46 with frontal recession (photo)

I recently turned 46, and I’ve been damn lucky with my hair. Around 5 years ago, I wanted to change my hairstyle to go more forward, rather than back. I was 41. I noticed that when styled more toward my forehead, my hair looked a little stringy. I initially thought it was just a bad haircut. Upon closer inspection, the individual hairs/follicles appeared to have gotten thinner at the front of my hairline. Probably further back as well, but I have enough coverage that it’s harder to notice. There has also been some recession of my hairline (maybe a quarter of an inch), although not much, and happening extremely slowly. It’s difficult to tell a significant difference in photos from 5 years ago to today. The top of my head/crown is still full; no bald spot at all, just the cowlick I’ve had since I was a kid. At 46, does this just sound like normal aging, or is there something to be concerned about?

The things to try would include (1) oral minoxidil, (2) oral finasteride, and (3) microneedling. If these don’t work, then at 46, a hair transplant is the best option, and it will work, provided that you get a competent doctor. Your hair loss is likely to have been present for more than 5 years. The combination of all three drugs should be tried first unless you decide on a hair transplant, which is no fuss and with a good doctor, and best of all, there is no uncertainty.