Affects roughly half of men by age 50 and a third of women by age 60. Genetic, hormonal, predictable in pattern. Treatable in stages, restorable with the right approach at the right time.
Androgenetic alopecia is the gradual miniaturisation of hair follicles in genetically susceptible areas of the scalp, driven by dihydrotestosterone (DHT) — a derivative of testosterone that progressively shortens the follicle’s growth cycle and thins each successive hair.
The pattern in men is the classic Norwood progression: temporal recession, then crown thinning, then bridge between front and crown. The pattern in women is Ludwig: diffuse thinning across the top with a preserved frontal hairline.
The condition is hereditary — typically inherited from either parent, sometimes both. Family history of male or female pattern hair loss is the strongest predictor of whether you’ll experience it and roughly when. Onset can be as early as the late teens; most affected men see clear progression by their mid-thirties.
Diagnosis in men is usually straightforward — the pattern is distinctive and the family history typically confirms it. Photo consultation is sufficient in the great majority of cases.
Diagnosis in women requires more work. Female pattern hair loss can mimic — and be mimicked by — telogen effluvium, thyroid disorders, iron deficiency, postpartum changes, perimenopausal shifts, and several rarer conditions. Bloodwork, sometimes trichoscopy, sometimes a referral to dermatology is the right first step before any treatment plan.
The Norwood scale (men) and Ludwig scale (women) are used to stage the condition objectively — informing what treatment fits at the stage you’re at.
Early stages (Norwood I–II, Ludwig I): Finasteride + minoxidil. Reassess at 12 and 24 months. Surgery rarely justified at this stage.
Mid stages (Norwood III–V, Ludwig II): The bulk of surgical patients. FUE or FUT, paired with ongoing medical therapy to preserve the surrounding native hair.
Late stages (Norwood VI–VII, Ludwig III): Surgery still possible but graft demand is high; donor management becomes the central challenge. Sometimes scalp micropigmentation is added to create the appearance of density without additional grafts.
The right approach is usually combined: medication to slow progression, surgery to restore what’s already gone, maintenance therapy to preserve the result for life.
The fastest way to know your stage and your treatment options is to send photos. Dr. Jones reviews and sends back a written assessment within 48 hours.