This is exactly the type of hair loss I have, but I also have extreme total hairline recession and miniaturization. I first noticed the loss of nape hair, and thereafter loss of density and complete recession of every area of the hairline. I have miniaturization throughout my entire scalp, but the emphasis seems to be on the hairline and top of my head (especially that front area like this photo). I have tried Spironolactone 200mg, Cyproterone acetate 50mg, Diane35 birth control, 0.5mg Dutasteride, 5% topical Minoxidil, 2.5mg oral Minoxidil, microneedling, topical Estrogen, topical anti-androgens (RU58841, Darolutamide), every manner of oral supplement, iron infusions, sulfasalazine, and setipiprant. The list is endless. Nothing has stopped my hair loss or miniaturization. I have been diagnosed with hypogonadotropic hypogonadism as of 2015, but the hormone replacement therapy I am on addresses this issue. I have no other hormonal or autoimmune issues. I was diagnosed with androgenetic alopecia via scalp biopsy. It has been through my own research that I have come to understand that my hair loss is classed as retrograde with diffuse female pattern loss, or diffuse unpatterned alopecia. I frequent hair loss forums where a few others have this pattern, and we have all been non-responders to all treatments. I believe that there must be something more to this pattern than what we currently know.
You clearly have a difficult problem. There is a cosmetic treatment for thinning and hair loss for women; it is called Scalp Micropigmenmtation. This may be something worth considering to address what you look like. However, it will not fix the underlying problem.
