Time to take the plunge?

[enigma23]

Jump below to skip the history.
I had very dense hair in my early 20s (-always- commented on by barbers). However, in my mid 20s I started to notice more hairs on my pillows. Looking with a mirror or camera, I couldn't see density differences (or feel any), so I largely chose to deny and ignore it.

Then, right before I turned 30, I had one barber comment that I was losing hair in the crown, and maybe some on top. This freaked me out for a bit, and I started to be more conscious of my hair. This is also around the time that I had stopped trimming the back of my own neck, so I stopped having a regular view of the back of my head.

Soon afterwards, I went to two dermatologists who both said they saw no hair loss, and a hair transplant doctor who even under the microscope said he saw little miniaturization. He did take a density measurement (HMI 84).

Two months later was the first time that I took photos of the top of my head, and was really disheartened, as the density was way less than I remember when I used to see the backside. I got an updated measurement (HMI 59), and was shocked at the sudden change. Immediately went on minoxidil, but couldn't pull the trigger on finasteride.

A couple of years later I decided to get on finasteride, and I've been on it for the last 3. I've largely ignored the issue, as my hairline looks nearly the same as it was in my 20s (using side-by-side photos). However, I recently took an updated look at the back, and there is no denying it, it's pretty thin. There is hair all over the crown, it's just very wispy, with some bunches of long strands.

skip history here
Long story short, I've been on minoxidil for 5 years, and finasteride for 3. I've been very consistent with both. I've also been using 2% keto for 5 years as well. Given that the front half of my scalp seems to be pretty dense, with the same temples I've had since 20, and the crown seems to show no improvement (I wasn't super consistent in the photos from 5yrs ago, 3yrs ago, and recently), I'm considering taking the plunge on a transplant.

Any thoughts? I know that the rest of my hair (back, sides/back) is very coarse and thick, so I assume this means the donor hair would be more effective. I just wonder about the fact that I still have hair on the crown. Is that an issue?

[JoeTillman]

Is hair in the crown still an issue? Simple; it depends on how much hair is still there and which doctor you choose to address it. Given that it is even close to be thin enough to warrant surgery, some surgeons may think it is still too much. Others may think it is fine to deal with. Some will require shaving the area so they can better see the gaps left by the lost hair.

It really is impossible to say since you didn't share any photos so the best thing to do is to take photos of your situation to send to various clinics. Before you send the photos, ask yourself if the thinning is visible. If it isn't, the doctors won't be able to give you an accurate assessment. Don't use the flash on your camera as that only exasperates the issue beyond reality. Better yet, go see some doctors in person and you can start your search on who to see and consult with here.. https://www.iahrs.org/hair-transplant

[enigma23]

Thanks for the advice, Joe.