Mehmet Erdogan, MD

Thank you for sharing your history.

Based on what you've described — progressive thinning since age 18 and a general decrease in hair density — it does sound somewhat consistent with diffuse androgenetic alopecia (a subtype of male pattern baldness). However, after reviewing your photos, we noticed that the most significant thinning seems to be localized at the crown (vertex) and behind the ears. This isn’t a typical pattern for classic diffuse androgenetic alopecia, where thinning tends to be more uniform across the top of the scalp.

Because of this unusual distribution, we highly recommend that you also consider a detailed medical workup to rule out additional or secondary causes of hair loss, such as:

1. Nutritional deficiencies (iron, zinc, vitamin D, B12)

2.Thyroid function abnormalities

3.Chronic stress or past illness (telogen effluvium)

4.Scalp inflammation or dermatological conditions

5.Autoimmune factors

In other words, before starting any treatment or medication, it’s essential to identify the exact cause of your hair loss. Otherwise, therapy may be ineffective or even inappropriate.

As for treatment - topical form of Minoxidil and finasteride remain first-line therapies for androgenetic alopecia and could still be beneficial in your case — especially if there is any hormonal component involved.

1. Minoxidil can improve blood circulation and stimulate regrowth.

2. Finasteride reduces DHT levels, which helps prevent further miniaturization of hair follicles.

That said, if medications and supportive therapies prove ineffective and the hair loss continues to progress, then surgical options such as a hair transplant should only be considered a few years after the active shedding phase has ended. Performing a transplant while the hair loss is still unstable could lead to poor long-term outcomes, so timing and proper stabilization are crucial.

What you’ve described — a naturally high or M-shaped hairline without signs of active hair loss — is actually more common than it may seem, and we do receive requests for cosmetic hairline refinement from patients like you. These procedures are typically performed for aesthetic reasons, not due to balding, and can be highly successful when planned conservatively and with long-term naturalness in mind.

We’ve had a chance to review your photos, and one of the key observations — particularly regarding the muscle structure of your forehead — is that the temple corners lack underlying frontalis muscle. This is actually a positive sign, as it means those areas can often be safely filled in with transplanted grafts without risking unnatural movement or future complications.

Your naturally thick hair is a great advantage in designing a refined, natural-looking hairline. Also, since your hairline has remained unchanged since your late teens and there are no signs of progression, the use of finasteride or minoxidil is not necessary in your case — especially considering your past side effects. You may still be a very good candidate for hair transplantation with proper planning and realistic expectations.

Based on the photos you’ve shared, we estimate that approximately 1500–1700 grafts would be needed to achieve your desired hairline design. Your donor area looks more than suitable for this number of grafts, and since there is no ongoing hair loss, it's very likely that you won’t need a second procedure in the future.

If the transplant was in the forehead and temple area, it is advisable not to touch the grafts for the first 7–10 days — even a soft fabric such as a bandana can disrupt their fixation or cause friction. During this period, the skin is still healing, and any contact can cause harm.

But after 10 days, when the scabs have fallen off and the skin looks calm, you can carefully put on a loose, non-pressing bandana, the main thing is that it:

does not rub against the hairline and temples,

does not squeeze the head,

is easy to remove without touching the skin.

By the way, if you have slightly longer hair on top, this is a great way to cover the transplant line. Just let it fall freely forward without fixing it with gel or a comb, and it will gently cover the desired area without harming the grafts.

So, yes, wait a little while, and then you can cover it with either your hair or a neat piece of fabric.

Based on photos, you're currently at approximately Norwood level 6, which means full restoration would typically require 8,000–9,000 grafts over 2–3 sessions. However, your donor capacity appears limited, and we estimate that around 3,000 grafts could be safely harvested in the first session.

With that number, we could focus on reconstructing your hairline and frontal zone. Future surgeries (sessions 2 and 3) would depend entirely on how your donor area looks one year later, but realistically, coverage of the midscalp and crown would remain difficult due to your donor limitations.

Beard or chest hair could potentially be used as supplemental sources in the future, but they don’t offer the same quality or yield as scalp grafts, and the cosmetic result is generally less predictable.
Generally, patients with Norwood 6 hair loss and a weak donor area are usually not ideal candidates for full restoration. But — if your expectations are realistic, and you’re not aiming for ultra-dense coverage or a full head of hair — we can still create a natural-looking frontal hairline and rebuild the "hair frame" of the face. It’s not about perfection, but it can absolutely be about strategic improvement.

If you’ve already been on dutasteride, finasteride, minoxidil, and even HRT, and still aren’t seeing improvement — then something’s off, and it might not be about the meds themselves.

Here’s what could be going on:

Maybe it’s not androgenetic hair loss.
Everyone assumes it is, but if it's actually something like chronic telogen effluvium, autoimmune alopecia, or even a mild scarring condition, DHT blockers won’t help.

Some types of hair loss just don’t respond to these meds.
For example, diffuse shedding from stress or hormones might need a different approach — sometimes even just time.

Your body might be missing key support.
Things like low ferritin, zinc, vitamin D, thyroid issues — if one of these is off, no amount of dutasteride will fix it.

Inflammation on the scalp.
If your scalp is oily, itchy, or irritated, that underlying inflammation could be limiting how well treatments work.

Maybe it’s just too early.
These meds don’t work overnight. Dutasteride especially can take 6–12 months — or longer — to really show effect.

Bottom line? If you're on everything and still not seeing a difference, it might be time to stop throwing treatments at it blindly and go back to basics: clear diagnosis, blood work, and scalp check.