Where on the Norwood Scale am I/Should I consider transplant?

[dm3431]

My background: I'm 25. My dad went bald gradually, starting with a bald spot at the crown and then receding hairline. My mom's side has very good hair genes; my grandfather had a mostly full head of hair until he passed away at 91 and my uncles have pretty thick hair as well in their 60s. My brother (in his 30s) does not have noticeably thinning hair either. 

At some point last year, it seems, my hair started thinning out considerably. I had a short buzz cut for a while so I didn't notice it, and when I grew it out again I still didn't really see anything drastically different. But I did notice that the texture started to feel a little different and that it kind of reminded me of other people whose hair is thinning. So I take a picture of the top of my head and notice that there are a bunch of random thin patches all over my head. I couldn't see them when combed, but I was really surprised. So I buzzed it off, thinking it might have been clumping/damage from overzealous use of gel (which I had been doing). But as the buzz cut grew in, I still noticed that it looked drastically thinner on top, and that I had a noticeable thin spot right behind my hairline. There was also strange thinning on the sides as well. 

I went to a dermatologist, who didn't really do a very thorough exam but confirmed there was thinning without specifying a cause. He gave me oral minoxidil (2.5 mg) and I've been taking it daily since the beginning of September. I know it takes 4-6 months for it to fully take effect, but I have not noticed any preliminary results at all yet after about 3 months. 

What could this be? Someone on Reddit says I'm a Norwood 6, but I don't have any recession in my hairline at all. I do not want to take finasteride because I've dealt with some of the side effects while taking another medication and would not want to even risk having them come back after all I went through. Should I consider a hair transplant? I am unable to afford one at the moment, but maybe I will have enough in the future. 

It's all been very discouraging for me.  

https://imgur.com/a/BOmQFOl Here are pictures for reference

[StillAlive]

Pictures would really help us make a more informed diagnosis here. 

[dm3431]

I linked to pictures at the bottom of the post

[LaserCaps]

15 hours ago, dm3431 said:

My background: I'm 25. My dad went bald gradually, starting with a bald spot at the crown and then receding hairline. My mom's side has very good hair genes; my grandfather had a mostly full head of hair until he passed away at 91 and my uncles have pretty thick hair as well in their 60s. My brother (in his 30s) does not have noticeably thinning hair either. 

At some point last year, it seems, my hair started thinning out considerably. I had a short buzz cut for a while so I didn't notice it, and when I grew it out again I still didn't really see anything drastically different. But I did notice that the texture started to feel a little different and that it kind of reminded me of other people whose hair is thinning. So I take a picture of the top of my head and notice that there are a bunch of random thin patches all over my head. I couldn't see them when combed, but I was really surprised. So I buzzed it off, thinking it might have been clumping/damage from overzealous use of gel (which I had been doing). But as the buzz cut grew in, I still noticed that it looked drastically thinner on top, and that I had a noticeable thin spot right behind my hairline. There was also strange thinning on the sides as well. 

I went to a dermatologist, who didn't really do a very thorough exam but confirmed there was thinning without specifying a cause. He gave me oral minoxidil (2.5 mg) and I've been taking it daily since the beginning of September. I know it takes 4-6 months for it to fully take effect, but I have not noticed any preliminary results at all yet after about 3 months. 

What could this be? Someone on Reddit says I'm a Norwood 6, but I don't have any recession in my hairline at all. I do not want to take finasteride because I've dealt with some of the side effects while taking another medication and would not want to even risk having them come back after all I went through. Should I consider a hair transplant? I am unable to afford one at the moment, but maybe I will have enough in the future. 

It's all been very discouraging for me.  

https://imgur.com/a/BOmQFOl Here are pictures for reference

Review the Norwood chart and look at a class 5a.  Color the entire figure.  This means you can have hair but, if you can see through and see the pattern underneath, it's likely where you'll be classified.  

You have hair throughout.  We typically refer to this as diffused thinning with lots of miniaturized hairs.

There are two types of loss. The type you can see, and they type you can't see.  What you do see in the brush, pillowcase, shower stall, is normal.  The follicle gets tired of producing hair and goes into a dormant period of 3-4 months.  The follicle then resumes growing. This will happen randomly to all the hair in your head.  100 hairs a day is considered normal.  Hair loss is different, you don't see it.

Start looking at the hair in your temporal areas.  Notice each strand and pay particular attention to the caliber.  Some thick and some not so much so.  Eventually the hair dissipates and disappears.  We refer to this as miniaturization.  Once gone, the hair will not return. 

Propecia and Rogaine are considered to be the best meds for retention in the crown.  The problem is that of expectations a year later when patients see not visual change. The meds are not intended for you to grow anything.  Rather, they're to keep you from losing more.  If a year later you look the same, the meds did what they were intended to do.  Research PRP and Laser.  These two can help reverse miniaturized hairs

Rogaine by itself is like using a band-aid.  It's a great adjunct when you combine other modalities as there's synergy and cross synergy.  I would encourage you to do all of them and stay on them.  A year later you can decide if the outcome is worth the time, trouble and expense.  I would hold off on the thought of transplants. 

[StillAlive]

LaserCaps made some excellent points -even though personally I'm not convinced of the efficacy of PRP and Laser Hats/Combs on hair maintenance or regrowth. 

You are unfortunate, in that you have DUPA (diffuse unpatterned alopecia) which may not erode your hairline, but may thin your hair everywhere around your scalp and make surgeons hesitant to take you on as you are a more challenging case compared to a 'traditional' MPB patient.

Stay on minox for a year now that you've started and consider adding Saw Palmetto to your regimen as a natural, no risk and lower efficacy, alternative to finasteride. Use Nizoral 2% shampoo once per week. Stay on this regime for a year and evaluate yourself afterwards. Does your hair look worse? Better? About the same? 

If it's the same, you are in luck. It means that you have things under control and may in time, proceed with hair restoration. But not just yet, you still have too much native hair in the process of miniaturization, that may still be reversible. 

Edited November 23, 2022 by StillAlive

[WhereIsMyMind]

Well, you are basically Norwood 0 atm but your future balding pattern looks to go straight into NW6 in a diffuse pattern.

You are a classic example of:  "get medicated early, and no transplants until 30 year old" situation.