Thinning hair on crown and top of head, seems to get better and worse for some reason. Any treatment options available? (Photos)

I suggest seeing a hair loss expert now to evaluate and go over your condition and provide you information about your best treatment options. There are great non-invasive options like prp/progesterone and/or hair transplantation. See an expert. Best, Dr. Emer

Hair loss can be a highly concerning and emotional herald of the inevitable march of time. By contrast a full, youthful head of hair, for many, is central to presenting a confident exterior both personally and professionally. For this reason, it is vital to understand what causes hair loss as well as the effect hair restoration can have on your daily interactions in all aspects of your life.
While testosterone is central to the process of hair loss, DHT (dihydrotestosterone) is believed to be the actual offending agent. Testosterone levels in some men drop by 10 percent each decade after thirty. As testosterone is converted to DHT by Type II 5-alpha reductase, the binding of DHT to receptors in scalp follicles causes shrinkage hair follicles. The hair of the anterior hairline and crown are most androgen sensitive, thus the classic pattern of preservation of the horseshoe of the parietal and occipital scalp.

Ultimately, the absolute levels of these hormones are less important than the overall balance. Under normal conditions, women have a minute fraction of the level of testosterone that men have, but even a lower level can cause DHT- triggered hair loss in women. Women's hormone levels decline as menopause approaches and drop sharply during menopause and beyond. The androgens, as male hormones are called, do not need to be raised to trigger a problem. Their counterpart female hormones, when lowered, give an edge to these androgens, such as DHT.

Treatments for hair restoration can be divided into preventative and restorative (and the 2 are not mutually exclusive). Preventative treatments will include non-prescription grade topicals (Hairmedica) and prescription grade (Minoxodil and Finasteride) medical therapy as well as PRP (platelet rich plasma) and LLLT (low level light therapy). All of these can also be used for restorative purposes, however, the pinnacle of restorative hair medicine is FUE

While hair restoration continues to surge in popularity (the worldwide extrapolated number of hair restoration patients treated in 2012 represented a 5% increase from 2 years prior). Many potential patients shy-away from (or are not candidates for) the traditional “strip method” of hair replacement because of the slow recovery time, the loss of feeling at the incision site, the linear scar on the back of the head, or the amount of post-operative pain involved.

The FUE method of hair transplantation removes individual hair follicles from the scalp in their naturally occurring groupings of about 1-4 hairs and are then placed in the areas of the scalp where balding has occurred. NeoGraft FUE advanced technology offers a discrete solution to hair loss, allowing patients to achieve natural looking results with no linear scar, minimal downtime and a shorter recovery period. NeoGraft generally has a greater than 90% take rate, thus ensuring a high quality result.
With regards to your specific question, you may want to consider PRP as you are younger and have likely not established a stable hair loss pattern (grafting at this point will likely necessitate further grafting in the future). There are little to no side effects of PRP therapy with benefits ranging from cessation of loss-thickening of existing hair-regrowth.
For anyone with concerns surrounding hair loss or with interest in hair restoration, seek out a well trained board certified practitioner with experience in hairline design who can incorporate the latest medical and surgical modalities. Hair restoration is a continuum and there is no single “magic bullet.” There are, however, a number of tools at your specialist’s disposal to provide a natural and long lasting result.

Hello,
There are different options available.
PRP + ACell may be preferred option or thinning hair. PRP growth factors stimulate the hair follicles to build hair and ACell help to improve thickness and length.
All the Best, See an Expert.
Ray Bayati, MD Sacramento Area, California

The important thing to keep in mind is that you may be at high risk for advanced balding patterns. Surgery would not be advised at present and you will want to exercise good judgement as to when to have surgery as you may have a very limited donor area. It is quite likely you have less than 2500 grafts for movement via hair transplant surgery and it could be much less. The crown is the major area if hair loss but hair transplants are not recommened for the crown area until well into the 30's. If you are not considering oral finasteride, options include topical minoxidil with topical finasteride, laser and PRP. I would encourage you to speak to many surgeons. Envision what your hair coukd be like at age 70 and then work back.

A great first step would be an online consultation. Often you can submit photos to top FUE hair restoration surgeons for a complimentary evaluation. This should help lead you in the right direction. Having multiple consultations with different doctors cannot hurt. 

See a doctor who specializes in hair restoration. It appears from the photos that you have genetic balding in its early stages. This can be treated medically with minoxidil and finasteride.