Author: Dr. William Rassman

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.

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.

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.

I just watched the Andy Irons documentary (A Pro surfer) with Andy and his brother who are known to have used hardcore drugs and are perfect Norwood 0’s. David Bowie, Bob Dylan, Robert Plant, Comedians like Richard Pryor, Joey Diaz. Do you think hardcore drugs lower your Testosterone and DHT levels? When ever I hear people saying hair is a diet thing I think absolute bullshit. David bowie lived off of cocaine in the 80s with like a can of tuna fish and some peanut butter or some shit and had perfect hair.

These guys are public. I doubt that their hair has anything to do with hard drug use.

You have an infection of the recipient area with multiple pustules evident on the pictures. You need a surgical drainage of these pustules by your surgeon

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.

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/