I'm 41 years of age and can't grow anything close to a beard. What should I do? (Photo)

Just like male pattern balding is a genetic trait, beard hair growth is also a (separate unrelated) genetic trait.Some men can't grow beards.  Some of these men may choose hair transplant (from their scalp) to their face to add hair.  

Having a good beard is important to many men, however, not all are genetically or medically capable of doing so. This is when a beard transplant steps in to become the savior.
What is a beard transplant?
A beard transplant is a procedure that involves the re-distribution of hair follicles from the scalp to the beard to make it fuller than it currently is.
When does the beard stop growing?
The start of the facial hair streak begins after an adolescent reaches puberty. Facial hair grows in slowly and becomes thicker, coarser and more full. Gradually by the time the man reaches his/their late twenties or early thirties is when the growth reaches a peak.
Who is a good candidate for a beard transplant?
An ideal candidate for a beard transplant would be one who has sparse or patchy facial hair, however, they should also have a full head of hair with no co-morbidities like; male pattern baldness, alopecia, and other cardiovascular ailments. It would be an added bonus if the patient is a non smoker.

You can consider having a beard hair transplant. Beard transplants are generally successful if done by an experienced surgeon and can bring out a natural looking beard. 

Some men are just not genetically programmed to develop beard hair. It is difficult to see your beard area in the photograph submitted but perhaps you should just accept that this is your situation. A hair transplant to create a beard is a possibility but is reliant on sufficient donor hair and the likely aesthetic result could only be described to you following a face to face consultation with a hair transplant surgeon.

You can do a beard transplant and in the hands of a skilled surgeon, it isvery successful.    Since beard transplant requires a lot of skill, you have to make sure you go to a doctor that has done it  and can show you before and after pictures of the previous clients. 

It's very hard to see what your beard does or doesn't look like from the photo, but let's assume that your face is as smooth as a baby's bottom. Beard growth is under genetic and hormonal control; paradoxically, as you may know, the same hormone--dihydrotestosterone, or DHT--responsible for male pattern baldness is what initiates the secondary male sex characteristics, including growth of facial hair at puberty. In adult males, it is DHT--a far more potent androgen than testosterone--that increases the length and coarseness of facial hair; accordingly, in some cases, the same drug--finasteride (Propecia)--that blocks the formation of DHT from testosterone can cause thinning of facial hair.If you have not yet had your testosterone level checked, it would probably be a good idea. It is unlikely that your testosterone level is low enough to be the culprit, so be careful not to fall prey to one of the many doctors who have drunk the "Low T" Kool-Aid. If everything seems in order, you could consider seeing a hair transplant surgeon to discuss the possibility of a beard/mustache transplant. This is probably your best option. Aside from the fact that it is a monumental PITA, any growth you might get from applying minoxidil to your face would likely be minimal.

Hair transplants do a fine job to create a beard. We have performed beard transplants on men who have 'missing spots in the beard and it works well. There is nothing else that work for someone like you.