25 yo male with low density and male patern baldness

[damngenetics]

Hello everyone, I came here to post my pictures so you can give me your opinions. I think (my impression) that I have thick hair but with a very low density, I shaved it all 1 week ago and now I can see that it seems like I have lower density in the areas affected by male pattern baldness, and definitely, it looks like the areas less affected are the same where my dad still has some hair (sides).

Story: I have been losing hair since I was 17, and significantly since I was 21. I have diagnosed Hashimoto's hypothyroidism (I take T4 daily and I have controls once a year for it, everything is under normal values) and my dad, uncles and granpa are bald (but no one of my cousins are bald)

Treatment: I started with finasteride 20 months ago but I think I'm not getting better hair, just mantaining it but still losing some hair. Last month I added minoxidil 5% daily and dermarrolling 1 mm weekly. I have tried minoxidil before but I was not regular with it and also I had a lot of shedding at that scared me a lot so I decided not to continue with it.

Also I take a vitamins pill everyday. I also asked to a doctor for a hair transplant for increasing the hair density in the M shape and a bit maybe in the crown and he said that I am able to do it, but now I have serious doubt about the quantity of hair that he can get of my donor areas.

Questions:

1) Do you think I have enough hair density for a transplant? Or am I a lost case? I don't mind if I'm the second one, just want an honest opinion
2) Should I continue with minoxidil for a time before getting the hair transplant?
3) Can I use Dutasteride instead of Finastiride in the long term? What about saw palmetto?
4) I think I am a Norwood 3V scale, am I right?
5) Should I add ketoconazol 1% to the routine?

Pictures (I have a scar in the donor area too, for reference it has 1.6 cm)

 

[Selb]

Go to a reputable transplant doctor for a second option, they can analyze your donor hair and see how many grafts would be right for you. We can’t exactly tell if your donor is good or not, it looks fine to me but the doctor will know exactly.

Also, finasteride is mostly for maintenance and you have that, so dutasteride isn’t necessary. However, if your hair is continuing to thin, then duta might be worth a shot.

Your hair seems to be okay besides the mid scalp area, might be diffuse thin all over though. Hard to tell when it’s buzzed like that. I would continue the microneedling and minoxidil and focus on those two areas. I can see some good regrowth potential there

 

[damngenetics]

Go to a reputable transplant doctor for a second option, they can analyze your donor hair and see how many grafts would be right for you. We can’t exactly tell if your donor is good or not, it looks fine to me but the doctor will know exactly.

Also, finasteride is mostly for maintenance and you have that, so dutasteride isn’t necessary. However, if your hair is continuing to thin, then duta might be worth a shot.

Your hair seems to be okay besides the mid scalp area, might be diffuse thin all over though. Hard to tell when it’s buzzed like that. I would continue the microneedling and minoxidil and focus on those two areas. I can see some good regrowth potential there

Thank you Selb, do you think 1 mm dermarroller is enough? Should I press it until my scalp bleeds a little? Once a week is ok?

I add more photos 1 month before my buzz, as you can see I have trouble with my crown and the M shape, it was getting a bit difficult to have a decent hair style.

 

[Selb]

Thank you Selb, do you think 1 mm dermarroller is enough? Should I press it until my scalp bleeds a little? Once a week is ok?

I add more photos 1 month before my buzz, as you can see I have trouble with my crown and the M shape, it was getting a bit difficult to have a decent hair style.

Yeah you’re not too far gone. The rest of your hair looks thick and healthy. I can’t speak to if you can recover your temples but that thin area on top can definitely be revived with microneedling and minoxidil.

I’d suggest a pen, but if you want to use a dermaroller that’s fine. Once a week, skip min use that day. 1 mm or 1.5mm, whichever gives you enough redness. The goal is not to bleed that much, but cause enough micro wounds to give a nice sunburn redness. Bleeding is okay though if it happens