Author: Dr. William Rassman

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Do I Have a Juvenile or Mature Hairline at 26 Years Old? (with Photo)

Hello, I’m 26 years old and was curious if I have a juvenile or mature hairline in my photo. My hairline has been the same since I was 16 or so by looking at past photos and I’ve had no hair loss or recession in other areas. The current length of it is 1/2in.

You have my permission to use for the site.

Thanks for your permission to post this. Click to enlarge:

 

This is a great picture because you wrinkled your brow, as I always ask my patients to include in their photo, is touching the highest wrinkle. If you follow the highest crease, that is where your hairline was when you were 7-9 years old. The corners are rising very slightly, but this is still in the Norwood class 1 category and I would consider this a juvenile hairline still.

There is a wide range between when your hairline hugged the highest crease to a fully mature hairline. What is noteworthy about your present hairline is that the mid-line ‘kisses’ the upper crease, which is clearly the same hairline you had in the middle when you were between 7-9 years old.

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Do Gray Hairs Fall Out?

Good morning doc. I’m a 26 year old male who is starting to go gray, pretty heavy on the sides & starting to in the front as well. Is this a good sign that said gray hair won’t fall out? Does this mean the gray hair has already passed a barrier to balding or is it just as likely to fall out as the other “youthful” (brown) colored hairs? Thanks for the great blog!

The graying of hairs is independent of balding (no relationship). Graying is genetic and not necessarily reflecting getting ‘old’, and you are not alone. I have seen many men and women who turn gray in their 20’s. The reason most people do not see them is that they hit the dying bottle and never show their secret.

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Do Hair Doctors Still Use Plugs?

Are doctors still using the plugs that I see on the street, in the malls and at airports all of the time?

Not as a rule. The old plugs that gave this industry a bad name in the 1970-80s have largely been replaced with small grafts that are called follicular units. But there are some doctors that use ‘combination grafting’ which is a mixture of larger small grafts and naturally occurring follicular units. Only the follicular units are undetectable in bright light or close inspection.

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Do Hairy People Respond Better to Finasteride?

Yes, usually hairy people who take finasteride are early in the hair loss process, so that is when finasteride is most effective. At the end of the hair loss process, large balding areas rarely respond to finasteride. Everything else is in-between.


2019-07-29 11:13:59Do Hairy People Respond Better to Finasteride?

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Do I Have DUPA or Alopecia Areata?

29 years old, male. Around 1 1/2 year ago I started thinning all over, except for 3/4 of the neck area (the last inch), but even there i am sure it is somewhat thinner. I probably lost 50% of volume. I shed 50+ hairs just in the shower. We can call it DUPA. Blood analysis are ok: ferritin, diabetes, thyroid, hepathogram.

Now, the thing is that some months ago I had Exclamation-mark hairs. I would see that most of the shorter and thinner hairs in the shower were even thinner at the root (say 30 or 40% thinner). The Average hair was 3 or 4 cm long (1 inch and a half) and this tapered hairs 1 to 3 cm (0.5 to 1 inch). I thought it was just miniaturizating really fast. But now i know they can be a sign of alopecia areata. I don’t have them anymore. Now the roots are thicker than the distal end as it should be in a normal hair. They disappeared after a diet (no dairy, sugar, flour) or by coincidence. I thought I was improving because of that and because the dandruff decreased. But i still shed many hairs and I am still getting worse (maybe at a smaller rate, only maybe).

Is it just DUPA? Can I have DUPA with Tapering hairs? Could be areata? If not, what else should I check for? Considering that i dont have Tapering hairs anymore (maybe some long ones, but it is really not the same), would a scalp biopsy help to know?

Diffuse unpatterned alopecia (DUPA) and alopecia areata are both very rare in men, but I can not tell you what is going on without seeing you. An examination is necessary, so you should see a good dermatologist in your area who should be able to tell the difference.

I wish I could provide more info, but this isn’t something that can or should be diagnosed just based on your description.

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Do I have DUPA?

Many men have written to me to ask me if they had Diffuse Unpatterned Alopecia (DUPA), which I defined in the literature with Dr. Bob Bernstein in 1996. This is a “female type of pattern” where the hair in the donor area has significant miniaturized hairs. In men, it is also called Senile Alopecia when appearing in aging men, but here, the hair is uniform in thickness, so miniaturization is not present. The basic premise in hair restoration surgery is that the donor area (a rim of hair about 2 1/2 inches above the ears and around the base of the skull) is privileged hair protected against the genetic of balding. The Norwood Classification shows this area in the Class 7 patterned patient.

The diagnosis is critical because the donor area is no longer protected from the balding process. We don’t believe that DUPA is necessarily inherited, but we don’t know. Sometimes, this donor area miniaturization will respond to finasteride but often does not. If any surgeon dares use this as a source of hair for a hair transplant, the hair transplant will fail, which is a classic malpractice, in my opinion. But for those impacted, controlling their hair loss becomes a real challenge. We have seen the existence of genetic patterned hair loss with DUPA also present, so these men are unfortunately double challenged.

This link shows a classic case of DUPA (https://baldingblog.com/do-i-have-dupa-photo/), so I ask all of my patients to get a hand microscope and cut the hair short in the area, just enough to use the hand microscope and get a good picture as shown in the above post.

Another man just wrote to me, got a hand microscope, and showed me photos of his donor area. I told him he didn’t have DUPA now, without a doubt. See the photos he sent me below. Very few miniaturized hairs are present, certainly not enough to reach the 20% threshold I use to diagnose DUPA.

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Do I have DUPA (Diffuse Unpatterned Alopecia)? (Photo)

i’d really appreciate if you could have a glance at these pictures taken with a microscope to confirm whether i have dupa hair loss/miniaturization. pardon the oily hair and hair fragments (recent haircut) 🙂

There are 9 slightly miniaturized hairs (arrows point to them) out of a total 50 hair count. This is not DUPA as it requires substantially more than 20% of the hairs. Also it is important that these miniaturized hairs are usually part of a follicular unit with at least 2 normal terminal hairs, so your donor hair count may be just dropping slightly, something I see as boys become men, or as men get older.


2019-09-14 09:49:25Do I have DUPA (Diffuse Unpatterned Alopecia)? (Photo)

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Do I have DUPA

I took these photos of my donor area. I can see though my donor area which worries me about having DUPA

Diffuse Unpatterned Alopecia (DUPA) is determined when the hair in the field of view substantially exceeds 20% miniaturization. I generally like to cut the hairs in the view so that it is easier to count. One of these views is hitting up against the 20% number suggesting that better photo are ideal to pin down this diagnosis. The middle photo suggests that the miniaturized hairs are more than 20% but the other photos don’t back this up.


2018-12-26 09:05:14Do I have DUPA

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Do I have DUPA

I would like to have a HT in the future when my diffuse thinning on top gets really bad, but I don’t know if I have DUPA, is it possible to see from photos from my iphone?

To make the diagnosis, buy a hand microscope from Amazon ($30 range) and then get photos like these from your donor area: https://baldingblog.com/do-i-have-dupa-photo/