Dr. Umar of Dermhair Clinic Discusses Body Hair Transplant For DPA and DUPA Forms of Male Pattern Baldness

heal-frontalWith typical forms of androgenic alopecia in men, baldness occurs progressively through distinct phases.

This usually involves the depletion of the hairline , temples, top section and vertex and is illustrated in the images of the Hamilton Norwood scale. 

This is a chart which is widely used by hair restoration doctors to diagnose patients with the different stages of male pattern baldness.

However, there are also less typical forms of this condition known as DPA (diffuse pattern alopecia) and DUPA (diffuse unpatterned alopecia).

In a recent post on his site, Dr. Umar discusses both types and how body hair grafts can help benefit patients with these manifestations.


DPA and DUPA are both androgenic forms of hair loss, much like the classically recognized occurrences of male pattern baldness. In other words, they are caused by certain hair follicle receptors which are sensitive to the damaging effects of a testosterone breakdown product known as DHT (dehydrotestosterone). This causes the hair follicles to miniaturize and lose their ability to grow hair as they did before.
For some people, this means losing hair completely. Others may lose some of their hair and continuing to grow hair shafts that are much thinner. This is the case with DPA and DUPA patients.

Diffuse Patterned Alopecia is marked by profound thinning across the head. The thinning occurs in a more global fashion as opposed to a phased progression (separate bald areas in the front and crown which gradually become a single uniform area of hair loss)
What remains is a relatively well defined horse shoe region along the bottom and sides of the head. This is known as the stable permanent zone.

A similar form of thinning occurs as well in Diffuse Unpatterned Alopecia. However, the horse shoe zone of hair on the back and sides has far less definition since this area is also affected by thinning. Instead of being a solid high density area, much of the scalp is visible. Hair loss occurs more rapidly in DUPA .

Between these two rarer forms of androgenic alopecia, DPA occurs more commonly in men compared to DUPA.


The most effective way to determine a proper hair restoration treatment intervention is to first determine the cause(s). Diffuse thinning, especially if it lacks definition, may be due to various factors. A doctor would need to thoroughly examine individual cases to determine whether or not they are caused by genetics or a separate medical condition such as thyroid imbalances.
In androgenic alopecia, deviations in DNA code sequences result in hair follicle protein receptors which offer lower degrees of defense against DHT. And this damages the tiny hair organs, causing them to shrink. New hair will fail to grow. Or it may become much thinner than it used to be.

Due to the possibility of higher sensitivity to DHT, a higher percentage of those with diffuse forms of androgenic alopecia may respond better to Finasteride compared to individuals with more classic signs of male pattern baldness.

If medication fails to provide significant improvement, then hair transplant surgery may be considered as the next option.


The standard source of grafts for most hair restoration procedures is the scalp itself. The follicles that are selected must be healthy and robust .Those that have been affected by DHT related miniaturization would not be able to produce quality growth that patients would expect for the final surgical results.

Individuals with DPA will have a stable permanent zone of rather solid hair density on the back and sides of their head. This can be used to harvest donor grafts. But this horse shoe region is usually comparable to the Norwood 6 area of remaining hair. Norwood 6 is one of the last two stages of male pattern baldness. Any hair derived from the stable permanent zone would be very minimal.

DUPA patients would not qualify as candidates for standard hair restoration procedures using head hair grafts. This of course is due to the pronounced thinning of the hair regions along the lower margins of the scalp.


The ability to create quality coverage of the thinning areas in DPA and DUPA patients depends on having the right number of quality hair follicle grafts. If donor supplies on the head are deficient or non-existent, then another supply would be needed.
If the individual has enough thick caliber hair (comparable to head hair) on other regions of their body, these follicles can be harvested for insertions on the head.

Unlike head hair, body hair actually thrives when DHT levels are high. They emerge during puberty when testosterone is being produced in much greater quantities.

Testosterone itself breaks down into DHT with the help of the alpha-reductase enzyme. Therefore, high quantities of testosterone eventually turn into abundant supplies of DHT which supports the growth of body hair.

Those who are considering any type of BHT procedure may want to be aware that their grafts are likely to flourish due to the DHT in their body.