I am 45 and am worried about more hair loss if I get a hair transplant (photo)

You have a Class 3 Vertex pattern of hair loss which means that you are losing frontal hair and crown hair. At your age, I would suspect that if you lose more hair, it will not be very dramatic. You could try the drug finasteride (requires a doctor write a prescription for it) or you can transplant it. Transplants will work well for someone of your age and probably you will be stable so after a hair transplant you will just look like you never lost any hair