Do I have DUPA? (photos)

I am scheduled for an upcoming hair transplant, and I am worried about having Diffuse Unpatterned Alopecia (DUPA).  The surgeon didn’t understand when I asked him about DUPA in my donor area, and I don’t want to go forward if I have DUPA.  Please help me with the diagnosis.  Here are four pictures from my donor area.  

The first picture qualifies for DUPA as there are many hypopigmented hairs in the field of view. The other photos show a much more straightforward case of DUPA.  I define DUPA as miniaturization over 20% of the hairs in the donor area.  The third photo shows well over 20% miniaturized hair, which you can count easily.  I would want a more extensive evaluation of the donor area before tackling a hair transplant, but what is here strongly suggests DUPA. He met face-to-face with three doctors before speaking with me by phone.  Shame on the doctor for (1) not understanding his concerns about DUPA, (2) not listening to his concerns, and (3) not making the diagnosis when he was before them.  Some doctors just do this for the money and really don’t care what happens to these patients after the surgery.  I tell the patient to ask himself the question: “Is this a doctor you trust?” This is a critical question everyone should ask before allowing them to work on their scalp.

I outlined in a circle (the third picture is the same photo as #2) with arrows and circles showing the hairs in the field that I think are miniaturized.  As this is part of the donor area, it would worry me a great deal if a hair transplant was on the agenda unless, that is, a better and more comprehensive assessment of the donor area is performed. Click on the photo to enlarge it. 

Dr. Robert Bernstein and I discussed DUPA and concluded that Finasteride works in most men to some degree.  It is worth trying this for a year and then reassessing the patient’s situation as having great before pictures is invaluable.