Shock Loss and FUE, Density, Diffuse Thinning

Hello Dr. Rassman,

Thanks for this Q&A forum! I have three questions as below and your response would be greatly appreciated!

1. As you can see in my picture [editor’s note: see below!], which you can use on the forum with the response btw, seems like I have diffuse thinning. Im not sure what Norwood pattern this is, but does my pattern rule me out for a FUE hair transplant? I think I read somewhere that diffuse thinning candidates are not sutable for hair transplants. The hair in the back of head is pretty thick and looking at my dad and my older brother, I see no danger of losing hair in the back. It’s mostly crown thinning and almost bald on the top. I’m 39 years old

2. You mentioned that South Asians have less density than say those of European descent. I always thought it was the reverse? based on what I see in terms of density in the back of my head, looks like I should be able to get more drafts from my donor area??

3. Is there any way to reduce/eliminate shock loss from neighboring areas after a FUE transplant? Does one have to take propecia to eliminate shock loss? I tried finestaride (.25 mg) for a month and the side effects were frightening, so I stopped.

Thanks in advance!

Thanks for allowing me to post this photo. Click it to enlarge!

1. Looking at the only photo you sent, you look like you have LOTS of hair on your side and thinning hair on top. I have no idea how your hair looks like on the back (donor area) and what percentage of your hair are miniaturized in key areas. So in short, I cannot tell you if you really have diffuse thinning and I cannot give you a personalized diagnosis… but with little that I do see and what you described as mostly thinning at the top, I don’t think you have diffuse thinning. You most likely have an early Norwood Class 5 or 6 pattern. I would see a physician (hair transplant physician if possible) for a good diagnosis and a miniaturization study.
2. Asians have less hair density than their European counterpart, but much of the time Asian hair is thicker and coarser as compared to the European fine hair. This can make Asian hair look more full. I have no idea what your density is. Your guess is as good as mine (its only a guess) so go to a good doctor and have it measured.
3. Propecia (finasteride in 1mg strength) does not “eliminate” shock loss. It decreases the risk. There is no guarantee you will or will not have shock loss after a hair transplant surgery. Generally younger men in their early 20’s and men who are losing hair rapidly have more chance of shock loss.

Finally, I do not know what frightened you in to stopping finasteride. If you have side effects I would discuss them with your doctor to find out if it really is a side effect or something unrelated. Negative sexual side effects occurs in 1 to 2% of men who take the medication and they are reversible.