I’ve Been on Propecia for a Year and I Got Shock Loss After a Small FUE Procedure

Dr. Rassman,

I have used the search function and read all about telogen effluvium and shock loss post-transplant. I just had a very minor FUE procedure of 400 grafts performed a few days ago.

I have been on Propecia (1 mg) for over a year and have diffuse alopecia. However, I am now experiencing hair loss all over my head (including what I believe to be the donor area). Is this telogen effluvium from the shock of surgery or just ordinary shock loss? The doctor said it was probably just some shock loss. What the are long-term effects of something like this?

I notice the hair loss by doing a gentle (very gentle) pull test in all areas. Thanks for your help.

I honestly do not know. I am not trying to brush you off, but every case and every patient is different. What is your age? What did your hair look like under miniaturization mapping prior to your follicular unit extraction (FUE) procedure? Did you have diffuse unpatterned alopecia (DUPA)? If you had done a proper pull test, you might have developed a telogen effluvium (TE). Differentiating TE and shock loss may be difficult at this time. If you had DUPA, you could be at the forefront of disaster. If it is TE, then the hair may return, but if you are under 30 years old, I would want to know, because shock loss is often permanent in the very young men. For shock loss, it does not matter if you had a small surgery or a big surgery, as just the anesthesia can precipitate the process (even without the surgery).

This question points out a series of problems for me when trying to answer some questions here. I sometimes get minimal information and am asked about diagnosis and prognosis. What I do when I see a patient is get a complete medical history, including significant discussions on the hair loss history. Then I perform a very thorough examination, which includes mapping the scalp for miniaturization. I put it all together at that point. As you can see from the above email I received, when little information is available to me it is difficult to really help.

Consider a visit to my office for an appointment and then maybe I can help you more extensively. The cost of a trip to Los Angeles has to be minimal when compared to a large amount of hair loss, which is priceless. Or please speak with your doctor regarding this matter. In your case only time will tell and following it with your doctor may give you some comfort in what is happening to you.