People usually talk about men going bald in their 30s and 40s, but it is also quite common for women to experience the same problem. Although it may not be as pronounced as in men, female pattern hair loss can cause excessive thinning and even leave a noticeable balding area at the top of the head.
Doctors use the Ludwig Scale to determine how far it has progressed and to decide on the best treatment options. We will explain how it works and what the different stages look like, and talk a bit about the possible solutions.
Did you know?
Hair loss is not just a male problem. In fact, according to the 2025 ISHRS Practice Census, 15.3% of all surgical hair restoration patients were women, highlighting just how common and impactful female pattern hair loss can be.
What Is the Ludwig Scale?
It is merely a way to quantify and track female pattern baldness. The scale is based on visual references, with each stage having a clear description and specific look, though there are no sharp cut-off points. An experienced medical professional will be able to use this tool to accurately assess each case and recommend the best approach.
Stages of the Ludwig Scale
Unlike men, whose hairline first starts receding and they get distinct bald spots, women only experience hair thinning along the parting area at the top of the head. Also, while the standard Norwood scale for men has seven stages, the female version only has three:
- Stage 1: Mild thinning occurs at the very top and doesn’t reach the hairline.
- Stage 2: There is now a moderate amount of thinning, and the parting area has spread more toward the sides of the head. The remaining hair is also thinner and weaker.
- Stage 3: A good deal of hair loss, which can leave a bald spot at the crown of the head, and significant thinning in a broader area, though the rest of the hair is usually still strong and dense.
As you can see, it is more of a continuum, and it is up to the doctor’s discretion to gauge when a patient has progressed to the next stage.
How the Ludwig Scale Helps with Diagnosis
The reason why this scale is so useful is that several other medical conditions can cause hair to fall out in women, so it’s important to rule these out.
A good way to tell whether it is genetic rather than temporary or a side effect of a more serious illness is to perform a pull test. This involves a light tug on a strand to see if the follicles can easily be removed, which is a clear sign of female pattern baldness.
Another tell-tale sign is that the area at the front of the head is fairly stable and dense. Your hair should also start to grow back after treatment if it was a side effect of another condition.
Causes of Female Pattern Hair Loss
Most women affected by this condition will experience androgenetic alopecia, a genetic predisposition. However, another big reason for hair loss in women is wearing very tight braids and similar hairstyles that place a lot of stress on the roots.
These can weaken the follicles over time and cause thinning, while excessive stress is another big factor that can cause hair to fall out. There is also an autoimmune condition, alopecia areata, where bald patches appear on different areas of the head, but that is an entirely different issue.
Treatment Options Based on Ludwig Stage
Luckily, there are several solutions that you can try, which may be more or less effective depending on the stage you are currently at. We’ve provided a table detailing all the available options:
Ludwig Stage | Treatments | Effectiveness |
Stage I | Topical Minoxidil (2% or 5%) | High |
Laser Therapy | Moderate | |
Anti-androgen pills | Moderate | |
PRP (Platelet-Rich Plasma) | Moderate | |
Stage II | Topical Minoxidil (5%) or Oral (Low-Dose) | High |
Anti-androgen pills | High | |
PRP Therapy (3–4 sessions) | Moderate | |
Laser Therapy | Low-to-Moderate | |
Stage III | Hair Transplant Surgery (FUE or FUT) | Very High |
Scalp Micropigmentation (SMP) | Cosmetic only | |
Wigs, Toppers, Hair Systems | Cosmetic only | |
Medications | Good for maintenance |
Hair Transplant Solutions for Women (Without Shaving)
There have been some incredible advancements in the medical field in the past two decades, so you can now get a specialized no-shave hair transplant in Istanbul at affordable prices.
That means the existing hair in the recipient area will be left long, allowing you to effectively cover up the initial swelling and scabs from the procedure. It’s a very inconspicuous procedure that will give you a natural and voluminous look.
The best part is that there are all-inclusive travel packages, where the clinic takes care of all the logistics for you.
Lifestyle and Hair Care Tips to Slow Progression
Apart from hair transplants, you can also apply natural oils like rosemary and jojoba to slow down the thinning. It’s also important to be careful when brushing your hair and to avoid styling techniques that use heat, like a curling iron. An overall healthy diet rich in omega-3, minerals, antioxidants, and protein can also help, as can reducing stress and improving your sleep.
FAQs
How can I know which Ludwig stage I am in?
All you need to do is look at the reference images and descriptions for each stage and compare them with your hair. It’s easier if you take a few pictures from different angles and place them side-by-side with the references. Of course, it’s best to consult a doctor because there may be another medical issue causing your hair loss, and you want to get a professional diagnosis just to be safe.
Is a hair transplant suitable for women with Ludwig Scale hair loss?
It’s actually the most effective treatment available, but it’s not advised for those in stage 1. With the latest unshaven FUE and DHI techniques, you can get a dense and luscious look in a year after the surgery, and it’s easy to cover up the minimal signs.
Will a hair transplant give natural results in women?
Reputable clinics usually have surgeons with over a decade of experience and cutting-edge equipment, so you can expect some truly impressive results. They use 2000+ grafts, implanted in a fairly dense pattern, which makes everything look natural.