rarely2. Sometimes3. Often4. Always
Q5 - The condition of my hair affects my social life 0. Never1. Rarely2. Sometimes3. Often4. Always
Q6 - The condition of my hair makes me depressed 0. Never1. Rarely2. Sometimes3. Often4. Always
Q7 - My scalp burns 0. Never1. Rarely2. Sometimes3. Often4. Always
Q8 - I stay at home more often because of my hair loss 0. Never1. Rarely2. Sometimes3. Often4. Always
Q9 - I worry that the condition of my scalp could lead to scarring/disfigurement 0. Never1. Rarely2. Sometimes3. Often4. Always
Q10 - My scalp itches 0. Never1. Rarely2. Sometimes3. Often4. Always
Q11 - The condition of my hair affects how close I can be with people close to me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q12 - I feel ashamed of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q13 - I am afraid that my hair loss might get worse 0. Never1. Rarely2. Sometimes3. Often4. Always
Q14 - I do things alone more often because of my hair loss 0. Never1. Rarely2. Sometimes3. Often4. Always
Q15 - The condition of my hair affects how close I can be with people close to me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q16 - Water (e.g. when washing my hair) affects the condition of my hair and my scalp 0. Never1. Rarely2. Sometimes3. Often4. Always
Q17 - The condition of my hair makes it difficult for me to show affection to other people 0. Never1. Rarely2. Sometimes3. Often4. Always
Q18 - My scalp is in poor condition 0. Never1. Rarely2. Sometimes3. Often4. Always
Q19 - My scalp is irritated 0. Never1. Rarely2. Sometimes3. Often4. Always
Q20 - The condition of my hair affects my relationships with other people 0. Never1. Rarely2. Sometimes3. Often4. Always
Q21 - I am embarrassed by my hair loss 0. Never1. Rarely2. Sometimes3. Often4. Always
Q22 - My hair loss is a problem for the people close to me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q23 - The condition of my hair frustrates me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q24 - My hair is very sensitive 0. Never1. Rarely2. Sometimes3. Often4. Always
Q25 - I socialize less because of the condition of my skin 0. Never1. Rarely2. Sometimes3. Often4. Always
Q26 - I feel humiliated by the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q27 - My scalp bleeds 0. Never1. Rarely2. Sometimes3. Often4. Always
Q28 - The condition of my scalp/hair makes me angry and irritable 0. Never1. Rarely2. Sometimes3. Often4. Always
Q29 - My sex life is affected by hair loss 0. Never1. Rarely2. Sometimes3. Often4. Always
Q30 - The condition of my hair annoys me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q31 - I have control over the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q32 - I have trouble sitting on the bus, in the cinema, or in the theatre where others can see my hair clearly 0. Never1. Rarely2. Sometimes3. Often4. Always
Q33 - I am happy with myself despite the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q34 - I feel like an outsider because of the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q35 - Life is worth living despite the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q36 - I worry that my hair makes me look old 0. Never1. Rarely2. Sometimes3. Often4. Always
Q37 - The condition of my hair makes it difficult for me to achieve as much as I normally do 0. Never1. Rarely2. Sometimes3. Often4. Always
Q38 - Other people make fun of me because of the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q39 - Overall, despite my hair Self-confidence 0. Never1. Rarely2. Sometimes3. Often4. Always
Q40 - Other people show understanding of the condition of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q41 - I go to the hairdresser as often as usual despite the condition of my hair/scalp 0. Never1. Rarely2. Sometimes3. Often4. Always
Q42 - People talk behind my back about my hair loss/the appearance of my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q43 - Compared to others, I am lucky to have this hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q44 - The condition of my hair disfigures me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q45 - I hate my hair when I see it in the sink, in the comb, on the sofa 0. Never1. Rarely2. Sometimes3. Often4. Always
Q46 - The condition of my hair is what people mainly notice about me 0. Never1. Rarely2. Sometimes3. Often4. Always
Q47 - I look in the mirror every morning/evening to see if my hair 0. Never1. Rarely2. Sometimes3. Often4. Always
Q48 - My doctor has not taken my hair problems seriously at all 0. Never1. Rarely2. Sometimes3. Often4. Always
Thank you very much for completing all the questions in this questionnaire.
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