Norwood and Ludwig scales: understanding the stages of baldness

What are the Norwood and Ludwig scales for?

Losing your hair, or not? Hair loss is far more common than it seems. It affects men and women alike, in different proportions and at different rates. In some men, baldness starts early. Its causes are many: genetic, hormonal or even linked to lifestyle. Scales are therefore used to measure this loss.

These are the Norwood scale for men and the Ludwig scale for women. Their role is simple. They make it possible to:

• visualise how much hair has been lost at the time of the examination;
• get a sense of the loss to come, if the alopecia (hair loss) progresses;
• guide treatment, depending on the stage observed.

Alopecia does not present in the same way in men and in women. Because the hormonal factor is present, the loss does not look the same. That is why women refer to the Ludwig scale.

What is the Norwood scale (or Hamilton-Norwood scale)?

The Norwood scale, also called the Hamilton-Norwood scale, is used to grade male pattern baldness. It is a visual system that originated in the 1950s and was improved in 1975. It is still used today to identify the stage of alopecia. It has seven stages, from Norwood I (no hair loss) to Norwood VII (advanced hair loss). Healthcare professionals use it to adapt the treatments they offer.

What are the 7 stages of baldness on the Norwood scale?

Here are the stages in order, from the first receding of the temples to near-total baldness. Stage III also exists in a variant known as ‘vertex’, which affects the top of the head.

Norwood I, II and III: the temples begin to recede

• Norwood I: this is the starting stage. There is no noticeable hair loss, and the frontal hairline is normal for the person’s age.
• Norwood II: a slight recession of the temples appears: they begin to ‘hollow out’. This is the start of male pattern baldness, still barely visible.
• Norwood III: the frontal hairline takes on a characteristic ‘M’ shape. The recession at the temples becomes much more obvious.

Norwood III vertex, IV and V: the top of the head starts to thin

• Norwood III vertex: in addition to the recession at the temples, there is also hair loss at the top of the head (the vertex). This loss forms a kind of swirl.
• Norwood IV: the hairline recedes further, and a large bald area forms at the top of the head.
• Norwood V: the band of hair between the temples and the top of the head becomes thinner still. The baldness spreads towards the back of the head.

Norwood VI and VII: advanced baldness

• Norwood VI: only a narrow band of hair remains around the head, a sort of natural monk’s tonsure.
• Norwood VII: this is the most advanced stage. Only a small ring of hair remains at the back of the head, and the baldness is almost total.

What is the Ludwig scale for hair loss in women?

For women, the Ludwig scale is a tool similar to the Norwood scale: it is used to classify hair loss. It was created in 1977. Its author had noticed a steady increase in cases of alopecia in women and wanted to meet the needs of their patients. Unlike the Norwood scale, it has only three stages, from Ludwig I (diffuse thinning) to Ludwig III (severe hair loss). The classification is more complex in women, because there are many possible causes.

Note: this is only a general classification. Not every case of female alopecia follows the Ludwig stages exactly.

What are the 3 stages of the Ludwig scale?

Ludwig I: at this stage, there is a slight loss of hair density on top of the head (the vertex). The central parting may look wider. A thin frontal border of hair remains, with almost normal density, of about 1 to 3 cm.

Ludwig II: the hair loss gets worse. A wider area of sparse hair appears at the top of the head, in the vertex area. Hair density and volume decrease all over, and the central parting becomes more obvious.

Ludwig III: this is the most advanced stage, with severe hair loss on top of the head. The bald area is large, and the remaining hair is sparse, almost downy.

Can these scales tell you the cause of hair loss?

No. According to the medical library StatPearls, these scales help to classify the severity of hair loss. They only classify the extent of the loss: they do not tell you why you are losing your hair.

The cause may be genetic, hormonal or linked to lifestyle. To find out what it is, you need an accurate diagnosis, made by a healthcare professional. It then makes it possible to offer treatments suited to each patient.

At Klineva, you can request a free diagnosis from our specialist: all you need to do is send a few photos.

From which stage can a hair transplant be considered?

Alopecia is not necessarily inevitable. Medication and a healthy lifestyle can help to slow hair loss. The guide on hair loss treatments gives an overview.

From stage II of the Norwood or Ludwig scale onwards, a hair transplant starts to be considered. This is especially true if the hair loss has stabilised. A transplant can address established baldness, but it is not always an option at the final stages. Only an examination of your case can tell you what is possible. In general, the earlier you act, the better your chances of preserving your hair in the long term.

There are several techniques, such as DHI, FUE, Sapphire FUE or no-shave hair transplants. The guide FUT, FUE or DHI: which technique should you choose? introduces them, and When should you have a hair transplant? helps you choose the right time. For women, there is a page devoted to hair transplant for women. If you are considering a transplant in Turkey, see how to choose a clinic.

Learn more about our techniques

In brief

• Two scales. Norwood for men, Ludwig for women: two visual reference points to gauge the extent of hair loss.
• Norwood. Seven stages, from Norwood I (no noticeable hair loss) to Norwood VII (almost total baldness), with a ‘vertex’ variant at stage III.
• Ludwig. Three stages, from diffuse thinning (I) to severe hair loss (III): a general classification that not every case follows to the letter.
• Their limitation. They classify the extent of the loss without giving its cause: that requires a diagnosis made by a healthcare professional.
• Hair transplant. It starts to be considered from stage II onwards if the hair loss has stabilised; at the final stages, it is no longer always possible.