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https://www.hgspecialist.com/resources/product-files/files/Finasteride-10-year-follow-up.pdf

of the 113 patients followed for 10 years, only 14% worsened, whereas the remaining (86%) had benefits (21%)
from the treatment duration or (65%) persisted in their improvements. Patients not improved at all
after one year (i.e., with a significant decreasing in their hair growth) could be considered not respondent to a long-term therapy.

Side effects were observed on 5.9% (7) patients, but these effects were not age related (12–14). Some
of the patients who experienced side effects did not drop out of the treatment because of perceived
good results.

I am 39 years old. I have not taken any medication for my hair loss.

I have written about this before on Reddit. Medical treatment is important, but at 39, it is unlikely that you will get a good response to it. It is worth trying anyway. I am concerned about the pattern of balding you are showing. I want to ascertain that this is genetic, not a form of autoimmune disease, as your pattern is not classic for genetic balding. Good doctors routinely perform trichoscopy to rule out diseases of the recipient and donor areas. I would look at the nature of the hair and the skin in and around the balding area. If I am concerned, then I would biopsy the areas of concern because autoimmune diseases of the scalp kill hair transplants. Assuming you have no autoimmune scalp disease, I would establish your lifetime donor supply of grafts, including (1) donor density and (2) hair shaft thickness of the donor’s hairs. This will tell the surgeon what you will look like after the hair transplant, which should be shared with you. Not all grafts are equal; for example, coarse hair has 10 times the value of very fine hair (cosmetic-wise). Hair transplant science is well-established today.

[If you have any questions, you can reach me at williamrassman33@gmail.com]

Finasteride should not be the cause of your hair loss. See your doctor and find out what is happening as weight loss of this magnitude is significant to your overall health.

This may not be thinning. If a person with an average hair thickness was to bundle all of the hair (like a pony tail) on the head, it would make a circle about 1/2 inch thick. Now spread that out all over the scalp, and that is the coverage one gets. Short hair, a bright flash and straight hair can make a normal person look like this. To find out if you are balding, a HAIRCHECK test will tell you that (see here: https://baldingblog.com/haircheck-test-how-it-is-done-video/)

I have noticed that I’ve been losing my hair since I was about 18 years old. For the past few years , I’ve been using finasteride, nizoral, and minoxidil. It worked for a couple years but now I’m noticing that my hair has been falling at a very fast rate. I currently live in Seoul, South Korea, and I have been thinking about having a hair transplant but I’m afraid of having one at a young age.
Do you have any advice?

There are things you need to be clear of:
1) Losing hair is not fun but it may be something you may have to face. More than 50% of men face some degree of genetic hair loss. If you are worried, find a doctor who can give you a diagnosis and a Master Plan for how to possibly address the hair loss.
2) You don’t have to have a hair transplant. Losing hair does not automatically mean you need to have surgery. There may be other options such as medication or scalp micropigmentation.
3) As you live ins Seoul Korea, you can always visit my colleague Dr. Jino Kim of New Hair Institute in Seoul Korea.

Two things should be evident when you look at this photo. (1) the scar from the hair transplant (easily taken care of with scalp micropigmentation, see here: https://scalpmicropigmentation.com/gallery/scar-covering/#!https://scalpmicropigmentation.com/wp-content/uploads/2016/04/scalp_micropigmentation-new_hair_institute-146-scalp_scars.jpg and (2) the Island of Hair surrounded by the balding that occurred after he had his hair transplant (easily fixed with another hair transplant). The surgeon and the patient didn’t recognize that he was going to develop a Class 7 pattern at the time of his original hair transplant. I hope that the patient was aware that hair loss is progressive and that this progression is a real risk for this type of hair transplant in advanced pattern balding men. Fortunately, it looks like he has enough hair to fix this problem.

Diffuse Unpatterned Alopecia (DUPA) hits the donor area (back of the head) as it does everywhere else on the head. Men with DUPA should not have a hair transplant. The arrows point to only three normal terminal hairs in this patient’s donor area within the field of view. All of the other hairs are in some degree of miniaturization.