Balding or Big Forehead? (photo)

Normally, when people first start noticing hair loss and seek help, they have already lost 50% or more of their hair.

In assessing hair loss in our practice, we usually do first an evaluation. We get the patient’s family history since hair loss patterns sometimes run in families. We also do physical examinations using a microscope to distinguish the difference between strong hairs which are also called terminal hairs from thin or fine hairs. Hairs don’t normally thin automatically but go through a hair growth cycle. One of the phases of the cycle is the telogen phase where hairs shed off.

Currently, there are two medications that are approved for treating thinning hair: one is minoxidil and the other is finasteride. Both of these medications are shown to be effective. However, they have some side effects such as in the case of finasteride which has sexual side effects.

In our practice, we have been using a Hair Regeneration treatment using a material called extracellular matrix (ECM) made by ACell combined with platelet-rich plasma(PRP) to help reverse hair thinning. Extracellular matrix triggers the body to produce adult stem cells called progenitor cells that are absent in balding men. Progenitor cells signal the dermal papilla to begin the hair growth cycle. This material has been used before for wound healing and is injected and applied to the different levels of the skin. Interestingly, it has been very successful in helping our patients. In fact, younger males seem to have better results than middle-age men. 

I advise you look into treatments like Hair Regeneration, but they are not that common and there are a lot of questions about its application.  As multi-specialty surgeon, I have used extracellular matrix on other tissue regeneration procedures like ear replacement and facelift incisions. It isn't a generic procedure so many hair loss specialists may not be aware of it. So, get some attention and information, and make decisions based on the fact that it is better to save your hair than transplant it because you won't get the same volume and hair density from a transplant alone.  I hope that was helpful, and thank you for your question.

It difficult to make a good assessment based on your photos. There does appear to be some thinning but it's essential to perform a full history and exam. You're in a good position to start preventing additional hair loss if it is beginning. There are many options available. Propecia is a common mediation used to block dihydrotestosterone, which causes hair to miniaturize and leads to terminal hair loss. This has a low side effect profile and is generally well tolerated. 50% of men see a stabilization of their hairless and 50% see additional growth. There are a various biostimulatory injectables that can be used from PRP to micronized fat grafting that helps stimulate and prevent hair loss. Hopefully you can prevent the need for grafts but if you can stabilize your current hairline then you could consider grafts in the future if you're looking for more density. 

Analysis of your situation is best done by an in person consultation based on several factors.
Temporal recession is a normal variant of hair loss seen in most adult males.  Some patients opt to create a more forward looking hair style based on preference.  
Trichoscopy can help determine if miniaturization is taking place and the extent of it anteriorly.
Genetic testing and history can help determine your future hair loss plan.
Your hairloss solution can vary from evidence based medical therapies to conservative hair transplant in certain situations.   Best Anil Shah