You need your donor density and donor hair mass measured to find out if you are a suitable candidate and what you can expect.  Make sure that you get numbers from your doctor as this is mathematically based.  I have answered this question many times, so read many of my answers here: https://baldingblog.com/?s=how+many+grafts 

There is a misconception that many patients and surgeons that they must replace the recipient area density in the balding area when having a hair transplant. Nothing could be further from the truth.  Too many Reddit patients are wasting their donor supply by using too many grafts to cover Class 3 or 4 patterns of balding. Too many Reddit patients do not seek a Personalized Master Plan ((https://baldingblog.com/creating-a-personalized-master-plan-for-present-and-future-balding) with their surgeon before they embark on a hair transplant in Turkey or elsewhere. First, look at the analogy and the following numbers: Assuming a surgeon removed 12,500 grafts from the donor area in a Class 7 patterned patient. The average man has 50,000 follicular units (grafts) on his head (race in not dependent upon this number) of which 12,500 grafts reflect the donor area (12,500 grafts reflect 25% of the total follicular units).  The total donor supply equals 25% of the total hair supply. This means that if the surgeons did only FUE and transplanted 12,500 grafts in the recipient area, there would be nothing left in the donor area. In such a surgery, the patient would likely become either bald in the donor area or heavily overharvested in the donor area if partial follicular units were excised rather than full FUe grafts. This patient would have a new problem: a bald donor area. His recipient area density would not exceed 30% of the original recipient donor density. With too many grafts removed from the donor area, there is no going back after this is done. Even transplanted numbers of 5000, 6000, or 7000 grafts reported by many Reddit patients reflect the maximum yield of their donor area if they have fine or possibly medium-weight hair. They may end up with a see-through donor area for their entire lives. Many of these Class 3, 4, or 5 balding patterns may leave very few grafts left in the donor area to address almost certain future balding because hair loss is ALWAYS progressive. When I review Reddit’s transplanted patient posts, I often see too many grafts for a particular balding pattern, reflecting poor planning and an impulse surgery decision in men who are often too young.

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.

I have been on oral minoxidil and been microneedling for a year or so, then I added finasteride just 3 months ago.  What do you think?

I suspect if you continue with this routine, you will get the results you are hoping for.  Finasteride works well in the crown, more than the frontal areas.  Your frontal areas have filled in nicely and I would expect the crown to follow.  Keep it up.

How often do you see such dramatic improvements using oral min among your patients? Thanks

It occurs often. I only started prescribing it a four-five years ago, and I have been more than surprised with the results

Yes, minoxidil has known side effects, and one of them is dangerous. It is called Pericardial Effusion, which means fluid builds up inside the heart sac. As the fluid builds up, blood is restricted from entering the heart. This produces significant swelling of the legs and feet, shortness of breath, and easy fatigue, and if it goes untreated, it could kill you. If you note swelling of your face, hands or feet, notify your doctor and consider stopping the minoxidil.  It is also a hypotensive agent, and some men can’t tolerate it because of fast heartbeats and repeated bouts of headedness.

As a man, I don’t know what you are talking about. I have never felt my prostate in any manner. If you are talking about orgasm, then yes, I have heard that finasteride, in some men, will reduce the volume and consistency of the ejaculate, and that may decrease the pleasure of orgasm for some men. I had taken finasteride for many years and never felt that my orgasms were any different than when I was not on finasteride. 

I’m mid 40s and have Been on Fin for year exactly now. Hairline has definitely seen an improvement but after getting a haircut yesterday I am now wondering if the temples have improved a bit too.  Here is a comparison between July (pic on left) and Dec (pic on right). Is it just me or is the temple hair coming forward a bit?

The temple peeks do not have the same genetics as the balding scalp. What you are pointing to may or may not be regrowth. This would be unusual from finasteride which doesn’t seem to implact the temple peaks in my experience.